Surgical release or conservative management for my baby's tongue-tie

Assessment comes first

Seeing a frenulum under a baby’s tongue does not, by itself, tell you whether treatment is needed. The important question is how your baby’s tongue and mouth are functioning during feeding, and whether this is affecting breastfeeding, bottle feeding or both.

A feeding assessment can look at your baby’s oral function alongside the feeding itself, including attachment, milk transfer, swallowing, suction, comfort and your baby’s ability to maintain an effective feed. It can also help identify other factors that may be contributing to feeding difficulties.

If a tongue-tie is identified, there is not one treatment pathway that is right for every family. Some babies and caregivers benefit from conservative management, while others may be considered for infant frenulotomy, also known as tongue-tie division or tongue-tie release.

The decision can be made after assessment and discussion of the available options, rather than simply because a frenulum is visible.

Conservative management

Conservative management is an active approach to supporting feeding without dividing the frenulum. For some families, this may be the preferred option, particularly when feeding difficulties can be addressed through feeding support and other practical measures.

Depending on your individual circumstances, support may include:

• skilled breastfeeding or infant feeding support

• positioning and attachment adjustments

• support with milk supply where needed

• expressing and maintaining milk supply when direct feeding is difficult

• paced and responsive bottle feeding

• strategies to support oral function where appropriate

• addressing factors such as reflux symptoms, colic or nasal congestion when these are present

• consideration of appropriately qualified bodywork or osteopathic support where this may be helpful as part of wider care

These approaches can support feeding and address contributing factors, but they do not divide or remove a restrictive frenulum. If a structural restriction is present, it remains present unless the frenulum is divided.

It is also important not to assume that reflux, colic, congestion or other infant behaviours are caused by tongue-tie. Babies can have several overlapping factors affecting feeding, and a good assessment considers the whole feeding picture.

You can read more about supporting feeding when a tongue-tie is not divided in Untreated Tongue-Ties.

Infant frenulotomy

Infant frenulotomy is a procedure in which the lingual frenulum is divided. You may also hear it described as tongue-tie division, tongue-tie release or tongue-tie surgery.

For carefully selected infants with documented functional difficulties, frenulotomy may improve some aspects of feeding. However, it is not an instant fix and it does not guarantee that every feeding difficulty will resolve.

The evidence is also not equally strong for every outcome. O’Shea et al. (2017) found that frenotomy may reduce maternal nipple pain in breastfeeding, but evidence for improvements in infant feeding outcomes was limited. Other reviews have similarly found uncertainty around many longer-term feeding outcomes (Francis, Krishnaswami and McPheeters, 2015).

More recent evidence continues to support a cautious and individualised approach. Dhar et al. (2026) found evidence of a reduction in maternal nipple pain and improvements in maternal perception of breastfeeding. However, evidence for some objective feeding measures was less consistent, particularly when frenotomy was compared with control groups.

This means that the decision should consider your baby’s individual feeding difficulties, the assessment findings, the potential benefits and limitations of the procedure, and your family’s priorities.

What does the evidence say about breastfeeding?

The strongest evidence for frenotomy relates to short-term maternal nipple pain in breastfeeding dyads.

For example, Buryk, Bloom and Shope (2011) found that frenotomy was associated with improvements in maternal nipple pain and breastfeeding effectiveness compared with a sham procedure. Emond et al. (2014), however, found no significant improvement in breastfeeding scores at five days, although mothers in the early-frenotomy group were more likely to report improvement in breastfeeding difficulties.

The Cochrane review by O’Shea et al. (2017) concluded that frenotomy may reduce breastfeeding mothers' nipple pain in the short term, but there was insufficient evidence to determine whether the procedure improves longer-term breastfeeding outcomes.

Dhar et al. (2026) similarly found a substantial reduction in maternal nipple pain and an improvement in maternal perception of breastfeeding, while noting that evidence for other feeding outcomes remains limited or uncertain.

This is why a feeding assessment remains important. Nipple pain or difficulty maintaining a latch can have several causes, and dividing a frenulum will not necessarily address every contributing factor.

For practical support with bottle feeding, see How to Pace Bottle Feeds: A Calm, Practical Guide.

What about bottle feeding?

There is less research specifically examining frenotomy for babies who are exclusively bottle fed or who have significant bottle-feeding difficulties.

This does not mean that a baby who bottle feeds cannot have functional difficulties associated with tongue movement. It means that the evidence base is smaller, so decisions should be based on an individual assessment rather than assuming that frenulotomy will improve bottle feeding.

Bottle feeding can also be affected by teat flow, positioning, pacing, coordination, oral-motor skills, airway or nasal factors and the baby’s individual feeding pattern.

A responsive feeding approach can sometimes make a significant difference without surgery. You can read more in How to Pace Bottle Feeds: A Calm, Practical Guide.

Do you have to decide quickly?

There is no universal deadline by which a tongue-tie must be divided during infancy.

Some providers and services have age or weight limits for infant procedures, while others may assess older babies and children. If you are considering frenulotomy, ask the provider you are considering about their own age limits and arrangements.

If you are unsure, it is reasonable to take time to understand what is happening with feeding, consider conservative management and discuss the potential benefits and limitations of frenulotomy before making a decision.

A visible frenulum does not mean that a procedure has to happen immediately.

What should you know about the procedure?

Frenulotomy is a surgical procedure and, like any procedure, it has potential risks.

These can include:

• bleeding

• pain or discomfort

• infection

• oral aversion or feeding reluctance

• injury to nearby structures

• problems associated with the healing process

Serious complications appear to be uncommon, but they cannot be completely excluded. Dhar et al. (2026) reported a pooled adverse-event frequency of approximately 4%, with bleeding the most commonly reported adverse event, although the certainty of this evidence was very low.

The provider should explain the potential benefits and risks before you decide whether to proceed, including what you should do if bleeding, feeding difficulties or other concerns occur after the procedure.

You can read more about potential complications in YOUR TONGUE-TIE RISKS BLOG.

What technique is used?

Different techniques are used for infant frenulotomy, including scissors and laser.

In the UK, scissors are commonly used for infant tongue-tie division, and NICE guidance describes division using scissors. However, this does not mean that scissors are universally better than laser.

Dhar et al. (2026) found that scissors and laser appeared to have comparable effectiveness, although the evidence comparing techniques was limited. There is currently not good evidence to suggest that one technique is universally superior for every baby.

The technique is therefore only one part of the decision. The assessment, experience of the practitioner, understanding of infant feeding, informed consent and aftercare arrangements are also important.

Aftercare matters too

Frenulotomy is not simply a procedure followed by an immediate return to normal feeding. Your baby may need time to adjust to changes in tongue movement and feeding, and the healing process needs to be considered.

Your provider should explain what to expect after the procedure, how to recognise problems and who to contact if you have concerns.

Feeding support may still be needed after frenulotomy. Improving tongue movement does not automatically mean that a baby immediately develops a new feeding pattern, particularly if they have been compensating for restricted movement for some time.

You can read more about this in Beyond the Tongue-Tie Release: Why Aftercare Matters.

Choosing a practitioner or service

If you are considering frenulotomy, look for a practitioner or service that can explain both the procedure and the alternatives.

You may want to ask:

• Are you professionally registered with an appropriate UK regulator?

• What training and experience do you have in assessing and treating infants?

• Will my baby have a feeding assessment as part of the assessment?

• What other factors could be contributing to the feeding difficulty?

• What are the potential benefits and limitations of frenulotomy for my baby?

• What are the risks and possible complications?

• Which technique do you use and why?

• What aftercare do you recommend?

• What happens if my baby has a problem after the procedure?

• What feeding support is available afterwards?

• What happens if we decide not to proceed?

A practitioner who also has appropriate infant feeding expertise, such as an IBCLC or another suitably qualified infant feeding specialist, may be able to consider the procedure alongside the wider feeding picture.

You can also read How Is Tongue-Tie Assessed in Babies Safely? before choosing a practitioner.

Neither option is the “easy” option

It can be tempting to think of conservative management as doing nothing, or frenulotomy as a quick solution. Neither description reflects the reality for many families.

Conservative management can involve ongoing feeding support, repeated adjustments, observation and review. Frenulotomy involves a procedure, a period of healing and potentially further feeding support while your baby adapts.

The important question is not which option sounds easiest. It is which information, support and approach fit your baby’s individual feeding assessment and your family’s circumstances.

There is also no requirement to choose a procedure simply because a frenulum is visible, and choosing conservative management does not mean that you are ignoring a problem. Equally, choosing frenulotomy does not mean that you have failed to try other approaches.

The aim is to understand what is affecting feeding, consider the available evidence and uncertainties, and make an informed decision with appropriate support.

References

Buryk, M., Bloom, D. and Shope, T. (2011) ‘Efficacy of neonatal release of ankyloglossia: a randomised trial’, Pediatrics, 128(2), pp. e280-e288. doi: 10.1542/peds.2011-0077.

Dhar, V., Marghalani, A.A., Amini, H., Brickhouse, T., Caffrey, E., Jayaraman, J., Keels, M.A., Messner, A., Patterson, K.K., Raol, N., Shrestha, P., Stark, C.M., Susarla, H.K. and Thomas, J. (2026) ‘Frenotomy for Ankyloglossia Associated With Feeding Challenges in Infants: Effectiveness, Technique, and Safety—A Systematic Review and Meta-Analysis, Part 2’, Pediatric Dentistry, 48(2), pp. 33E-68E. PMID: 42050812.

Emond, A., Ingram, J., Johnson, D., Blair, P., Whitelaw, A., Copeland, M., Sutcliffe, A., Emmett, P. and Salisbury, C. (2014) ‘Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie’, Archives of Disease in Childhood: Fetal and Neonatal Edition, 99(3), pp. F189-F195. doi: 10.1136/archdischild-2013-305031.

Francis, D.O., Krishnaswami, S. and McPheeters, M. (2015) ‘Treatment of ankyloglossia and breastfeeding outcomes: a systematic review’, Pediatrics, 135(6), pp. e1458-e1466. doi: 10.1542/peds.2015-0658.

National Institute for Health and Care Excellence (NICE) (2005) Division of ankyloglossia (tongue-tie) for breastfeeding. HealthTech guidance 95 (formerly IPG149). London: NICE. Available at: https://www.nice.org.uk/guidance/htg95/ (Accessed: 18 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. doi: 10.1002/14651858.CD011065.pub2.