Tongue-tie appears in about 3–8% of newborns worldwide, with rates shifting by definition and screening method across studies today.
Tongue-tie prevalence in newborns: what the numbers say
Tongue-tie, or ankyloglossia, describes a tight lingual frenulum that limits tongue lift or extension. Research doesn’t land on one figure because studies use different checklists and cutoffs. A 2022 meta-analysis across 71 studies pegged overall prevalence near 5% across ages, rising to about 7% in infants, with tool-based estimates ranging from 2% to 20%. The AAP clinical report summary also notes a rise in diagnoses linked to wider screening and variable definitions.
| Source | How tongue-tie was defined | Reported rate in newborns |
|---|---|---|
| JADA meta-analysis 2022 | Mixed tools (Coryllos, Hazelbaker, BTAT, author criteria) | ~5% overall; ~7% in infants; 2%–20% by tool |
| Canadian Family Physician review 2007 | Five studies with varied criteria | 4%–10% |
| NHS leaflets (UK, 2022–2025) | Clinical assessment with function-first approach | 5%–10% (often quoted) |
| GP Infant Feeding Network (UK) | Collated systematic reviews and NICE context | 0.2%–10.7% |
Why the wide range? Some tools classify a visible thin band as a tie even when function is fine, while others require clear feeding impact. Posterior ties add more spread, since teams disagree on where to draw the line. The AAP report flags this disagreement and urges careful, function-based checks before any procedure.
Why estimates differ
Screening in the birth unit may pick up many possible ties. A full feeding assessment trims that list by looking at latch quality, tongue lift, cupping, and milk transfer, not just the look under the tongue. Studies that rely on a quick look tend to post higher rates. Studies that require impaired function report lower rates.
Different scoring systems also push numbers up or down. The Coryllos types lean on anatomy. BTAT and the Hazelbaker tool add function. Teams also use local cutoffs, which changes how many babies meet the “tie” label. Training level and how many assessors score the same baby on the same day also change results in published cohorts. Small samples push figures up or down from month to month. That’s why one ward might see double the rate of the hospital next door.
Are tongue ties common in babies? rates, patterns, and gaps
Across modern studies, a middle band of 3%–8% keeps showing up. Boys show a small edge in many cohorts. Family clusters pop up in some reports, which hints at genetic factors, though no single gene explains most cases. Geography matters too. Places with routine early checks and easy referral often record higher rates than regions that gate referral behind a full lactation and feeding review.
Not every baby with a tight frenulum runs into trouble. Many feed well from day one. The Canadian Paediatric Society notes that lots of babies with a tie show no symptoms at all. This gap between anatomy and feeding is why teams now talk more about symptomatic ankyloglossia rather than a tie by looks alone.
When a tie affects feeding: measuring real impact
Feeding challenges linked with a tight frenulum can include shallow latch, nipple pain, prolonged feeds, poor milk transfer, slow weight gain, or early breast refusal. A skilled feeding assessment checks both sides of the dyad: positioning, attachment, tongue movement, and milk flow. Many cases turn around with latch coaching, body position tweaks, paced breaks, or changes to feeding plans. The AAP encourages trying these low-risk steps first; a release can be offered when problems persist and the tie is clearly contributing.
When bottle-feeding, signs might include weak suction, clicking, dribbling, or long, tiring feeds. Teat flow, positioning, and pacing can make a big difference here as well. Again, the point is showing that tongue movement is truly restricted and that the restriction is driving the feeding pattern.
How teams assess a suspected tongue-tie
Clinics blend a structured tool with hands-on feeding observation. Popular options include:
- Hazelbaker ATLFF: anatomy plus function scores; requires training to score consistently.
- BTAT: a short four-item tool that rates lift, protrusion, spread, and snapback.
- Coryllos types I–IV: an anatomy map that doesn’t rate feeding by itself.
No single checklist acts as a gold standard. Inter-rater agreement varies, which again nudges prevalence figures up or down across studies.
Frenotomy: when it’s offered and what to expect
Frenotomy divides the frenulum to free tongue movement. In newborns this is usually a quick scissor snip at the bedside or clinic. Laser release exists too, though current guidance doesn’t show better feeding outcomes with laser over scissors. Minor bleeding or soreness can occur. Serious issues are rare. Teams often reassess latch right away, since better tongue lift can change the feel and the milk transfer on the spot.
| What parents notice | Possible link | What the team checks |
|---|---|---|
| Nipple pain or damage | Shallow latch; restricted tongue lift | Latch depth, seal, suck-swallow pattern, tongue elevation |
| Long, sleepy feeds | Poor milk transfer | Milk flow, transfer by test weigh, fatigue cues |
| Clicking or dribbling on bottle | Seal breaks from limited cupping | Teat flow, jaw and tongue coordination, chin support |
| Slow weight gain | Low intake across the day | Daily volumes, feed frequency, transfer, other medical factors |
| Gassy, unsettled periods | Air intake from poor seal | Seal quality, burping need, over-fast flow |
Why “posterior” tongue-tie stirs debate
Some teams diagnose a posterior tie when a thick, submucosal band limits lift even if the front looks normal. Others see the same exam and call it normal variation. The AAP review states that consensus is lacking here. Until definitions line up, population rates will keep drifting from one service to the next.
What the latest guidance says
The AAP clinical report urges function-first exams, early skilled lactation help, and careful follow-up on weight and feeding. It also notes that release can ease nipple pain for many pairs and may improve milk transfer in selected cases, yet not every tie needs a cut. UK sources echo a similar line: use an assessment that blends structure and function and offer a quick snip when a clear link with feeding problems remains after skilled help.
What current studies still miss
Studies often use different checklists, mixed age groups, and short follow-up windows. Different cutoffs mean the same baby can score “tie” in one clinic and “normal” in another. Speech outcomes beyond early childhood remain thin in the literature, and feeding outcomes past weaning are rarely tracked.
Release techniques get uneven study too. Randomized trials comparing scissor and laser are scarce. Feeding help before and after a procedure also varies widely across services, which blurs cause and effect. Better, multi-site studies with shared methods would narrow the range of prevalence figures and give clearer guidance on who benefits most today.
Quick glossary for parents
- Ankyloglossia: the medical term for tongue-tie.
- Frenulum: the small fold of tissue under the tongue.
- Function-first assessment: a check that looks at latch, lift, extension, cupping, and milk transfer, not just appearance.
- Symptomatic tie: a tight frenulum linked with clear feeding problems after skilled feeding care.
- Frenotomy: a brief cut of the frenulum to free movement.
- BTAT / Hazelbaker: scoring tools used by trained staff; scores feed into the full clinical picture.
- Posterior tie: a debated label for a deep band that restricts lift even when the front looks normal.
Plain-language takeaways
- The best single-line answer to “how common” sits near 3%–8% of newborns, with tool choice widening the range.
- A tie by looks alone doesn’t equal a feeding problem. Many babies with a tight frenulum feed well.
- Feeding issues have many roots. A full, hands-on feeding assessment helps sort tongue movement from latch or flow factors.
- A quick snip can help when a proven restriction is driving problems that don’t ease with skilled feeding care.
- Teams differ on “posterior” ties, which keeps prevalence figures spread out.