The frenulum is a thin tissue that attaches the tongue to the floor of the mouth. When a baby has a shortened frenulum, the tongue’s movements are restricted, and the baby may have difficulty latching to the breast, or may latch but then have difficulty maintaining the feeding. He may loose suction repeatedly, slip off the breast after several suckles and repeat this behavior over and over. Typically, the baby does not gain weight well, because he has trouble with milk transfer-getting the milk out of the breast and into the baby.

Mothers also may have nipple soreness that worsens despite using creams and working on positioning. Occasionally, mothers develop mastitis and other complications from repeated nipple trauma. This is one reason infants may have difficulty breastfeeding. An evaluation from a trained provider experienced in evaluating frenulums is necessary to determine if this is a difficulty you and your baby may be having with breastfeeding.

What Does the Tongue Look Like in a Tongue-Tied Baby?

  • The tip of the tongue may be heart-shaped, or have a “V” shape indentation in the center when the baby opens her mouth or cries.
  • The tongue does not protrude past the gum-line. (With a tongue-tie, babies have difficulty extending their tongue past the gum line when crying or feeding.)
  • The edges of the tongue do not rise on either side of the finger or “cup” with sucking on your finger. (When you place your finger in your baby’s mouth, the edges of the tongue should cup or rise on either side of the finger and look like a “U” shape with your finger in the middle.)
  • The tongue does not move from side to side, easily touching the gum-line when stimulated with your finger.
  • A thin stretch of skin can be seen close to the tip of the tongue. (This is the frenulum attached to the tip, or near the tip of the tongue — rather than 1/3 to half-way back on the floor of the mouth. Even if it’s attached near the front of the mouth, the baby may still be able to nurse effectively due to the frenulum stretching well and being more elastic in nature.)

How is Tongue-Tie Treated?

The treatment for tongue-tie involves evaluating the baby and determining if the baby needs the tongue to be clipped. This is a quick, painless procedure done in the office without anesthesia. Health care providers who evaluate tongue-ties include Pediatricians, Family Physicians, Ear, Nose and Throat specialists (ENT), oral surgeons, generals surgeons, dentists, Nurse Practitioners and Physician Assistants. The baby should be put to breast immediately after the procedure. Occasionally, there is a more complicated tongue-tie called a posterior tie that will need a more specialized evaluation.

You can find more information about tongue-tie at and and

If you’re wondering whether your baby has a tight frenulum or tongue-tie, ask for an evaluation with a provider, or at our Breastfeeding Center of Pittsburgh.

Beverly Curtis is a former Kids Plus Provider.