Choosing Your Tongue-tie Practitioner

A feeding consultation should never feel like a conveyor belt towards a procedure. When choosing your tongue-tie practitioner, the most useful question is not simply, “Can they perform a frenulotomy?” It is, “Can they help us understand what is happening with our baby’s feeding, consider the full picture, and support us whichever path feels appropriate?”

A visible lingual frenulum is a normal anatomical structure. In some infants, restricted tongue function may be relevant to feeding difficulties; in others, it may not be the main factor, or may not be causing difficulty at all. Feeding can also be affected by positioning, milk flow, breast or chest comfort, bottle teat choice and pacing, infant maturity, health, muscle tone, oral motor coordination and many other factors.

Anatomy provides information. Function provides context.

This guide is for families seeking care and for professionals signposting them. It focuses on the features of safe, compassionate and evidence-informed practice.

Choosing your tongue-tie practitioner starts with assessment

A practitioner should be interested in your baby and your feeding experience, not only in the appearance of the mouth. A skilled assessment brings together a relevant health history, observation of feeding where possible, consideration of tongue function and a conversation about the difficulties that matter to your family.

For breastfeeding or chestfeeding families, this may include comfort, attachment, milk transfer, feeding frequency, breast or chest changes and the baby’s growth pattern. For bottle-feeding families, it may include dribbling, prolonged feeds, coughing, distress, fatigue, difficulty maintaining a seal or the practical realities of combination feeding.

These observations do not confirm tongue-tie on their own. They help build a clinical picture.

Ask whether the practitioner will assess feeding function before discussing treatment. If an in-person feed cannot be observed, perhaps because a baby has recently fed or practical circumstances make this difficult, a careful history still matters. The practitioner should explain the limitations and arrange appropriate follow-up where needed.

Assessment should also include differential diagnosis: a thoughtful consideration of other possible contributors to the concerns. This does not mean dismissing a caregiver’s experience. It means making sure that care is proportionate, individualised and not based on one finding alone.

Look for relevant qualifications, training and accountability

Tongue-tie assessment and treatment require specific training, but it is also useful to understand the practitioner’s wider professional background and experience.

A practitioner may have undertaken a specific tongue-tie training course and developed substantial experience in this area through their clinical practice. For some practitioners, tongue-tie and infant feeding become a particular area of professional expertise and a long-term vocation. Others may bring additional qualifications and experience from nursing, midwifery, medicine, dentistry, lactation or neonatal care.

Rather than assuming that one professional background is automatically better than another, ask what qualifications the practitioner holds, what training they have undertaken and how their experience relates to the care they provide.

Consider their infant-feeding knowledge

There are different levels of education and professional support within infant feeding and lactation. The Lactation Consultants of Great Britain (LCGB) provides an overview of the different roles involved in breastfeeding support, including peer supporters, breastfeeding counsellors and International Board Certified Lactation Consultants (IBCLCs). LCGB also explains how families can check whether a practitioner is currently an IBCLC through the international registry (LCGB, n.d.).

An IBCLC has followed a defined pathway of education, clinical experience and examination specifically relating to lactation and infant feeding. Other practitioners may have substantial infant-feeding knowledge through their professional education, clinical experience and additional training.

This does not mean that every tongue-tie practitioner needs to hold an IBCLC qualification. It means that families should be able to understand what level of infant-feeding knowledge their chosen practitioner has and whether this is appropriate to the support they may need.

It is also worth asking whether the practitioner undertakes regular update or continuing professional development training. Tongue-tie practice, infant-feeding knowledge, clinical guidance and evidence continue to develop, so maintaining current knowledge is an important part of safe professional practice.

For registered nurses and midwives, the NMC Code specifically requires registrants to keep their knowledge and skills up to date through appropriate and regular learning and professional development (NMC, 2018). Other regulated healthcare professionals have their own professional requirements for maintaining competence.

A practitioner should also be able to recognise when a feeding difficulty falls outside their own scope of practice and when additional support or referral would be appropriate.

Check professional registration where applicable

If your practitioner is a registered nurse, dentist or doctor, you can check their professional registration with the relevant regulator:

• Nursing and Midwifery Council (NMC)

• General Dental Council (GDC)

• General Medical Council (GMC)

Professional registration does not automatically mean that someone is a tongue-tie specialist. However, it provides a framework of professional standards, accountability and scope of practice.

It is therefore reasonable to ask about both the practitioner’s underlying professional qualification and their specific training and experience in tongue-tie assessment, frenulotomy and infant feeding.

The Association of Tongue-Tie Practitioners (ATP) also recognises the importance of professional regulation within its membership structure. Its full membership is open to current tongue-tie practitioners who are regulated healthcare professionals registered with the NMC, GMC or GDC and who are registered with CQC or an equivalent regulator where applicable. ATP also has affiliate membership for other professionals involved in tongue-tie and infant-feeding care (ATP, 2026).

ATP membership itself is not a statutory requirement for providing tongue-tie services. ATP is a professional association, not the statutory regulator of healthcare professionals.

Check CQC registration in England

In England, frenulotomy performed by or under the supervision of a healthcare professional falls within the CQC regulated activity of surgical procedures. CQC has specifically confirmed that frenulotomy is a regulated activity because it involves surgical cutting of the lingual frenulum (CQC, 2022).

CQC registration is a statutory requirement for providers carrying on a regulated activity. CQC states that it is an offence to carry on a regulated activity without registration where registration is required (CQC, 2022).

CQC registration may be held by an individual practitioner or by an organisation or employer through which the service is provided. There may also be arrangements involving practising privileges within a registered service. The important point is that the CQC registration arrangement must appropriately cover the regulated activity being provided.

Families can search the CQC website to find the relevant provider or service and check the registered activities. Where an inspection or assessment has taken place, the CQC profile can also provide information about the service and its rating.

A CQC rating, where one has been awarded, should also be displayed by the service in accordance with CQC requirements.

CQC registration is separate from membership of a professional organisation. For example, membership of ATP is not a legal requirement for providing tongue-tie services, whereas the appropriate CQC registration for the regulated activity of surgical procedures is a legal requirement in England (CQC, 2022; ATP, 2026).

Consider the regulatory framework where you live

Regulation is not identical across the UK and Ireland. If you are seeking care in Scotland, Wales, Northern Ireland or the Republic of Ireland, check which regulatory framework applies to the practitioner and service in that country.

The important principle is to understand what professional registration and regulatory requirements apply to the person providing your baby’s care and to the service in which the procedure is being undertaken.

Remember that frenulotomy is a surgical procedure

Although frenulotomy may be a relatively quick procedure to perform, this should not be confused with the overall care that surrounds it.

A frenulotomy is a surgical procedure and, like any procedure, carries potential risks. The practitioner you choose should therefore have appropriate training and experience not only in performing frenulotomy, but also in recognising and responding appropriately if something does not go as expected.

Families can reasonably ask what arrangements are in place for managing unexpected concerns, obtaining further clinical advice and arranging referral or escalation when required. A responsible practitioner should be able to explain the risks in a calm and proportionate way, without either minimising them or unnecessarily alarming families.

It is also reasonable to ask how frequently the practitioner performs frenulotomy and how they maintain their knowledge and skills. Experience is not simply about the number of procedures performed; it also includes clinical decision-making, consent, safety, follow-up and knowing when additional assessment or referral is needed.

Most importantly, the feeding relationship with the practitioner should not end when the frenulum has been divided.

Infant feeding is multifactorial. A frenulotomy may address one anatomical restriction, but it does not automatically resolve every factor contributing to feeding difficulty. Feeding patterns, oral function, positioning, milk flow, infant regulation, muscle tone, coordination, previous feeding experiences and the caregiver’s own experience can all form part of the picture.

For this reason, a procedure should be viewed as one part of a feeding journey, not the end of it.

A short procedure does not mean that the feeding care surrounding it should be short. Building an understanding of the baby’s feeding, considering what may need to change and supporting the caregiver and infant afterwards may require time and continuity.

Ask how treatment decisions are made

A frenulotomy may be considered when there is evidence that restricted tongue function is contributing to significant feeding difficulty and when this is discussed within the wider clinical context. It is not an automatic response to a frenulum, feeding discomfort or a referral label.

The evidence base is limited by small studies and variation in definitions, assessment and outcomes. A Cochrane review found that frenotomy reduced maternal nipple pain in the short term in the studies available, but evidence for consistent improvement in infant breastfeeding outcomes was less certain (O’Shea et al., 2017).

More recent clinical guidance similarly stresses that a restrictive frenulum should be considered in relation to feeding function and within the wider clinical assessment of the breastfeeding dyad (Mehta et al., 2024; Thomas et al., 2021).

This does not make caregivers’ difficulties any less real. It means a responsible practitioner should describe what is known, what is uncertain and what alternatives are available.

They should be comfortable supporting conservative management, offering feeding support, recommending review, or discussing frenulotomy when it is clinically appropriate and consistent with the family’s informed preferences.

Be cautious if you are told that every tongue-tie needs releasing, that a release will definitely resolve all feeding concerns, or that tongue-tie explains a wide range of future difficulties without a careful individual assessment.

Equally, a practitioner should not minimise persistent pain, feeding distress or worries about intake simply because a baby is gaining weight. Growth is one important measure, but it is not the whole feeding story.

Understand the procedure, method, risks, consent and follow-up

If frenulotomy is being considered, it is reasonable to understand how the practitioner carries out the procedure. Different practitioners may use different techniques, and the method used can affect what happens before, during and immediately after the procedure.

You can ask:

• What method do you use for frenulotomy?

• What, if any, anaesthetic or pain-relief measures are used?

• What can I expect during and immediately after the procedure?

• What are the potential risks?

• What arrangements are in place if an unexpected concern occurs?

• What aftercare and follow-up are provided?

There is no single question about technique that will determine whether a practitioner is right for your family. Understanding the method used simply allows you to make an informed choice and to know what to expect.

Our separate guide to tongue-tie division methods explains the different approaches in more detail.

Before any procedure, you should have time to ask questions and make a voluntary decision. A clear consent discussion should cover why frenulotomy is being considered, the expected benefits and uncertainties, potential risks, alternatives, what will happen on the day and when to seek further help.

The practitioner should also explain whether your baby is eligible for care within their service and whether there are circumstances that require medical review elsewhere.

Aftercare is part of the feeding journey

Aftercare should not be treated as an optional extra.

A frenulotomy may change the available movement of the tongue, but feeding remains a learned and developing process. An infant may need time and appropriate support to adapt to changes in tongue movement and feeding mechanics. Caregivers may also need support as they adjust to changes in feeding.

This is particularly important because feeding difficulties are often multifactorial. If several factors have contributed to a feeding problem, addressing one anatomical restriction does not necessarily resolve every aspect of feeding immediately.

Ask what follow-up is included, how long it is available for, who you can contact if questions arise and whether ongoing feeding difficulties can be reassessed.

A good service should be able to explain what support is available if feeding improves, if progress is slower than expected, or if the original feeding concern continues.

Where appropriate, this may involve working alongside your midwife, health visitor, GP, paediatric team or lactation professional.

NICE guidance highlights the importance of appropriate training, consent, audit and arrangements for clinical support when tongue-tie division is undertaken (NICE, 2005).

Notice how the service communicates

The quality of communication can tell you a great deal. Families deserve plain language without alarmist claims, jargon without explanation or judgement about how they feed their baby.

A good practitioner will listen to what is hardest, acknowledge uncertainty where it exists and make space for your priorities.

This may mean supporting a caregiver who wants to continue breastfeeding or chestfeeding, a family using bottles, someone expressing milk, or those combination feeding. It may mean recognising that an immediate procedure is not right for every baby, and that waiting or seeking another opinion can be reasonable choices.

Family-centred care is not about directing families towards one outcome; it is about helping them make informed decisions with skilled support.

For some families, practical details matter just as much as clinical expertise. Check where the appointment is held, whether another supporter can attend, what to bring, how long to allow, and how to contact the service afterwards.

These details can reduce stress at a time when sleep and confidence may both be in short supply.

Questions worth taking to an appointment

You do not need to become an expert before seeking help. It can be useful, however, to ask how the practitioner assesses feeding function, what else they will consider, and what support is available if a frenulotomy is not recommended.

You might also ask:

• What professional qualification do you hold?

• What level of infant-feeding training do you have?

• What specific tongue-tie training have you undertaken?

• Do you undertake regular update or continuing professional development training?

• Are you registered with the NMC, GDC or GMC, where applicable?

• Is the service appropriately registered with CQC where required?

• What method do you use for frenulotomy?

• What anaesthetic or pain-relief measures are used?

• How do you obtain consent?

• What follow-up and aftercare are included?

• What happens if feeding difficulties continue?

• How can I contact you if I have concerns after the procedure?

• When would you recommend further assessment or referral?

If you leave feeling rushed, unheard or unclear about why a recommendation has been made, it is reasonable to pause and ask for clarification. A second opinion can be particularly helpful where feeding concerns are persistent, the proposed plan feels unclear, or there are other health factors to consider.

Choosing a practitioner is about more than the procedure

The right practitioner will not promise a particular feeding outcome.

They will offer careful assessment, appropriate training, current knowledge, honest discussion, safe care and compassionate support for the next step — whether that involves targeted feeding help, watchful review, referral or a considered frenulotomy.

When choosing a tongue-tie practitioner, look beyond the procedure itself. Consider their professional background, level of infant-feeding knowledge, specific tongue-tie training, ongoing education, experience, professional registration where applicable, CQC registration in England and the quality of the clinical governance and aftercare surrounding their service.

The procedure may be only one part of the appointment. The relationship that supports your baby’s feeding journey should extend much further.

References

Association of Tongue-Tie Practitioners (ATP) (2026) Membership Application. Available at: https://www.tongue-tie.org.uk/membership-application (Accessed: 8 September 2026).

Care Quality Commission (CQC) (2022) Briefing for providers: Registration requirements for tongue-tie procedures. Available at: https://www.cqc.org.uk/news/providers/briefing-providers-tongue-tie (Accessed: 8 September 2026).

Care Quality Commission (CQC) (2025) Surgical procedures. Available at: https://www.cqc.org.uk/guidance-regulation/providers/registration/scope-registration/regulated-activities/surgical-procedures (Accessed: 8 September 2026).

General Dental Council (GDC) (n.d.) Standards and guidance. Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance (Accessed: 8 September 2026).

General Medical Council (GMC) (2024) Good medical practice. Available at: https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice (Accessed: 8 September 2026).

Lactation Consultants of Great Britain (LCGB) (n.d.) Who’s Who in Breastfeeding Support and Lactation in the UK. Available at: https://lcgb.org/why-ibclc/whos-who-in-breastfeeding-support-and-lactation-in-the-uk/ (Accessed: 8 September 2026).

Mehta, B., et al. (2024) ‘Identification and management of ankyloglossia and its effect on breastfeeding in infants: Clinical report’, Pediatrics, 153(2), e2024067605.

National Institute for Health and Care Excellence (NICE) (2005) Division of ankyloglossia (tongue-tie) for breastfeeding. Interventional Procedures Guidance 149. London: NICE.

Nursing and Midwifery Council (NMC) (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at: https://www.nmc.org.uk/code/ (Accessed: 8 September 2026).

O’Shea, J.E., Foster, J.P., O’Donnell, C.P.F., Breathnach, D., Jacobs, S.E., Todd, D.A. and Davis, P.G. (2017) ‘Frenotomy for tongue-tie in newborn infants’, Cochrane Database of Systematic Reviews, 3, CD011065.

Thomas, J., Brodsky, D., et al. (2021) ‘Academy of Breastfeeding Medicine position statement on ankyloglossia in breastfeeding dyads’, Breastfeeding Medicine, 16(4), pp. 278–281.