Tongue Tie and Breastfeeding: Signs to Watch and What to Do

How Do You Know If Tongue Tie Is Affecting Breastfeeding?

Tongue tie, or ankyloglossia, is when the tissue connecting the underside of the tongue to the floor of the mouth is unusually short or tight. This restricts tongue movement — and a baby needs full tongue mobility to latch deeply, compress the breast, and transfer milk. When tongue movement is limited, the result can be a shallow, painful latch that affects the whole feeding experience.

The picture often looks like this: your nipple comes out of your baby's mouth flattened or creased at the tip. You hear a clicking sound mid-feed, or your baby pulls off repeatedly and seems frustrated. Nursing hurts more than the early days would suggest, and yet your baby still seems unsettled after long sessions.

These aren't signs that breastfeeding isn't working — they're patterns worth paying attention to and bringing to a lactation consultant.

What Is Tongue Tie, Exactly?

Ankyloglossia refers to a short, thick, or tight lingual frenulum — the small band of tissue that runs from the underside of the tongue to the floor of the mouth. When this band restricts the tongue's range of motion, a baby may not be able to extend their tongue past the lower gum, cup the breast properly, or create the seal needed for efficient milk transfer.

According to the AAP's 2024 Clinical Report on Ankyloglossia, tongue tie affects approximately 4–11% of newborns, though assessment rates have risen significantly as awareness has grown. Tongue tie varies widely in severity. Some cases are clearly visible — a tight band you can see when the baby lifts their tongue. Others are "posterior," sitting farther back and not immediately obvious without a hands-on assessment.

Signs That May Indicate Tongue Tie Is Affecting Feeds

Many different things can make early breastfeeding uncomfortable — positioning, latch technique, engorgement, and more. But when you're seeing these patterns repeatedly, they're worth investigating:

Signs in your baby:

• Can only achieve a shallow latch, or struggles to latch at all
• Makes a clicking sound while nursing (repeatedly losing suction)
• Pulls off the breast frequently, especially when flow increases
• Takes very long feeds but still seems unsettled or hungry afterward
• Gains weight slowly despite nursing often
• Can't visibly lift their tongue past the lower gum when crying

Signs you might notice:

• Nipple pain that persists well past the first two weeks
• Nipples that come out flattened, creased, or wedge-shaped after feeds
• Repeated blocked ducts or mastitis from incomplete drainage
• A sense that your baby isn't emptying the breast efficiently despite long sessions

La Leche League International notes that when tongue movement is restricted, a baby's ability to compress the breast and express milk is significantly reduced — which can affect both milk transfer and a parent's supply over time if it goes unaddressed.

What Happens When Tongue Tie Is Suspected

Start with lactation support

The AAP's 2024 Clinical Report is clear: most feeding difficulties — including nipple pain — are not caused by tongue tie alone, and the differential for feeding challenges in newborns is broad. The recommended first step is a thorough evaluation by an IBCLC, who can assess latch mechanics, observe a full feeding session, and rule out other contributing factors like positioning, breast anatomy, and early supply dynamics.

Many parents find that a few sessions with a skilled lactation consultant — adjusting positioning, working on latch depth, and troubleshooting any other factors — make a real difference before the question of tongue tie even comes up.

If a frenotomy is discussed

When an evaluation does find that tongue mobility is genuinely restricted and contributing to feeding challenges, a frenotomy — a brief procedure to release the frenulum — may be discussed. The evidence on outcomes is nuanced. A 2024 review published in the NIH's PMC database found that frenotomy showed the clearest benefit for anterior tongue tie with documented functional limitation, while the evidence for releasing posterior tongue tie or lip tie is considerably thinner.

The AAP guidance encourages parents and providers to weigh this decision carefully, seek appropriate evaluation from providers with experience in lactation, and give non-surgical support adequate time to work. A second opinion is entirely reasonable here.

If you're navigating the early weeks of breastfeeding more broadly, the post on how to know if your baby is getting enough milk covers the key signs of adequate intake that are worth tracking alongside any feeding assessment.

Tracking Feeds When Tongue Tie Is in the Picture

Whether you're in the early stages of evaluation or following up after a procedure, consistent data makes a real difference. When you're sleep-deprived and nursing every two to three hours, it's nearly impossible to remember whether the latch felt better yesterday than today — or whether comfort levels are trending up or down over the past week.

Milk & Minutes includes a built-in LATCH breastfeeding assessment that lets you score each nursing session on the standard 0–10 LATCH scale, covering latch quality, audible swallowing, nipple type, comfort, and hold. Logging these scores over time gives you something concrete to bring to your IBCLC or pediatrician — not just "feeds feel hard," but a visible trend showing whether things are improving, plateau-ing, or getting worse.

The app also lets you track comfort and pain levels session by session, run weighted feeds (pre and post weights to estimate milk transfer), and monitor which side your baby is taking more from — all of which can surface patterns that are invisible when you're just trying to get through the next feed.

Sources

1. American Academy of Pediatrics — Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants (2024 Clinical Report)
2. La Leche League International — Tongue and Lip Ties
3. NHS (UK) — Tongue-tie and Breastfeeding
4. NIH / PMC — Evaluating the efficacy of frenotomy in breastfeeding success: a review of current guidelines and outcomes (2024)
5. HealthyChildren.org (AAP) — Tongue Tie in Babies: How Ankyloglossia Affects Breastfeeding

Ready to track your breastfeeding journey with more clarity? Download Milk & Minutes free on the App Store or Google Play — log your first feed and LATCH score in under a minute.