evidence showing how Tongue tie release can help with breastfeeding

How Tongue‑Tie Release Can Help with Breastfeeding: What the Evidence Says

Tongue‑tie (ankyloglossia) occurs when the lingual frenulum — the thin piece of tissue under the tongue — is unusually tight, short, or thick and restricts normal tongue movement. While many infants with tongue‑tie breastfeed normally, a subset struggle with latch, efficient milk transfer, pain, or reflux‑like symptoms because they can’t use their tongue effectively at the breast. 

One common treatment for symptomatic tongue‑tie is frenotomy (or frenulotomy) — a quick, minimally invasive procedure to release the restricted tissue and improve tongue mobility.

Below, we break down what research shows about how tongue‑tie release impacts breastfeeding outcomes.

1. Improvements in Maternal Pain and Breastfeeding Confidence

A prospective cohort study with 237 breastfeeding mother‑infant pairs found significant improvements in breastfeeding outcomes after frenotomy:

• Less nipple pain post‑procedure

• Higher breastfeeding self‑efficacy

• Improved milk transfer, with average intake increasing by ~155% after release

• Benefits apparent as early as 1 week and continuing through 1 month post‑procedure 

Why this matters: Pain and difficulty transferring milk are two of the most common practical barriers to successful breastfeeding. Improvements here often mean a more positive breastfeeding experience overall.

2. Systematic Evidence: Meta‑Analysis Shows Positive Effects

A 2022 systematic review and meta‑analysis examined data across multiple clinical trials and found:

• Significant improvements in standardized breastfeeding difficulty scores after frenotomy

• Significant reductions in maternal nipple pain scores

• Trends toward benefits in infant feeding markers such as latch and efficiency 

This analysis pools higher‑level evidence and supports that frenotomy can improve breastfeeding difficulty and pain — though study designs vary.

3. Real‑World Observational Studies Also Report Improvements

Other cohort studies suggest:

• Maternal reports of improved latch and reduced pain after frenotomy

• Higher LATCH scores (a standardized measure of effective breastfeeding)

• Better maternal perception of breastfeeding efficiency and shorter feeding times following release 

These kinds of studies reflect real clinical practice, where parents and clinicians observe changes over time.

4. What Large Reviews Say About the Strength of Evidence

The Cochrane Review — one of the most rigorous forms of evidence synthesis — found that:

• Frenotomy likely reduces maternal nipple pain in the short term, based on pooled results

• Evidence is less consistent for objective improvements in infant feeding among trials

• Evidence quality is still limited due to small trial sizes and methodological issues 

👉 This doesn’t mean frenotomy doesn’t work — but it does mean more high‑quality research is needed to define who benefits most and to what extent.

5. Safety and Long‑Term Breastfeeding Considerations

Most studies report that frenotomy is a safe procedure with few serious complications, especially when performed by experienced clinicians. Improvements in breastfeeding outcomes are most noticeable early (within weeks) but can extend months after release. 

That said, major pediatric bodies (e.g., American Academy of Pediatrics) note that breastfeeding difficulties have many causes and recommend first trying comprehensive lactation support before surgery. Surgery is best considered when persistent symptoms correlate with restrictive frenulum anatomy and careful assessment supports that release may help. 

6. Bottom Line: What the Evidence Supports

Tongue‑tie release can improve key breastfeeding outcomes in many infants who are struggling, especially:

✅ Maternal nipple pain

✅ Breastfeeding self‑efficacy

✅ Measures of latch and feeding efficiency

✅ Some measures of milk transfer

However:

⚠️ Evidence is mixed on long‑term breastfeeding success

⚠️ Not all babies with tongue‑tie need or benefit from release

⚠️ High‑quality controlled trials are limited

Practical Takeaways for Parents

If an infant with tongue‑tie is having symptoms such as:

• Painful latch

• Inability to maintain latch or transfer milk well

• Slow weight gain related to feeding

• Gastroesophageal‑like symptoms linked with feeding struggles

Then a thorough assessment by a qualified clinician — including an IBCLC and pediatric specialist — is critical.

Treatment plans might include:

✔ Lactation support

✔ Oral motor exercises

✔ Frenotomy when appropriate

Also to note, some of these studies we know were done when tongue tie releases were incomplete. It has been my experience by working with around 2,000 families who have chosen to a tongue tie release, that the majority of them see some improvement and a good portion see resolution of most or all symptoms.

1. Prospective Cohort Evidence

Breastfeeding improvement after tongue‑tie/lip‑tie release (Ghaheri et al. 2017)

This prospective cohort study of 237 mother‑infant dyads found significant improvements in breastfeeding self‑efficacy, nipple pain, reflux symptoms, and breastmilk intake after frenotomy, with changes seen as early as 1 week and continuing through 1 month. 

Citation:

Ghaheri BA, Cole M, Fausel SC, et al. Breastfeeding improvement following tongue‑tie and lip‑tie release: A prospective cohort study. Laryngoscope. 2017. DOI: 10.1002/lary.26306. 

Effect of frenotomy on breastfeeding and reflux – BRIEF cohort (Slagter et al. 2021)

This longitudinal cohort study (175 women) showed significant improvement in breastfeeding self‑efficacy, reduced nipple pain, and improved reflux symptoms after frenotomy, with benefits lasting up to 6 months. 

Citation:

Slagter KW, Raghoebar GM, Hamming I, et al. Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study. Clin Oral Investig. 2021. DOI: 10.1007/s00784‑020‑03665‑y. 

Effect of frenotomy on breastfeeding variables (2009 Cohort)

(Older but relevant)

A prospective before‑after study found significant improvements in maternal nipple pain and LATCH scores after frenotomy, with patients reporting better ability to extend the infant’s tongue. 

Citation:

Effect of frenotomy on breastfeeding variables in infants with ankyloglossia (prospective before‑after study). PubMed. 2016. 

2. Systematic Reviews & Meta‑Analyses

Systematic review and meta‑analysis (Bruney et al. 2022)

This meta‑analysis pooled several clinical trials and found that frenotomy significantly improved standardized breastfeeding difficulty scores and maternal pain, supporting the effectiveness of interventions for symptomatic infants. 

Citation:

Bruney TL, Scime NV, Madubueze A, Chaput KH. Systematic review of the evidence for resolution of common breastfeeding problems—Ankyloglossia (Tongue Tie). Acta Paediatr. 2022. DOI: 10.1111/apa.16289. 

Recent meta‑analysis (Cordray et al. 2024)

Although often behind a paywall, this recent systematic review reported quantitatively significant improvements in breastfeeding self‑efficacy, nipple pain, infant latch (LATCH scores), and gastroesophageal reflux after frenotomy. 

Citation:

Cordray H, Raol N, Mahendran GN, et al. Quantitative impact of frenotomy on breastfeeding: a systematic review and meta‑analysis. Pediatr Res. 2024. DOI: 10.1038/s41390‑023‑02784‑y. 

Cochrane systematic review (O’Shea et al. 2017)

The Cochrane Review of randomized controlled trials concluded that frenotomy reduces maternal nipple pain in the short term, but the evidence was limited and mixed for consistent improvements in infant breastfeeding across all studies. 

Citation:

O’Shea JE, Foster JP, O’Donnell CPF, et al. Frenotomy for tongue‑tie in newborn infants. Cochrane Database Syst Rev. 2017. Art. No.: CD011065. 

3. Other Individual Clinical Studies

Frenotomy and breastfeeding outcomes (Srinivasan et al. 2019)

In infants with posterior ankyloglossia, frenotomy was associated with significant improvements in LATCH scores and maternal nipple pain immediately and up to 14 days after release. 

Citation:

Srinivasan A, Al Khoury A, Puzhko S, et al. Frenotomy in infants with tongue‑tie and breastfeeding problems. J Hum Lact. 2019. DOI: 10.1177/0890334418816973. 

Hong Kong clinic observational study (Lam et al. 2023)

This observational clinical report found that frenotomy improved maternal nipple soreness and direct breastfeeding rates at 4 months compared with those who did not undergo the procedure. 

Citation:

Lam CC‑O, Wong S‑K, Wong FC‑Y. Effect of frenotomy for tongue‑tie on improving breastfeeding. Hong Kong J Gynaecol Obstet Midwifery. 2023. DOI: 10.12809/hkjgom.20.2.02. 

4. Additional Supporting Evidence (Context)

Impact on milk transfer (Case report)

A case report documented a substantial increase in milk transfer after frenotomy, supporting the idea that release can enhance feeding efficiency in practice. 

Citation:

Evidence of improved milk intake after frenotomy: a case report. PubMed. 2013.