Tongue-Tie Clinic

Ankyloglossia, frenectomy, frenotomy, frenum, posterior tongue-tie, anterior tongue-tie

What is a Tongue-Tie?

Fretnotomy in Children
A tongue frenulum is an extra piece of skin that goes from underneath the tongue to the floor of the mouth. Sometimes it is attached all the way to the tip of the tongue and sometimes only at the back of the tongue. Most tongue frenulums are very thin and look like a membrane, a few are thicker and look similar to the rest of the floor of the mouth.  A tongue frenulum becomes a tongue-tie when it causes symptoms (see described below). Research shows that up to 10% of babies have a tongue frenulum but just less than half of these babies have some difficulty with feeding. Historically, the presence of a tongue-tie resulted in its division immediately after birth, usually by the attending midwife.

The need for this practice came into question in the1940s and 1950s, in part, brought about by the rise in popularity of bottle feeding. Over the last 15 years there has been an ever growing body of evidence to support the impact that tongue-tie has on feeding and it’s management.  There is also a body of evidence (and practitioners) who believe that tongue ties should not have been divided. They must not have breastfed a baby with a tongue tie, or listened to a kid who has a very tight one go through years of speech therapy.

(Of course there are many adults with tongue ties who function perfectly, but there is usually something in their history that when questioned specifically, relates to tongue tie.)

The National Institute for Health and Clinical Excellence in the UK has published evidence supporting performing frenotomy for infants with tongue-tie and feeding problems.  Tongue tie causing maternal pain is a difficult area to study in a randomised fashion (the standard for medical publications), as those who are randomised not to have the procedure will almost always revert to the procedure group, which defeats the purpose!

Baby’s Symptoms

  • Difficulty latching onto the breast and/or maintaining latch
  • Clicking sounds whilst feeding
  • Poor weight gain of failure to thrive
  • How to know if a babys tongue tie is the problem?
    Baby unsettled/ hungry most of the time/ colic
    Prolonged feeds with short breaks
    Significant dribbling during feeds

Mother’s Symptoms

  • Nipple pain/damage
  • Painful breasts
  • Low milk supply
  • Mastitis

Speech Effects

Tongue tie may interfere with the ability to articulate certain sounds like “L” “d” “z” “s” “th” or roll an “r”.

It may make it difficult to wipe the teeth clean with the tongue, lick an ice cream or play a wind instrument effectively.

Types of Tongue-Tie

No two tongues and no two tongue ties are completely identical, and a very obvious tongue tie may actually cause no problems at all, just as a subtle posterior tie may cause awful pain for a feeding Mum. This is what makes a proper breastfeeding examination essential to ascertain what is causing the functional difficulty.

Having a frenulum or band of tissue under the tongue is completely normal. A normal frenulum is made up predominantly of elastin as opposed to dense collagen, allowing full function of the tongue. A tongue that is tied may or may not have an obvious frenulum (anterior or posterior types) but is made up primarily of collagen not elastin, and is restricted, or tight.

Tongue function needs to allow extension (sticking out) of the tongue as well as lateralisation (moving to the side) and elevation (lift)

Tongue ties are historically divided into anterior ties and posterior ties – anterior ties are the more obvious ones as the tight frenulum can reach the tip of the tongue (type I).

Posterior ties are known as submucosal or buried tongue ties, and primarily affect the lift of the tongue to the palate, a crucial movement for the tongue to allow pain free and effective breastfeeding.

Anterior – Type I


Anterior – Type II (img 1)
Anterior – Type II 


Posterior – Type III


Posterior – Type IV


Post Frenotomy


Where Do I Get Help?

The best person to assess your breastfeeding (and or breastfeeding difficulty) is a Lactation Consultant. They are also the best people to diagnose a tongue tie as they will assess your feeding completely and ascertain whether it is the tongue tie that is a causative factor in the feeding problems you are experiencing. Lactation counsellors and public health nurses or midwifes will often also have a special interest or particularly helpful insight and experience with tongue tie feeding issues. If you are having breastfeeding difficulty (chances are that you are, if you are reading this!), then I recommend you contact a lactation consultant to assess your feeding. You can find a list of all the Lactation Consultants here.

siun and nicola

If your HCP (healthcare professional) diagnoses or suspects a tongue tie, they will likely refer you to a practitioner who specialises in frenotomy procedures. There are many practitioners who do this – GPs, dentists (usually laser), paediatricians, ENT surgeons, General Surgeons and a plastic surgeon!

The Tongue-Tie Procedure


I just want to thank Dr Murphy and Nicola and yourself again for yesterday. You all made us feel so at ease and relaxed. Mum and I are super impressed with the care and treatment we received. The difference in his feeding from my breasts and spoon is like night and day!
We attended Dr. Murphy for division of our little boy’s posterior tongue tie when he was 5 weeks old. His feeds were taking forever, I had sore cracked nipples, was using shields, and was beginning to dread feeds. As a doctor myself, I quickly realised while researching the procedure that Siún is the most highly qualified person providing this treatment in Dublin (& beyond)…

Contact Me

Our tongue tie service consists of our Suite 35 admin staff, Siun, and two IBCLC s – Emma Greene RGN and Fiona Rea.

Blackrock Tongue-Tie Clinic

We run a tongue tie clinic once a week, usually on a Tuesday morning at Suite 35, Blackrock Clinic. (4th floor)

Additional Information about the Blackrock Tongue-Tie Clinic.

In order to book a consultation we require a referral letter either from a lactation consultant or GP only.

View Directions to Suite 35, Blackrock Clinic.

Healthcare Professionals Information

Fill out the Tongue-Tie Referral Form and also download a copy of the Tongue Tie Assessment Form.