We will begin by introducing ourselves and asking about any feeding difficulties you and your baby are experiencing. If your baby is hungry and ready to feed, we may observe a feed to help assess how the tongue-tie might be affecting feeding.

We will explain how we assess tongue function using the Hazelbaker scoring system, which looks at both the appearance and movement of your baby’s tongue. With your permission, we will carry out this assessment and then discuss the findings with you.

If a tongue-tie is identified based on the Hazelbaker score and the symptoms you and/or your baby are experiencing, we will talk through the small risks involved in the procedure and answer any questions you may have.

If you decide to go ahead, the tongue-tie division will be carried out. Your baby will be returned to you straight away for comfort and feeding, and you can choose to breast or bottle feed.

We will observe a feed after the procedure and offer support with positioning and attachment to help make feeding as comfortable and effective as possible. Before you leave, we will check that the wound is not actively bleeding and that you feel informed and supported.

You can access free follow-up support by contacting us via telephone. In-person follow-up appointments are also available

The Hazelbaker Scoring System is one of the most widely used tools for assessing tongue-tie in babies. It offers a clear, structured way to evaluate both how a tongue-tie looks and, more importantly, how well the tongue functions.

This is crucial because appearance alone doesn’t tell the whole story. Some tongue-ties may look severe but cause no feeding issues, while others may appear mild yet significantly restrict tongue movement and function.

The scoring system helps identify these cases by assigning two separate scores:

• Function – scored out of 14

• Appearance – scored out of 10

A score below 11 for function and below 8 for appearance suggests that the tongue-tie may be contributing to feeding difficulties and that treatment could be beneficial.

The Hazelbaker score supports both parents and professionals in understanding whether a tongue-tie is likely affecting feeding – especially in cases where symptoms are present but the tongue looks “normal” at first glance.

This tool helps ensure that any decision about treatment is informed, evidence-based, and tailored to your baby’s unique situation.

There is currently no official medical definition for a posterior tongue-tie, but it is generally understood to refer to a restriction located further back under the tongue, rather than near the tip.

Unlike the more visible anterior tongue-tie (where the membrane often reaches the tongue tip), posterior tongue-ties are harder to see and often go undiagnosed, especially by healthcare professionals who may have received little or no specific training in tongue-tie assessment.

Despite being less obvious, posterior tongue-ties can affect tongue function just as much as anterior ones. They may significantly impact feeding, causing pain for the parent or challenges for the baby such as poor latch, clicking, slipping, or ineffective milk transfer.

If you suspect your baby may have a posterior tongue-tie, it’s important to be seen by a practitioner who is confident in recognising and managing this type of restriction.

At Cheshire Baby Support, we are fully qualified and experienced in assessing and treating posterior tongue-ties. We take into account not just how the tie looks, but how your baby’s tongue functions - using evidence-based tools and a whole-baby approach to guide diagnosis and treatment.

The procedure is quick and carefully carried out by experienced professionals with your baby’s comfort and safety as the top priority.

During the procedure:

• Amanda, our IBCLC, gently and securely supports your baby’s head

• Jenny, our trained tongue-tie practitioner, carefully opens your baby’s mouth and lifts the tongue to assess the tie

• Using sterile, precision scissors, the membrane (frenulum) is gently divided

The procedure itself takes only a few seconds, and your baby is returned to you immediately afterwards for comfort and a feed.

Most babies are able to feed straight away, and we’ll stay with you to offer support and check how your baby is responding. Our goal is to make the process as calm and supportive as possible for both you and your baby.

It’s not uncommon for parents to receive conflicting advice about tongue-tie. Many healthcare professionals, including midwives, health visitors, and GPs, receive limited or no training in assessing oral restrictions. This isn’t a reflection on their skill, but rather on the scope of their role, which often doesn’t include in-depth tongue-tie assessment.

Identifying oral restrictions such as tongue-tie, especially posterior ties, is a specialist skill that takes years of training and clinical experience. Both Amanda (IBCLC) and Jenny (tongue-tie practitioner) have completed extensive training in this area and are confident in recognising and treating tongue-ties that may be affecting feeding.

That said, not all feeding difficulties are caused by tongue-tie, which is why every appointment with us includes specialist infant feeding support. Amanda provides tailored, one-to-one care to explore and address the underlying cause of your feeding challenges, not just the symptoms.

If you're still struggling with feeding and not sure why, we’re here to help. Click here to learn more about feeding consultations.

The tongue-tie division procedure is very quick and does not appear to cause significant pain in babies. Most babies will cry during the procedure and for a short time afterwards, but this is often due to being held still rather than from the procedure itself.

Babies are usually calm and settled within a few minutes, especially once returned to their parent for comfort and a feed. We are always led by your baby’s needs and will support you both throughout the process to ensure it feels as calm and gentle as possible.

All procedures carry some degree of risk, but tongue-tie division is considered a low-risk procedure when carried out by trained professionals.

The most common things parents may notice are:

• A small amount of bleeding – This usually looks heavier than it is due to mixing with saliva, but is typically only a few drops. Feeding your baby straight after the procedure helps stop the bleeding naturally.

• Temporary feeding changes – Some babies feed better straight away, while others take a few days or weeks to adjust. We will support you throughout this process.

• Mild discomfort – Some babies may be unsettled for a short time after the procedure, though many are quickly soothed by feeding and cuddling.

• Reattachment – This is uncommon but can occur as the wound heals. If feeding concerns return, we’re happy to reassess and support as needed.

We use blunt-ended scissors and all procedures are carried out by a qualified tongue-tie practitioner, with your baby’s head gently held and supported by an experienced IBCLC to reduce movement and increase safety.

The risk of infection is very low. We recommend sterilising dummies, bottles, and nipple shields after the procedure as a precaution.

That’s completely okay, making decisions about your baby’s care can feel overwhelming, and we’re here to support you without pressure.

After we assess your baby’s tongue function and appearance, we’ll talk you through the findings and what they might mean for feeding. We’ll also discuss alternative ways to manage feeding challenges, such as adjusting positioning or technique.

You are under no obligation to go ahead with the procedure. Our aim is to give you clear, honest information so you can make the decision that feels right for you and your baby.

We’re happy to answer any questions you have, whether you decide to proceed or not.​

​Currently health care professionals can complete a tongue-tie division course at Southampton hospital, Wolverhampton University or The Tongue Tie Academy.

We are very proud that Jennifer completed her Masters’ level qualification at Wolverhampton University. This course involved studying the theory of tongue tie and learning the practical procedure to the highest educational standard.

Absolutely not. Not every baby has a tongue-tie, and not every feeding issue is caused by one.

That’s why we use a structured scoring system to assess both tongue appearance and function. This helps us to objectively understand what’s going on and guide your care based on clear findings, not assumptions.

Our goal is always to provide thoughtful, individualised support that addresses the real cause of your baby’s feeding challenges, whatever that may be.

The Care Quality Commission (CQC) is the independent regulator of health and social care services in England. Their role is to make sure care is safe, effective, compassionate, and high quality.

Any tongue-tie practitioner who is CQC-registered must meet strict national standards, including:

• Person-centred care – Tailored to your baby’s needs and your preferences

• Dignity and respect – You’ll be treated with compassion at every step

• Informed consent – You’ll always be asked for clear consent before any procedure

• Safety – Procedures must be carried out by qualified, competent professionals in a safe environment

• Safeguarding – Protection from harm or improper treatment

• Clean and appropriate premises and equipment

• Good governance – Strong systems in place to maintain quality and reduce risk

• Duty of candour – Providers must be open, honest, and supportive if anything goes wrong

At Cheshire Baby Support, we are proud to be fully CQC registered, ensuring that our service meets the highest standards of care for you and your baby.

Association of tongue tie practitioners

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UNICEF and baby friendly

La Leche League:

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