Tongue-Tie and Lip-Tie in Children: What Parents Need to Know About Frenectomy

When a baby is born with a tongue-tie or lip-tie, it can feel like an overwhelming diagnosis — especially in those early days when breastfeeding is already challenging. For older children and adults, these conditions can contribute to speech difficulties, dental problems, and discomfort that's easy to overlook without knowing what to look for.

Here's what parents and patients need to know about tongue-tie, lip-tie, and the procedure used to treat them.

What is a tongue-tie?

A tongue-tie (ankyloglossia) is a condition where the lingual frenum — the thin band of tissue that connects the underside of the tongue to the floor of the mouth — is shorter, thicker, or attached further forward than normal. This restricts the tongue's range of motion, which can interfere with breastfeeding, speech articulation, eating, and in some cases, oral hygiene.

Tongue-tie exists on a spectrum. Some cases are visually obvious — the tongue may appear heart-shaped at the tip when lifted, or cannot extend past the lower gum. Others are posterior tongue-ties, where the frenum restricts movement without being visible at the tip, making them harder to identify and sometimes missed.

What is a lip-tie?

A lip-tie involves the labial frenum — the band of tissue connecting the inner upper lip to the gum above the upper front teeth. When this frenum is tight or thick, it limits how far the lip can flange outward, which can affect latching during breastfeeding and, later, the position of the upper front teeth or the creation of a gap between them.

Lip-ties are often diagnosed alongside tongue-ties, particularly when a breastfeeding mother is experiencing nipple pain or a baby is struggling to maintain suction.

How do these conditions affect breastfeeding?

Breastfeeding is the area where tongue-tie and lip-tie are most immediately noticed. A restricted tongue cannot create adequate negative pressure for effective milk transfer, which leads to:

Poor latch that keeps slipping off; inefficient feeding sessions where the baby tires quickly without transferring enough milk; maternal nipple pain, soreness, or cracking due to the baby compensating with gum pressure; and poor weight gain in the infant.

Not all breastfeeding difficulties are caused by ties, and not every tie causes feeding problems — assessment by a lactation consultant alongside a dental or medical evaluation gives the clearest picture.

Can tongue-tie affect speech?

Yes, in some cases. Sounds that require the tongue tip to touch the roof of the mouth or upper teeth — such as "t", "d", "n", "l", "r", and "s" — can be difficult for children with restricted tongue movement. However, many children with mild tongue-ties develop normal speech without intervention. The relationship between tongue-tie and speech is not straightforward, and speech therapy is often tried first in older children before frenectomy is considered.

What is a frenectomy?

A frenectomy is a minor surgical procedure that releases the restrictive frenum, allowing greater freedom of movement. It can be performed on the lingual frenum (for tongue-tie), the labial frenum (for lip-tie), or both.

There are two main techniques:

Frenotomy / frenectomy with scissors or blade

The frenum is snipped with surgical scissors or a blade after local anaesthesia or, in newborns, often without — newborns have few pain receptors in the frenum and bleed minimally. The procedure takes a few minutes and provides immediate release.

Laser frenectomy

A soft tissue laser (typically a diode or CO2 laser) is used to release the frenum. Advantages include minimal or no bleeding, reduced risk of infection, precise tissue removal, and often less post-operative discomfort. Laser frenectomy is increasingly common in paediatric dentistry and is well tolerated by older children and adults.

At what age should frenectomy be done?

This depends on the reason for treatment. For breastfeeding difficulties, frenectomy can be performed in the first days or weeks of life and may provide immediate improvement in feeding. For speech, most providers prefer to wait until the child is old enough for formal speech evaluation and therapy — often around age three to five — before proceeding with surgery, and only if therapy alone hasn't resolved the problem. For cosmetic or dental concerns related to a gap between front teeth, the timing relative to the eruption of permanent teeth matters, and your dentist will guide this decision.

What does recovery look like?

Recovery is generally straightforward, particularly for infants. In newborns, feeding can usually resume immediately, and most parents notice improvement in latch within a few feeds. A diamond-shaped wound under the tongue is normal and heals over one to two weeks.

In older children and adults, healing takes slightly longer. Stretching exercises are often prescribed to prevent the frenum from reattaching — your dentist or surgeon will show you exactly what to do. Some discomfort and swelling for a few days is normal and typically managed with paracetamol and soft foods.

How do I know if my child needs a frenectomy?

Start with your child's dentist or paediatrician, who can assess whether a functional restriction is present and refer you to the appropriate specialist — a paediatric dentist, oral surgeon, or ENT — if needed. For newborns with breastfeeding difficulties, a lactation consultant and dentist working together provides the most thorough assessment.

It's also worth remembering that many mild tongue-ties resolve naturally or never cause significant problems. A confident, well-informed assessment from a clinician experienced with these conditions is the most important first step.