Tight tongue tie (ankyloglossia) in babies and children
A tight tongue tie can make breastfeeding difficult for some infants. At Charlottenlund Private Hospital, ear, nose and throat specialists offer assessment and possible clipping of tight tongue and lip ties when there is a functional problem – not based on the appearance of the tongue tie alone.
Tongue-tie (ankyloglossia) is a congenital condition in which the membrane under the tongue (the lingual frenulum) is unusually short, thick, or tight, limiting the tongue’s range of motion. The condition is observed in approximately 4% to 11% of newborns; however, the vast majority of children with a tongue-tie experience no difficulties and require no treatment.
In some infants, a tight tongue-tie can make it difficult to latch and breastfeed effectively. Ultimately, it is the child’s actual functional challenges—such as feeding difficulties—that determine whether treatment is necessary. The procedure to release a tongue-tie is called a frenotomy.
What are the Symptoms of a Tight Tongue-Tie?
Symptoms are most apparent during breastfeeding and affect both mother and child.
In the baby, symptoms may include:
- Frequently slipping off the breast or losing suction
- Swallowing air, leading to post-feed restlessness or gassiness
- Making a distinct clicking sound while nursing
- Milk leaking from the corners of the mouth
- Poor or slow weight gain
- The tip of the tongue appearing heart-shaped or notched when the baby cries or tries to stick it out, because the tight band pulls the center backward.
In the mother, symptoms may include:
- Significant pain and sore, damaged nipples
- Recurrent mastitis (breast inflammation) due to incomplete breast emptying
- Prolonged, exhausting feeding sessions without effective milk transfer
The combination of restricted tongue mobility and these functional feeding issues is what determines the need for treatment—not simply the visual appearance of the tissue itself.
What About a Tight Lip-Tie?
A tight upper lip-tie (labial frenulum) is the membrane connecting the inside of the upper lip to the upper gum. It is evaluated under the exact same clinical principles as a tongue-tie: a release is only indicated if there is a clear functional problem, typically involving breastfeeding challenges. Releasing a lip-tie is performed on an outpatient basis in the same manner as a tongue-tie release.
When is a Tongue-Tie Release Relevant?
A frenotomy is indicated when a tight tongue-tie causes clear feeding difficulties that cannot be resolved through professional breastfeeding support.
According to national clinical guidelines, a frenotomy may be considered for infants up to 4 months of age who present with ankyloglossia alongside persistent breastfeeding difficulties. This clinical assessment must be based on a systematic evaluation of both the appearance of the frenulum and the overall mobility of the tongue.
Important Clinical Note: There is no documented medical evidence that releasing a tongue-tie improves reflux, colic, sleep issues, delayed language development, or motor restlessness. Consequently, Charlottenlund Privathospital does not offer the procedure for these conditions.
Do All Children with a Tight Tongue-Tie Require Treatment?
No. Most infants with a tight tongue-tie breastfeed successfully and do not require intervention. According to the Journal of the Danish Medical Association (Ugeskrift for Læger), only about 18% of children with physical characteristics of a tongue-tie actually experience functional difficulties because of it.
Treatment is therefore strictly reserved for documented functional problems—primarily breastfeeding issues that persist after professional guidance. In older children and adults, a tight tongue-tie rarely causes issues, but can be evaluated individually if restricted mobility interferes with speech, eating, or oral hygiene. Any decision regarding treatment is always made as a collaborative decision between the parents and our specialists.
What to Do Before Your Consultation
Before scheduling a consultation at our clinic, your child must have been evaluated by an International Board Certified Lactation Consultant (IBCLC). The family must have implemented recommended feeding adjustments and exercises without achieving sufficient improvement. This protocol aligns with Danish national guidelines advocating for a multidisciplinary approach where breastfeeding support is prioritized first.
According to the Danish Society for Otorhinolaryngology, Head and Neck Surgery (DSOHH), an Ear, Nose, and Throat (ENT) specialist is the qualified authority to determine if a release is surgically necessary. Charlottenlund Privathospital solely handles the surgical assessment and the procedure itself; we do not provide general breastfeeding support.
Exception: Newborns presenting directly from the maternity ward with a severe, pronounced tongue-tie (Type 1) that completely prevents breastfeeding are exempt from this requirement and can be scheduled directly.
How is a Tongue-Tie Release Performed?
The procedure is quick and performed on an outpatient basis using a advanced CO2 laser.
- Anesthesia: The area under the tongue is numbed with a mild local anesthetic.
- Setup: The baby is gently swaddled to keep them secure and still, and specialized eye protection is placed on both the baby and parents because a laser is in use.
- The Release: The laser treatment itself takes only 3 to 5 seconds. The laser cuts and instantly seals the tissue, meaning bleeding is typically minimal or non-existent.
- Comfort: While most babies cry briefly during the procedure, this is primarily due to being swaddled and held still rather than pain. The baby is returned to your arms immediately. We highly recommend breastfeeding or bottle-feeding right away, as this provides instant comfort and natural pain relief.
What to Expect After the Procedure
Following the procedure, your specialist will provide you with personalized aftercare instructions. For the vast majority of infants, the recovery process is straightforward and uncomplicated. You are always welcome to contact Charlottenlund Privathospital if you have any questions, or if your child develops a fever, unusual swelling, or persistent discomfort.
Treatment Fees
- Consultation & Laser Procedure (under local anesthesia): DKK 4,500
- Consultation Only (if no procedure is indicated or performed): DKK 2,400
Note: Any subsequent follow-up releases are only performed upon direct clinical referral. The final decision to proceed with treatment is always a joint agreement between the parents and the specialist; if there is no mutual agreement, the procedure will not be performed.
Expert Tongue-Tie Care at Charlottenlund Privathospital
At Charlottenlund Privathospital, all tongue and lip-tie assessments and laser releases are performed by leading ENT specialists on an outpatient basis. Procedures for children are performed by senior specialists Jacob Fisker and Kåre Håkansson.
Our evaluations prioritize tongue mobility and oral function from a rigorous surgical perspective, after conservative feeding guidance has been fully explored. We are dedicated to a sober, evidence-based approach, ensuring surgical intervention is only recommended when a true functional issue exists.
Sources:
- National klinisk retningslinje for undersøgelse og behandling af ankyloglossi hos ammede spædbørn. Sundhedsstyrelsen, 2020. Guideline National klinisk retningslinje for undersøgelse og behandling af ankyloglossi hos ammede spædbørn
- Mahmood B et al. Behandling af stramt tungebånd. Ugeskrift for Læger, 2020. https://ugeskriftet.dk/videnskab/behandling-af-stramt-tungeband
- Division of ankyloglossia (tongue-tie) for breastfeeding. NICE (HTG95, tidl. IPG149). https://www.nice.org.uk/guidance/ipg149
Frequently Asked Questions
What is a tight tongue tie?
Tongue-tie (ankyloglossia) is a congenital condition in which the tongue-tie is short or tight, limiting the movement of the tongue. It is seen in approximately 4-11% of newborns and can make breastfeeding difficult in some infants.
Should all children with a tight tongue tie be treated?
No. Most children breastfeed without problems and do not need treatment. Only about 18% of children who have objective signs of a tight tongue tie have actual problems. It is a functional problem – typically breastfeeding problems – that determines whether clipping is relevant.
When is tongue-tie clipping relevant?
When a tight tongue tie causes breastfeeding problems that are not resolved with breastfeeding guidance. According to the Danish national recommendations, the intervention is considered especially in infants up to 4 months.
Does the tongue-tie release hurt the child?
The procedure is short (typically 3-5 seconds), and the area is dabbed with local anesthetic. The baby often cries, but this is largely due to the restraint and the unfamiliar situation. Most people quickly calm down at the breast or bottle.
How much is it bleeding?
When cutting with a CO2 laser, bleeding is usually minimal because the laser seals the tissue. In rare cases, more severe bleeding may occur, which is stopped immediately.
What should we do before we arrive?
The child must have been assessed by a lactation consultant (IBCLC), and relevant treatment and exercises must have been tried without sufficient effect. Newborns with pronounced type 1 tongue tie are exempt.
Do you treat colic, reflux or sleep problems with clips?
No. There is no documented effect of clipping for these conditions, and the procedure is not offered on this basis.
How about a tight lip tie?
A tight lip tie is assessed according to the same principle as the tongue tie and is only cut when there is a clear functional indication, typically in connection with breastfeeding.
Can adults have their tongue tied cut?
In some cases. In older children and adults, a tight tongue tie rarely causes discomfort, but can be assessed individually if reduced tongue mobility affects functions such as eating or oral hygiene.
Can the procedure be repeated?
Yes. Any renewed haircut will only be performed after referral.
What does it cost?
Preliminary examination and procedure under local anesthesia cost DKK 4,500. If no cutting is performed, the preliminary examination alone will be invoiced at DKK 2,400.
Read also about
- Pediatrician
- Ear, nose and throat
- Children
Always book an appointment for an examination with a breastfeeding counselor or other professional before any treatment of a tight tongue tie with us.
If you suspect your child has a tight tongue tie, we recommend that you contact an osteopath or breastfeeding counselor for an impartial and professional assessment. This way, we can be sure that all other techniques and treatments have been tried and exhausted before resorting to surgery.
Prices
Children 0-3 months
Children up to approximately 3 months old can easily be restrained briefly for the procedure, which is performed with local anesthetic gel and CO2 laser.
PRICE
Preliminary examination 2,400 DKK Treatment with CO2 laser: 2,100 DKK
Total 4,500 DKK
Children 3-6 months
Children between 3 and 6 months old can in some cases participate in procedures under local anesthesia. In other cases, the children may be too large and strong to be restrained even briefly for the procedure. In these cases, full anesthesia may be considered - even if the child is not 6 months old. This typically applies to children over 6-8 kg.
Between the ages of 3-6 months, it is therefore an individual and medical assessment whether the child can be offered treatment under local or general anesthesia, or whether it is best to wait a few months and continue osteopathic treatment.
PRICE
Pre-study 2,400 DKK
Treatment with CO2 laser: 2,100 DKK
Possible anesthesia with Sevoflurane: 2,000 DKK
Total 4,500-6,500 DKK
Children 6-24 months
Performed with a CO2 laser under full anesthesia with Sevoflurane (gas) on a mask, which many people are familiar with, for example, from the placement of drains. No sutures are placed.
PRICE
Pre-study 2,400 DKK
Treatment with CO2 laser: 2,100 DKK
Anesthesia with Sevoflurane: 2,000 DKK
Total 6,500 DKK
Older children 24 months
The procedure can be performed either with a CO2 laser or as a classic surgical tongue depressor with surgical instruments and subsequent suturing of the "diamond". This minimizes the risk of adhesions and the need for follow-up treatments.
Offered to children over 24 months, older children and adults. The patient is intubated and anesthetized with TIVA (total intravenous anesthesia)
PRICE
Pre-study 2,400 DKK
Tongue-tie surgery with suturing: 3,100 DKK
Anesthesia (iv): 4,000 DKK
Total 9,500 DKK
Treatment with CO2 laser
Charlottenlund private hospital will offer treatment with CO2 laser as the only and first place in Denmark from February 2026. Treatment of tight tongue and/or lip ligaments with CO2 laser is preferred by the world leaders in the treatment of tight tongue ligaments, such as Richard Baxter from Alabama and Darius Moghtader from Oppenheim, whom we have visited and exchanged experiences with on several occasions, as well as many others.
See some of our partners below:
