top of page

Tongue-tie assessment and division

Baby with tongue.jpg
Calm birth and baby
Calm birth and baby

A short and/or tight lingual frenulum can restrict tongue mobility. The frenulum is a piece of membrane connected from the floor of the mouth to the tongue. The incidence of tongue-tie varies from about 2 to 12 percent.​ In many cases tongue-tied  babies can feed well, however, 1 tongue-tied baby is 5 will have a problem with feeding either on the breast or bottle and will experience some of the symptoms listed below. 

 Below are examples of signs and symptoms some tongue-tied babies and mums expecience:
  •  Cannot latch onto the breast

  •  Having difficulties to latch on the breast

  •  Shallow latch at breast or bottle

  •  Slides or pops on and off the nipple/breast

  •  Colic symptoms / Cries a lot 

  •  Reflux symptoms

  •  Clicking or smacking noises when eating

  •  Spits up often

  •  Gagging, choking, coughing when eating 

  •  Gassy (toots a lot) / Fussy often   

  •  Poor weight gain 

  •  Hiccups often

  •  Lip curls under when nursing or taking bottle

  •  Falls asleep while eating

  •  Gumming or chewing your nipple when nursing

  •  Pacifier falls out easily, doesn’t like, won’t stay in

  •  Milk dribbles out of mouth when nursing/bottle

  •  Short sleeping requiring feedings every 1-2hrs

  •  Snoring, noisy breathing or mouth breathing

  •  Feels like a full time job just to feed baby

  •  Nose congested often

  •  Baby is frustrated at the breast or bottle

  •  Sucking blisters on the top lip

  •  White tongue

  •   Sleeping with opened mouth and tongue is resting at the bottom of the mouth. 

  •  Long feeds (lasting over 45 minutes

  •  Very frequent feeds/cluster feeding all the time/continuous feeding cycle

Some mums and tongue-ties babies are experiencing only few of those signs and symptoms whiles others are experiencing lots of them. 

  •  Creased, flattened or blanched nipples

  •  Lipstick shaped nipples

  •  Blistered or cut nipples

  •  Bleeding nipples

  •  Pain during a feed

  •  Poor or incomplete breast drainage

  •   Infected nipples or breasts

  •   Plugged ducts / engorgement / mastitis 

  •   Nipple thrush 

  •   Using a nipple shield

  •  Baby prefers one side over other 

Expat Midwife Geneva
How does tongue-tie (ankyloglossia) affect breastfeeding?
  • The tongue plays a major role in feeding. When baby is breastfeeding or bottle feeding he or she needs to use his/her tongue in order to create a seal either around the breast or bottle and create a vacuum in order to remove milk efficiently. The peristaltic movement of the tongue pushes the milk back into the mouth and assists the swallowing reflex. Some babies who have restricted tongue mobility struggle with the feeding process.

  • Tongue-tie often causes ineffective milk removal that, in turn, leads to milk stasis. Mothers may experience engorgement, plugged ducts, or other forms of breast inflammation associated with milk back-up and their milk supply will be affected in the long run. Babies may experience compromised weight gain, slow feeding, or frustration during feeding; they may refuse to feed altogether. 

  • Some babies will not be able to latch on and create a seal while others will keep slipping off the breast. Some babies will learn to compensate for their handicap by using their gums instead of their tongue to create a seal which will be painful for the mother and their nipples will get sore. 

  • Babies who are bottle-fed may also experience feeding difficulties. They may take a long time to finish a bottle or take a bottle too quickly and end up choking, spluttering, coughing or leaking milk from the corners of their mouth.  

  • Some babies can also suffer from colic or reflux as a consequence of a tongue-tie as they are struggling to coordinate the complex process of breathing, sucking and swallowing. 

Tongue-tie assessment.jpg
Tongue-tie assessment

This consultation usually takes around an hour and half at the Lefko dental practice and includes:

  • Full medical, birth and feeding history

  • Full assessment of baby's mouth and sucking

  • Tongue-function assessment

  • Weighing baby (if needed)

  • Review of latch


  •  CHF 165*

*This fee is covered by your basic Swiss LaMal health insurance.

 +41 78 307 1444
Tongue-tie assessment and division (frenotomy)

This consultation usually takes around an hour and half at the Lefko dental practice and includes:

  • Full medical, birth and feeding history

  • Full assessment of baby's mouth and sucking

  • Tongue-function assessment

  • Weighing baby (if needed)

  • Review of latch

  • Explanation of the procedure and its risks

  • Tongue-tie division (frenulotomy)

  • Explanation of post division exercises and what to watch out for

  • Leaflet on what to expect after a tongue-tie division


  • varies from CHF 350 - CHF 390*

*This fee is usually covered by your basic LaMal health insurance. 

+41 78 307 1444
TT check.jpg
Follow- up check after a division (frenotomy)

 After a division we will ask you to come back to our surgery after one week to check that the tongue has not reattached, to answer your questions  and to ask you how the feeding is going.This consultation takes around 30 minutes.


  • Free of charge

  • Redivision CHF 215*

*This fee is usually covered by your basic Swiss LaMal health insurance. 

Please be aware that the basic LaMal insurance will cover the full cost of a tongue-tie division under the article 25 of the federal LaMal insurance law. (If your insurance refuses to reimburse you, you will have to send them a letter and remind them that: 'L'excision de frein de langue est une presentation obligator au send de l'article 25 de la loi fédérale sur l'assurance-maladie (LaMal). 

Expat midwife Geneva
Can tongue-tie cause problem when my baby gets bigger?


It is very difficult to tell if your baby's tongue-tie will cause any problems in the future.  It all depends on how severely the tongue's mobility is affected. 


Tongue-tie can also contribute to the formation of speech articulation errors, oral cleanliness compromises, and suboptimal formation of the jaw and mouth. Compromised orofacial development may possibly lead to long-term dental and airway integrity issues. 


Potentially, social issues may arise from tongue-tie: embarrassment; self-esteem compromise; social sensitivity; and difficulty engaging in the activities of daily living such as playing certain musical instruments and licking the lips, lollipops, and ice cream cones. Little research quantifies these issues. Despite the lack of research evidence, anecdotal reports show that these issues can have a profound impact on the individual, and should be seriously considered when making treatment decisions. 


Although more research needs to be done to confirm this hypothesis, infancy still appears to be the ideal time to treat tongue-tie. Early treatment may prevent the development of problems later in life when treatment is much more complex and invasive. 

What is the treatment for tongue-tie?


The procedure for the treatment of tongue-tie is called frenotomy (also called ankylotomy, clipping, division, frenulotomy). The procedure utilizes a pair of scissors to incise or cut through the lingual frenulum. It is a quick procedure performed without any anaesthesia. There is usually little blood loss and your baby will probably cry for few minutes after the procedure. 


No anaesthesia is necessary as it is not possible to inject the frenulum. Injecting the floor of the mouth and tongue would cause more discomfort than the frenotomy. Although the babies object to being held still, the entire procedure takes only seconds. 

What to expect after the procedure?

The risk of heavy bleeding is very low, 1 in 100 000. The risk of infection is 1 in 10 000 according to a South Hampton study. No other complications were recorded. 


Your baby might be a little bit unsettled for a couple of days, however from my experience, babies are more upset after their first vaccination than a frenotomy.


If your baby is over 8 weeks old you can give them Calpol. 


A white or yellow looking blister will appear on the following day which is a normal process of healing. 


If your baby feels hot, check his or her temperature. If the temperature is elevated it is a sign of an infection. It is important that you take your baby to your GP, walk-in clinic or A&E as soon as you can.  


In 2-4 percent of cases, the bottom of the tongue can reattach to the floor of the mouth. Encouraging your baby to stick his or her tongue out and lifting the tongue up 6 times a day for 3 to 4 weeks after the division can prevent the tongue from reattaching  back. A visit to a chiropractor or an osteopath is strongly recommended before and after a division.  

"When I contacted Mirka I had a really bad day coping with blocked ducts and a tongue-tied, hungry and crying baby. I felt that she got out of her way to call me back and arrange a next morning appointment. She was very helpful and relaxing, she gave me clear instructions on what to do and what i should expect. The process was quick and easy and she called me back in a week's time to see how things going. I would definitely recommend Mirka due to her ethos, professionalism and compassion."

Stella S.

Expat midwife Geneva
bottom of page