Tongue-Tie Release Exercises

Tongue-Tie Exercises After a Frenulotomy

If your baby has had a tongue-tie divided, you may have been given advice about exercises afterwards. The phrase “tongue-tie exercises” can mean quite different things, though, and this is where things can become confusing.

Some exercises are intended to help your baby learn to use their tongue more effectively after the restriction has been released. Others involve deliberately lifting, stretching, rubbing or manipulating the healing wound underneath the tongue.

These are not the same thing.

This distinction is particularly important because there is still no universally agreed approach to aftercare following infant frenulotomy. Different practitioners and organisations give different advice, and research into what is most helpful is continuing to develop.

Why might a baby be offered tongue exercises?

Dividing a tongue-tie releases a physical restriction, but it does not instantly give a baby perfect tongue strength, coordination or feeding skills.

The tongue is a muscular structure that has been moving in a particular way since before birth. If its movement has been restricted, a baby may have developed compensatory ways of feeding or may simply have had less opportunity to practise certain movements.

Think of it a little like giving someone more freedom of movement after they have been moving within a limited range. The freedom is important, but strength, coordination and confidence still develop through practice.

The tongue has a number of movements and functions that are important for feeding. These include:

• lateralisation – moving from side to side

• cupping – forming a shape around the breast or teat

• spreading – widening and flattening across the palate

• extension – moving forwards

• protrusion – bringing the tongue beyond the lips

• snapback – returning the tongue into the mouth after extension

• peristalsis – the wave-like movement that helps move milk backwards

• vacuum or draw – helping to create and maintain the pressure needed for milk transfer

These movements do not happen independently. Feeding is a coordinated activity, and a baby may be using several of them together during a single feed.

The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), for example, assesses a range of tongue movements and functions, although the terminology and number of functions used in different assessment systems can vary.

After a frenulotomy, feeding itself provides an important opportunity for the baby to practise using the tongue in its newly available range. Additional tongue-function activities may sometimes be used to concentrate on an area where movement, strength or coordination appears less developed.

The aim is therefore not simply to “exercise the tongue because it has been released”. The aim is to support function where it is actually needed.

Tongue-function exercises are not wound stretches

This is one of the most important distinctions to understand.

Tongue-function exercises are intended to encourage movement or function of the tongue. They are not necessarily intended to interfere with the healing wound.

Wound stretching or disruptive wound management is different. This involves deliberately manipulating the healing area underneath the tongue, for example by lifting the tongue to stretch the wound or rubbing or sweeping across the wound.

The Association of Tongue-tie Practitioners (ATP) describes four levels of aftercare:

1. Level 1 – feeding as usual, without specific tongue exercises or deliberate wound manipulation.

2. Level 2 – feeding as usual alongside tongue exercises intended to encourage tongue movement and function. These are not intended to deliberately manipulate the healing wound.

3. Level 3 – lifting the tongue to stretch the healing wound.

4. Level 4 – disruptive wound management (DWM), involving active manipulation of the wound, such as sweeping, rubbing or circular massage, sometimes with the intention of stretching or opening the healing area.

The important difference is that Levels 1 and 2 are focused on feeding and tongue function, whereas Levels 3 and 4 deliberately manipulate the healing wound.

The ATP supports aftercare up to Level 2 and does not recommend routine Level 3 or Level 4 wound management. It also highlights that there is not yet published evidence demonstrating which level of aftercare produces optimal healing or prevents the need for a second frenulotomy.

What is disruptive wound management?

Disruptive wound management is sometimes recommended with the intention of preventing the wound from healing in a way that might restrict tongue movement.

The reasoning is understandable. If the wound edges heal together, new tissue will form between them. It can therefore seem logical that repeatedly opening or stretching the wound might prevent a restrictive reattachment.

However, the question is not simply whether wound manipulation can change the way a wound heals. The important question is whether deliberately disturbing the wound provides enough additional benefit to justify doing it routinely to every baby.

There is emerging research in this area, including a 2025 US study which reported recurrent restriction in 5.6% of babies whose caregivers adhered to a postoperative stretching regimen, compared with 16% in the group who did not adhere to stretching (Miller et al., 2025).

That finding is relevant and should not simply be dismissed. However, it does not establish that every baby needs wound stretching, nor can the figures be directly compared with the ATP's UK estimate of around 2–4% reformation or renewed restriction because these figures come from different populations, settings and methods.

In fact, 5.6% is 1.6 percentage points above the upper end of the ATP's 2–4% estimate. That does not mean that stretching causes a higher rate, because the figures are not directly comparable. It does, however, illustrate why the question remains more complicated than simply assuming that more wound manipulation must always be better.

The ATP also identifies a number of potential concerns with Levels 3 and 4, including pain and discomfort, difficulty for caregivers in carrying out the technique accurately, oral aversion or feeding strike, infection and the possibility of disturbing the healing process.

For a procedure where the estimated rate of reformation or renewed restriction is already relatively low, any routine intervention that may be painful or distressing needs a clear and meaningful benefit to justify it.

That does not mean that emerging research should be ignored. It means that families deserve to know that there is still uncertainty about the best approach, rather than being told that wound stretching is an established requirement after every frenulotomy.

Expected wound healing

It is also worth understanding what happens as the wound heals.

After a frenulotomy, the edges of the wound need to heal. The body naturally repairs the area, with new tissue forming and then undergoing further remodelling as healing progresses. Some form of new tissue between the wound edges is therefore expected.

This does not mean that the tongue-tie has returned.

The inside of the mouth also heals differently from skin. Oral mucosa generally heals relatively quickly and tends to produce much less fibrotic scar tissue than skin, although healing still involves inflammation, new tissue formation and remodelling (Wong et al., 2009; Griffin et al., 2022).

A healing wound may therefore look as though tissue is forming underneath the tongue. It may initially appear more prominent or feel firmer, and its appearance can change considerably as healing continues. Tissue can soften and become more pliable as remodelling takes place.

Looking at the area alone cannot tell you whether the tongue has become functionally restricted again. What matters is function.

If the tongue continues to move well and your baby's feeding is comfortable and effective, the presence or appearance of healing tissue does not automatically mean that the frenulum has reformed in a way that requires further treatment.

This is one reason why deliberately disrupting the wound to try to prevent any tissue from forming is difficult to justify. The body has to heal the wound somehow. The aim is not to prevent tissue formation altogether. The aim is to allow the wound to heal while maintaining good tongue function.

A visible area of healing tissue, or a change in appearance underneath the tongue, can therefore be completely compatible with a successful frenulotomy.

A healed wound does not mean feeding function is complete

There is another important distinction here: the wound healing and your baby's feeding development are two different things. A wound can be fully healed while your baby is still learning how to use their tongue effectively.

Healing tells us that the tissue has repaired. It does not tell us that the tongue has reached its optimum strength, coordination, range of movement or feeding efficiency.

If your baby has spent weeks or months adapting to restricted tongue movement, they may need time and experience to discover what their tongue can now do. Feeding itself provides repeated opportunities to practise, while additional tongue-function activities may sometimes help where a particular movement or skill needs more focused support.

This means that there is no particular day on which we should expect feeding to suddenly become “perfect” simply because the wound has healed. Progress in feeding can continue after the wound looks completely healed, just as feeding difficulties do not necessarily mean that the wound has failed to heal.

The two things need to be considered separately.

Your baby's tongue should therefore be assessed by function rather than by the appearance of the wound or by whether the wound has reached a particular stage of healing.

What might tongue-strengthening exercises look like?

There is no single set of exercises that every baby needs.

Depending on the baby's age, feeding method, oral skills and individual assessment, activities might involve encouraging the tongue to move forwards or sideways, supporting cupping or tongue elevation, encouraging an appropriate response to touch around the lips and mouth, or using feeding itself as an opportunity to practise more effective tongue movement.

For some babies, ordinary feeding may provide all the practice they need. For others, additional activities may be useful for a period of time.

The important point is that these activities should have a purpose.

There is little value in giving a long list of exercises simply because a tongue-tie has been divided. If a particular movement or feeding skill is already working well, repeatedly practising it may not add anything useful.

Equally, if a baby is struggling with a particular aspect of tongue function, targeted activities may help provide additional opportunities to practise that movement.

This is why an individualised approach rather than a fixed routine that every baby is expected to complete is good practice.

Your baby's feeding gives important information

After a frenulotomy, it can be tempting to focus entirely on what the tongue looks like underneath the mouth. Feeding tells us much more.

A useful follow-up considers things such as how the baby is attaching, whether they can maintain a seal, how effectively they are transferring milk, whether they fatigue during feeds, whether they cough or splutter, whether they repeatedly lose their seal and how comfortable and settled feeding appears to be.

Breast and bottle feeding also place slightly different demands on the feeding system, so the assessment needs to reflect how your baby actually feeds.

If feeding is improving, that is useful information.

If feeding remains difficult, it does not necessarily mean that more exercises are needed. It may mean that the feeding picture needs to be reassessed.

The tongue does not function in isolation

The tongue is only one part of a much larger system involved in feeding.

The jaw, lips, cheeks, palate, head, neck and wider body all contribute to how a baby positions themselves and coordinates sucking, swallowing and breathing.

There is a growing and substantial body of research exploring manual and osteopathic approaches in relation to infant feeding. Studies have investigated areas including latch, sucking ability and other feeding-related outcomes, and recent reviews have brought together a much larger body of literature than was available a few years ago (Hawk et al., 2018; O'Connell et al., 2026).

The research is varied in its methods and quality, and not every study has demonstrated a feeding benefit. For example, a randomised controlled trial of osteopathic treatment in breastfed infants did not find an improvement in exclusive breastfeeding at one month (Jouhier et al., 2021), while other studies have reported improvements in measures of latch or sucking (Hafer et al., 2017; Fons et al., 2025).

Taken together, this means that body-based approaches are an area of active research rather than something that should be dismissed as having no evidence behind it. They may be considered alongside feeding support where an individual assessment suggests that wider physical factors could be contributing to feeding difficulties.

Body-based approaches should therefore be considered as an individualised adjunct where there is a reason to consider them, rather than as an automatic part of every tongue-tie release.

Birth can also be part of the wider picture

A baby's birth and early experiences may be relevant when considering movement, comfort and feeding. Assisted births, prolonged or difficult labours, different birth positions and caesarean birth can all form part of the history that a practitioner considers when looking at the feeding dyad.

This recognises that babies arrive at feeding with their own individual experiences of birth, movement and early adaptation, and that these may sometimes be relevant to the wider functional picture. For example, recovery following a caesarean birth can also affect the practical experience of establishing breastfeeding in the early days (Beake et al., 2017).

Feeding is still the main event

The purpose of improving tongue movement is to support function, particularly feeding.

Feeding provides repeated opportunities for your baby to use their tongue, jaw, lips and wider body together. Additional exercises can sometimes provide more focused practice where a particular area needs support, but they are not a replacement for looking at the whole feeding picture.

A wound can heal while feeding skills are still developing, and feeding can continue to change as your baby becomes stronger, more coordinated and more confident in using their tongue.

For some babies, feeding will gradually become easier as they become accustomed to their new range of movement. Others may benefit from more specific support with tongue function, feeding technique or wider physical factors.

There is no single point at which healing, tongue function and feeding development all arrive at the same destination. They are separate but connected parts of the same journey.

References

Association of Tongue-tie Practitioners (ATP) (2022) ‘Position statement: Infant frenulotomy’. Available at: https://www.tongue-tie.org.uk/position-statements

Beake, S., Bick, D., Narracott, C. and Chang, Y-S. (2017) ‘Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: a systematic review’, Maternal & Child Nutrition, 13(4), e12390. Available at: https://doi.org/10.1111/mcn.12390

Griffin, M.F. et al. (2022) ‘Understanding scarring in the oral mucosa’, Advances in Wound Care, 11(10), pp. 537–547. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9347381/

Hafer, R. et al. (2017) [study of osteopathic treatment and breastfeeding-related outcomes].

Hawk, C., Minkalis, A., Webb, C., Hogan, O. and Vallone, S. (2018) ‘Manual interventions for musculoskeletal factors in infants with suboptimal breastfeeding: a scoping review’, Journal of Evidence-Based Integrative Medicine, 23. Available at: https://doi.org/10.1177/2515690X18754391

Jouhier, A. et al. (2021) [randomised controlled trial of osteopathic treatment in breastfed infants].

Miller, A. et al. (2025) ‘Postoperative stretching after frenotomy for ankyloglossia and recurrent tongue-tie’. Available at: https://pubmed.ncbi.nlm.nih.gov/40010205/

O'Connell et al. (2026) ‘Osteopathic Manipulative Treatment for the Breastfeeding Dyad: A Scoping Review’, Journal of Human Lactation.

Wong, J.W. et al. (2009) [study of oral mucosal wound healing]. Available at: https://pubmed.ncbi.nlm.nih.gov/19769724/