Tongue tie in a newborn is fixed with a quick surgical procedure called a frenotomy, where a provider snips or lasers the tight band of tissue under the tongue to restore normal movement. The scissor method takes about one minute and is considered the gold standard. Before jumping to a procedure, though, it’s worth understanding how tongue tie is identified, what the experience looks like for your baby, and what recovery involves.
What Tongue Tie Looks Like in a Newborn
Every baby has a small strip of tissue connecting the underside of the tongue to the floor of the mouth. In tongue tie (the medical term is ankyloglossia), that strip is unusually short or tight, pulling the tongue down and limiting how far it can move. Your baby’s tongue may look heart-shaped at the tip or have a visible notch when they try to lift it. In more subtle cases, called posterior tongue tie, the restriction sits further back and can be harder to spot on a visual exam alone.
The signs that matter most are functional. In the baby, these include difficulty latching onto the breast (or crying when trying), clicking sounds during feeding, popping off the breast repeatedly, poor weight gain, very frequent feedings, and a lack of audible swallowing. For the breastfeeding parent, tongue tie often shows up as cracked or sore nipples, pain throughout nursing sessions, and eventually a drop in milk supply from ongoing transfer problems.
These symptoms overlap with other common breastfeeding difficulties, which is why the American Academy of Pediatrics recommends a team approach to diagnosis rather than relying on appearance alone. A lactation consultant can assess feeding mechanics, and a pediatrician, pediatric dentist, or ear-nose-throat specialist can evaluate the anatomy. One widely used assessment tool, the Hazelbaker questionnaire, scores both the physical appearance and the functional movement of the tongue to determine whether a release is warranted.
How Severity Is Classified
Providers typically classify tongue tie by how much “free tongue” the baby has between the frenulum attachment and the tongue tip. In a commonly used system developed by Lawrence Kotlow, normal free tongue length is greater than 16 mm. Mild restriction (Class I) measures 12 to 16 mm, moderate (Class II) is 8 to 11 mm, severe (Class III) is 3 to 7 mm, and complete tongue tie (Class IV) is less than 3 mm.
A separate classification by Coryllos divides tongue tie into four types based on where the tissue attaches. Types III and IV are posterior ties that sit deeper in the mouth and often go unrecognized because they don’t look like the classic visible band near the tongue tip. If your baby has feeding problems but no obvious tie is visible, a posterior tie is worth investigating with a provider experienced in identifying them.
The Frenotomy Procedure
A frenotomy is the standard procedure for releasing tongue tie in newborns. The provider holds the baby’s tongue up, identifies the tight band, and cuts it. With scissors, the entire process takes roughly one minute. Some providers use a laser instead, which may take slightly longer. Both methods accomplish the same goal: freeing the tongue so it can move with a fuller range of motion.
The tissue being cut has very few nerve endings and minimal blood supply in young infants, which is why the procedure can be done quickly and often without general anesthesia. Some babies cry briefly during the snip, then calm down almost immediately when offered a feeding. A small amount of bleeding is normal and typically stops on its own within minutes.
You may also hear the term “frenectomy,” which refers to a more complete removal of the tissue rather than just a cut through it. In newborns, a simple frenotomy is usually sufficient.
What to Expect After the Release
In the first day or two, you’ll likely notice a white or yellowish diamond-shaped patch under your baby’s tongue where the cut was made. This looks alarming but is a normal part of healing, not a sign of infection. It’s similar to how the inside of the mouth heals after any minor injury.
Some babies latch better almost immediately after the procedure. Others need a couple of weeks to learn how to use their newly mobile tongue. Your baby has never had full tongue movement before, so the muscles and coordination need time to catch up. Working with a lactation consultant during this period can make a significant difference, especially if your baby developed compensatory feeding habits before the release.
For pain management, infant acetaminophen (Tylenol) can be used for any discomfort. Avoid giving aspirin to anyone under 18, and be careful not to combine multiple pain medications that contain acetaminophen, as too much can be harmful. Many babies, however, show minimal signs of discomfort after the first day.
How Well It Works
A meta-analysis pooling six studies found that babies who had a frenectomy were 42% more likely to have improved breastfeeding outcomes compared to those who did not have the procedure. Improvements are most commonly measured through maternal reports of nipple pain, latch quality, and milk transfer. Many parents notice reduced pain during feeding within the first few days.
That said, the AAP’s 2024 clinical report notes that the evidence on whether releasing a tight frenulum clearly improves breastfeeding remains somewhat uncertain. Part of the challenge is that breastfeeding difficulties have many possible causes, and tongue tie may be only one contributing factor. A release works best when it’s paired with ongoing feeding support rather than treated as a standalone fix.
Risks and Complications
Frenotomy is a low-risk procedure. Two systematic reviews found an overall complication rate of about 1% for mild issues, with minor bleeding being the most common. Serious complications are rare. A prospective study in New Zealand that tracked outcomes over 24 months found that among the small number of babies who did present with complications, the most frequent were feeding difficulties afterward (44%), respiratory symptoms (25%), bleeding (19%), and weight loss (19%).
Scarring is uncommon but has been reported, particularly in cases where a baby underwent multiple procedures. One case in the New Zealand study involved an infant who had four frenotomies and developed scarring that worsened feeding. This underscores why getting a thorough evaluation before the first procedure matters, and why repeat procedures should be approached cautiously.
When Conservative Management Comes First
Not every tongue tie needs to be cut. If your baby is gaining weight well and feeding comfortably, a visible tie that isn’t causing functional problems can often be left alone. Some mild restrictions resolve or become less problematic as the baby grows and the mouth changes shape.
Before scheduling a frenotomy, many providers recommend working with a lactation consultant to optimize positioning and latch. In some cases, adjustments to feeding technique resolve the symptoms without surgery. If conservative strategies don’t improve things after a reasonable trial, that’s typically when a frenotomy enters the conversation. The key question is always whether the tie is causing a functional problem, not simply whether a tie exists.