A baby with a tongue tie may feed for extended periods while transferring relatively little milk. They are working hard but not feeding efficiently. Over days and weeks, this results in inadequate intake and slow or static weight gain, while the mother may experience a decreasing milk supply because the breast is not being adequately drained.
- Extended feeding times, regularly lasting over 45 minutes
- Feeding very frequently with short intervals between feeds
- Falling asleep at the breast before completing a feed
- Clicking sounds during feeding
- Decreasing milk supply despite frequent feeding
- Baby appearing hungry, unsettled, or rooting shortly after a long feed
The milk supply cycle
Milk supply is driven by demand and effective removal. If a tongue-tied baby cannot drain the breast efficiently, supply gradually decreases. The baby then has to work harder for less milk, becomes more fatigued during feeds, and may begin to resist the breast. The cycle can be difficult to break without addressing the underlying structural issue.
What about formula supplementation?
Formula supplementation may be medically necessary in the short term to support adequate nutrition. It does not preclude tongue tie assessment and treatment. We regularly support families who are combination feeding and want to return to breastfeeding or improve the breastfeeding component of their feeding plan.
Growth faltering and tongue tie
When weight concern is significant enough to be described as growth faltering or failure to thrive, it requires urgent medical assessment. If tongue tie has not been evaluated as part of that assessment, we can provide specialist evaluation in parallel with your paediatric care. Please contact us and we will prioritise your appointment.
Our approach: Release Restrictions, Retrain Function, Relieve Tension addresses the whole feeding picture, including the rehabilitation needed after any procedure to support effective feeding and supply recovery.
The National Tongue Tie Centre was established in 2007 as Ireland's first clinic dedicated entirely to the assessment and treatment of tongue tie. The centre treats over 1,000 patients per year and receives patients from across Ireland and internationally.
Led by Dr. Justin Roche (Consultant Paediatrician, FRCPCH, FRCPI, IBCLC), Kate Roche (Chartered Physiotherapist, IBCLC, Feeding Therapist). Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frequently asked questions
Not necessarily. Centile position alone is not the primary concern. It is the pattern over time, the feeding history, and the clinical picture that matter. If feeding is effortful, maternal nipple pain is present, and the baby is working hard at the breast, an assessment is appropriate regardless of centile.
Expected weight gain varies by age. Newborns typically regain their birth weight by 10 to 14 days and then gain approximately 150 to 200g per week in the first few months. Significantly below this, or static weight, warrants assessment. Your GP or PHN should be your first point of contact for weight concerns, alongside our specialist feeding evaluation.
Yes. If a tongue tied baby cannot drain the breast effectively at each feed, the supply-demand mechanism that drives milk production is disrupted. Supply decreases over time. Addressing the restriction and establishing effective feeding can support supply recovery, though this is individual and we will discuss realistic expectations with you.
In most cases, yes. Supplementation and breastfeeding are not mutually exclusive. We will work with you on a feeding plan that supports both your baby's nutritional needs and your breastfeeding goals.
A baby of this age with a prolonged weight gain concern needs comprehensive paediatric review. We can provide specialist oral function and feeding assessment alongside that review. Please contact us and describe the situation — we will advise on the most appropriate pathway.
Book a comprehensive assessment at the National Tongue Tie Centre. Our clinical team will assess your baby's tongue and lip function thoroughly, explain what we find, and give you an honest recommendation. Call us, complete our online enquiry form, or visit www.tonguet.ie. Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frenuloplasty is a surgical procedure. Risks, benefits, and individual expectations will be discussed in full at your assessment appointment before any decision to proceed is made.
