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Breastfeeding your newborn might seem like a natural thing, but it doesn’t always come naturally or easily to you or baby.

One reason some babies might have more difficulty breastfeeding is because of a tiny, barely noticeable extra bit of tissue under their tongue. This condition is called tongue-tie, and it can make breastfeeding more of a challenge for both of you.

Your healthcare provider or lactation consultant might recommend tongue-tie surgery, a small procedure that helps remedy this usually minor condition. Other experts don’t recommend tongue-tie surgery, though.

Here’s what to know to help you make the best decision for your little one.

About 10 percent of babies (mostly boys) are born with a tongue-tie, called ankyloglossia in medical terms.

Some of these babies might find it harder to latch on or suck in a coordinated way during breastfeeding. However, other newborns with tongue-tie may have no problems breastfeeding.

Everyone has a flap or fold of tissue or membrane connecting the underside of their tongue to the floor of their mouth. This membrane is called the lingual frenulum (or frenum). Typically, it gets thin and stretchy or mostly goes away before birth.

In babies with tongue-tie, the frenulum attaching the underside of the tongue to the floor of the mouth is still mostly there or still thick and short. When this happens, their tongue can be tethered or held down tightly and might not move like it should.

In addition to breastfeeding issues, signs and symptoms of a tongue-tie in newborns can include the following:

  • Their tongue looks shorter or doesn’t stick out as much.
  • The tip of their tongue looks heart-shaped or is differently shaped when it moves forward.
  • Their tongue looks like it’s pulled downward in the center when it’s lifted.
  • Their tongue can’t reach the roof of their mouth.

You may be able to see or feel firm tissue or a membrane attaching baby’s tongue to the floor of their mouth.

A posterior tongue-tie happens when the membrane attaches at the back of the tongue. A posterior tongue-tie can be harder to see visually, but it can still affect the function and coordination of your baby’s tongue.

Traditionally, healthcare providers recommended tongue-tie surgery very soon after a newborn was diagnosed. This was because they believed it would improve breastfeeding problems.

In fact, tongue-tie surgeries increased tenfold between 1997 and 2012.

It’s only in the last few years that research has started to look more closely at how beneficial surgery really is. Many lactation consultants and other providers have now started exploring other therapeutic interventions, rather than jumping straight to recommending surgery.

A 2019 study that looked at 115 newborns with a tongue-tie found that 63 percent of babies didn’t need tongue-tie surgery to improve breastfeeding if they had a thorough examination with a pediatric speech and language pathologist (SLP).

Their feeding issues were caused by other problems like:

  • infant reflux
  • poor latching
  • low milk supply

If parents worked with the SLP to address their particular difficulties, breastfeeding typically improved and surgery wasn’t necessary.

On the other hand, some research shows that tongue-tie surgeries can be helpful.

A clinical study in 2019 found that out of 345 newborns with problems breastfeeding, 116 had a tongue-tie. The babies with a tongue-tie typically had more serious breastfeeding problems than babies without.

In the tongue-tie group, 30 babies had surgery. According to researchers, the surgery group showed significantly more improvement in breastfeeding than babies with tongue-tie who didn’t have the procedure.

Here are some pros and cons of tongue-tie surgery in newborns:

ProsCons
may help improve breastfeeding problemsmay not help improve breastfeeding problems
babies may feed better and gain weight more quickly post-surgerymay cause infection and swelling
may prevent nipple pain for nursing parentsmay ultimately be unnecessary
may prevent dental problems later in liferequires daily exercises and stretching after the procedure to prevent the condition from reoccurring
may prevent speech problems later in life

Tongue-tie surgery is no longer a one-size-fits-every-baby procedure. And there are different kinds of tongue-tie surgeries.

Fortunately, the frenulum doesn’t have a lot of nerves and blood vessels, so the surgery won’t normally cause much pain or a lot of bleeding.

If you decide on tongue-tie surgery, your healthcare team will help you choose the best procedure for your baby.

A note on terminology

“Frenotomy,” “frenectomy,” and “frenulectomy” are all terms that tend to be used interchangeably. They’re not precisely the same, but they’re all used the same way.

Healthline

Frenotomy

This traditional procedure involves snipping or cutting the frenulum with a small scalpel to free the tongue.

Most babies don’t need numbing (anesthesia) and can feed right away after the surgery. Healing may take a few days.

Tongue-tie laser surgery

Laser surgery for tongue-tie is similar to a frenotomy except that a laser is used instead of a scalpel or knife.

Using a laser may help make tinier snips or cuts. This may help the area bleed less and have faster healing time.

Tongue-tie electrocautery

Electrocautery surgery uses electricity to heat and cut. This method is similar to frenotomy for a tongue-tie, except electricity is used to release the tongue instead of a scalpel.

It may help reduce bleeding and speed up healing time.

Frenuloplasty

This kind of surgery is for more complicated tongue-tie cases. It involves cutting and reattaching the frenulum with sutures.

A baby will have to be asleep (under anesthesia) for this procedure because it takes longer. In some cases, babies may need tongue exercises and speech therapy later on to fully recover.

In rare, complicated cases, your baby may have longer healing time after tongue-tie surgery. The procedure may also cause complications and side effects like:

  • dehydration
  • inability to feed
  • weight loss
  • damaged tongue muscles
  • damaged salivary (spit) glands
  • breathing problems

Healing and recovery after tongue-tie surgery depend on the type of tongue-tie your baby has and what kind of surgery was needed to treat it.

Some procedures may have a longer healing time, leading to a further delay in breastfeeding. Or your little one may find it easier to breastfeed right away after surgery.

Regardless of how the procedure is done — with a scalpel or laser — you’ll need to do oral exercises and stretches with your baby multiple times every day for several weeks afterward. This helps prevent the frenulum from regrowing in a restricted way.

Your doctor will show you which exercises to do and how to do them. It may feel uncomfortable to you at first — you’ll basically be stretching an open wound. But the exercises are an important part of finding success with the procedure.

A clinical study from 2018 followed 30 newborns that had tongue-tie surgery before they were 12 weeks old. Immediately after the surgery, 90 percent of the mothers reported improvement in breastfeeding and nipple pain. After 2 weeks, 83 percent of the mothers said there was improvement.

Tongue-tie is a minor condition that some newborns have at birth. In some cases, it doesn’t cause any problems at all. Other babies may have problems breastfeeding.

Tongue-tie can also cause problems later in life, like difficulty speaking or changes to the shape of the mouth.

Tongue-tie surgery is a small procedure that can help some babies with breastfeeding.

But new research shows that in some cases, surgery isn’t needed to improve breastfeeding in babies with tongue-tie. This can be especially true if parents see a lactation specialist for evaluation and nonsurgical treatment recommendations.

Your lactation consultant or healthcare provider can advise you on the best treatment for your little one and give you all the options if surgery is needed.