Ankyloglossia, or Tongue-Tie, is a common topic of conversation for primary care providers and breastfeeding families. The Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in the Breastfeeding Dyad (2021) and the American Academy of Pediatrics Clinical Report on the Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants (2024) are helpful resources when navigating the discussion.

Key Points: 

• Ankyloglossia, or "tongue-tie" refers to a linqual frenulum that limits the motion of the tongue. 
• Symptomatic ankyloglossia indicates the presence  of a tight frenulum, with limited tongue movement, along with the presence of breastfeeding difficulties (i.e. pain, difficulty latching) that do not improve with lactation support.
• There are multiple causes of breastfeeding difficulties, so it is important to evaluate and consider all the factors before deciding on treatment. 
• Families experience variability in diagnosis and treatment recommendations as there is not accepted diagnostic criteria, or standard indications for frenotomy treatment.
• While research is limited, and follow-up is generally short-term (~2 weeks), small randomized trials of frenotomy show a reduction in nipple pain following frenotomy, an important outcome given pain is a major reason for weaning.
• Further research on identifying ankyloglossia, long-term outcomes, and the natural history of ankyloglossia is needed.

Helpful starting points:

• Remember to evaluate breastfeeding and look at function.  This is where integrating with your lactation colleagues can be very helpful!
• Before considering frenotomy, make certain the nursing dyad has a complete breastfeeding assessment to evaluate and address other potential causes of suboptimal breastfeeding.
• If choosing conservative management, make certain the family has follow-up in a setting with breastfeeding support, and future availability of frenotomy if needed. 

Keep in mind:

• As the research evolves, patients need a balanced evidence-based discussion and the opportunity for shared decision making to help balance the variety of opinions received elsewhere.  
• Multi-disciplinary team-based care has been shown to reduce frequency of unnecessary frenotomies without negatively impacting breastfeeding. 

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Research Updates

Ankyloglossia, Breastfeeding, and Infant Weight Gain 

• 476 dyads prospectively followed for 6 months in India where the study population at baseline has high exclusive breastfeeding (EBF) rates, ankyloglossia is not typically regarded as barrier to breastfeeding, and frenotomies are not commonly performed.
• No difference EBF or infant weight gain velocity was found in infants with or without tongue-tie, as defined by the study authors, at 2-4 wks, 3 months and 6 months after delivery.  
• Study authors, Raol et al., conclude that ankyloglossia alone does not impact long term outcome and multidisciplinary management is important to focus on all causes of breastfeeding difficulties. 
• from Pediatrics January 2026

Untreated Ankyloglossia: a Broader Perspective 

• Dr. Ann Witt and Dr. Lydia Furman provide commentary to the above study by Raol, et al. and acknowledge the strengths and limitations of the study: 

• Stengths: "conducted in a setting in which breastfeeding is the norm ... enrolled a large of dyads, assessed exclusive breastfeeding, included long-term follow-up (through 6 months), and did not include a surgical treatment group permitting a long view of ankyloglossia natural history."

• Limitations: "1) how the diagnosis of ankyloglossia was made and 2) the range of ankyloglossia severity in the diagnosed group.... the tool and cutoff value selected by Raol, et al. may have led to a higher-than-expected ankyloglossia rate".
• The need for validated tools and standardizing the diagnosis of ankyloglossia are evident from this study:  "Raol, et al. used the Bristol Tongue Assessment Tool (BTAT) and used  a cut off score of 7 resulting in 110 infants in their ankyloglossia group whereas if the BTAT score 0-3 was used only 1.8% of the ankyloglossia infants had 'severe' ankyloglossia and if a score of < 5 was used then 33 (or about 7%)  infants would have been diagnosed with ankyloglossia."
• from Pediatrics January 2026

Tongue-tie diagnosis using the Lingual frenulum in newborn infants (LINNE)-scoring: A validation study 

• LINNE project is investigating tongue-tie epidemiology and this prospective, observational study aimed to validate a scoring tool to detect infants who require early tongue-tie treatment.
• LINNE scoring includes: 1) TABBY picture assessement of infant tongue, 2) Maternal breastfeeding experience scoring, 3) anamnestic factors associated with tongue-tie and breastfeeding problems.
• Of the 556 dyads studied, 72 (12.9%) of infants fullfilled early tongue-tie treatment criteria
• TABBY tool was very good with AUC 0.9 for ankyloglossia needing early treatment 
• from PLosS One. December 2025

Helpful Resources

• TABBY Visual tool:  This is a picture assessment tool for tongue-tie in breastfed babies. It was developed from the BTAT tool. A score of 8 indicates normal tongue function, 6 or 7 is considered as borderline, and 5 or below suggests an impairment of tongue function. In the study, a score of 4 or less had a frenotomy performed. 
• American Academy of Otolaryngology-Head and Neck Surgery Clinical Consensus Statement:  Ankyloglossia in Childhood