If you've been told your baby has a tongue tie, you've probably also found a lot of very fast, very confident advice online. Book an assessment, get it divided, feeding will improve within days. For some babies, that's genuinely how it goes. For a lot of babies, it isn't, and that's where things start to go wrong.
Are tongue ties becoming more common, or are we just better at spotting them?
This is a genuinely live question in the UK profession, not something with a tidy answer. What's clear is that diagnoses and treatment have risen sharply. NHS hospital data shows frenotomy procedures in England rising from around 3,671 in 2010–11 to 5,487 by 2016–17, and that figure doesn't even capture the large number now carried out privately, on which no official data exists. Across high income countries more broadly, tongue tie surgery rates have more than quadrupled over a decade.
What's far less clear is whether that reflects more babies actually being born with restricted tongue movement, or whether it reflects widening definitions, growing parental awareness, and pressure from social media pushing tongue tie as the default explanation whenever breastfeeding gets hard. Research published in the British Journal of General Practice notes that around 75% of babies found to have a tongue tie are asymptomatic, with no feeding difficulty at all. Having a tongue tie and having a tongue tie that's actually causing your feeding problem are two different things, and it's the second one that matters.
Why this matters for how an assessment should be done
If diagnosis has outpaced the evidence in some places, the answer isn't to ignore tongue tie altogether, it's to assess properly rather than reflexively. A tongue tie is a piece of tissue under the tongue that can restrict movement. But a restricted tongue is rarely the only thing going on when a baby is struggling to feed. Positioning, the birth itself, how the jaw and neck are moving, even how the pregnancy went, can all play a part, sometimes instead of a tongue tie, often alongside one.
A proper assessment takes time. It means listening to the full story first, the pregnancy, the birth, how feeding has gone so far, and watching a full feed before ever looking in a baby's mouth. It means asking what's actually causing the difficulty, not assuming the answer before the question's been asked.
Why division isn't always the answer
A division is a quick, simple procedure. That's exactly why it's tempting to reach for it fast. But once it's done, it's done, and if the tongue wasn't the real problem, or wasn't the whole problem, a family can end up with a baby who's had an unnecessary procedure and a feeding problem that's still there. A Cochrane Review, cited in UK general practice guidance, found that whilst tongue tie division can reduce nipple pain for the breastfeeding parent, there's no robust evidence it improves breastfeeding success in the longer term.
The more experience a practitioner has, the more likely they are to find that division isn't needed at all, because there's usually another route to improving feeding first: a positioning change, some gentle exercises, time. When division genuinely is the right call, it should be because everything else has been properly considered, not because it's the fastest thing to offer.
What to ask before you book an assessment
- How long does the assessment take, and what does it actually involve?
- Will you look at more than just my baby's mouth?
- What happens if you don't think division is the answer?
- Do you offer any follow-up support afterward?
If the answers are quick, generic, or make you feel rushed, it's worth pausing. A tongue tie assessment is a clinical decision about your baby, not a five-minute fix, and it deserves the time that comes with getting it right.