Tongue Tie Assessment: Evidence-Based Practice & Research
Clinical research, assessment and management principles, evidence informed guidance for health care practitioners and thoughtful care for babies and families.
Tongue tie assessment has become an area of growing clinical attention — and growing uncertainty — for both families and health professionals.
This page brings together published research conducted by clinicians affiliated with Baby Steps, alongside key clinical insights about how tongue tie should be assessed, interpreted, and managed.
The aim is clarity: supporting objective clinical decision-making, reducing unnecessary procedures, and helping families navigate a complex and often confusing area of infant care.
Research conducted by Baby Steps-affiliated clinicians
Recent research by Dr Eloise Wiffen, Jill Wiffen, and Dr Leon Levitt, published in Breastfeeding Review, examined how tongue tie assessment is performed in real-world clinical settings and how diagnostic decisions are made.
The study analysed clinical data from babies assessed within an outpatient multidisciplinary Baby Steps clinical environment, under appropriate consent and governance processes.
The research explored:
• how assessment tools are used in practice
• the role of clinical judgement alongside scoring systems
• the risks of diagnosing tongue tie based on appearance alone
• how multidisciplinary assessment influences decision-making
The findings contribute to a growing evidence base supporting functional, context-based assessment rather than reliance on isolated scoring tools.
Publication:
Breastfeeding Review
“Most babies referred for tongue tie assessment do not require a procedure.”
Key clinical insights from the research
The research highlights several important findings shaping contemporary clinical understanding of tongue tie.
Understanding tongue tie
- There is currently no universal professional consensus on how tongue tie should be classified or managed.
- Tongue tie is a complex condition, not always defined by appearance alone.
- A visible frenulum does not indicate tongue tie and should not determine treatment decisions.
- Tongue mobility — not appearance — was the strongest predictor of whether intervention was necessary.
What the research shows in practice
- In this study, only 35% of babies referred for tongue tie assessment required frenotomy.
- The majority were safely managed without surgery.
- Most families presented due to breastfeeding concerns, which are often multifactorial and not solely related to tongue structure.
- The majority of mid-posterior frenula do not cause functional feeding problems and do not require release.
Current trends and challenges
Upper lip tie
- There is no evidence supporting surgical release of upper lip frenula for feeding, speech, or orthodontic outcomes.
If treatment is needed
- Simple scissors frenotomy is usually safe and effective.
- Laser procedures are rarely required.
What this means
Careful, functional assessment remains central to decision-making.
An evidence-informed approach helps reduce:
- unnecessary procedures
- repeated appointments
- added stress for families
While supporting clear, confident clinical decisions.
What this means for families
Tongue tie can feel confusing and stressful for parents, particularly when different advice is given.
This research reinforces several important points:
- Most babies referred for tongue tie assessment do not need a procedure.
- A visible frenulum is normal anatomy — what matters is whether it actually restricts tongue movement and affects feeding.
- Feeding challenges are often complex and may involve positioning, milk supply, infant coordination, or other factors beyond tongue structure.
Careful assessment helps ensure that:
• families receive clear, accurate information
• unnecessary procedures are avoided
• decisions are made with confidence and support
A thoughtful, multidisciplinary approach can reduce repeated appointments, conflicting advice, and added stress during an already demanding time for families.
How tongue tie is assessed
Contemporary assessment should focus upon function rather than appearance alone.
Key elements include:
1. Feeding assessment
Usually led by an IBCLC (lactation consultant) to evaluate breastfeeding effectiveness.
2. Structural assessment
Examining the frenulum’s position, thickness, and attachment.
3. Mobility assessment
Evaluating how well the tongue can elevate, extend, and move freely.
4. Contextual factors
Considering infant age, feeding history, parental concerns, and access to follow-up care.
This structured, multidisciplinary approach helps ensure that intervention is recommended only when clear functional benefit is likely.
“Tongue mobility — not appearance — is the most important predictor of whether treatment is needed.”
Supporting evidence-informed clinical care
The findings of this research reinforce several principles increasingly recognised in best practice:
• assessment should precede intervention
• functional impact matters more than appearance
• feeding should be evaluated within the whole clinical context
• multidisciplinary input improves decision-making
• unnecessary procedures and expenditure should be avoided
Simple clinical management guidelines are provided. They provide more objectivity and lead to much more cost effective solutions for families and the health system.
Collaboration with referring clinicians
Baby Steps provides a clinical environment that supports careful assessment, clear communication, and continuity of care.
Clinicians referring to independent practitioners working within Baby Steps can expect:
• evidence-informed assessment
• multidisciplinary collaboration
• structured clinical reporting
• respect for shared care relationships
The focus is clarity, collaboration, and thoughtful clinical decision-making.
Ongoing research and clinical development
This publication represents part of a broader commitment by Baby Steps-affiliated clinicians to:
• clinical audit and quality improvement
• practice-based research
• contribution to the evidence base
• collaboration with colleagues interested in advancing best practice
Attribution
Research referenced on this page was conducted by independent clinicians affiliated with Baby Steps.
Baby Steps Health Centre provides the clinical setting and governance framework that supports independent practice and research activity but does not provide or direct clinical care.