Frenectomy: Magic Bullet Or Unnecessary Harm?

Baby sticking out tongue

How To Identify A Baby That Is Likely To Benefit From Frenectomy According To Research

Fast Facts

  • Tongue ties are diagnosed at a rate of 3 to 40%.
  • Maternal pain with breastfeeding improves on average by 1.6 points on a 0 to 10 scale compared to a sham procedure
  • Babies with and without feeding issues have similar frenulums
  • Randomized controlled trials demonstrate no improvement in babies with mild to moderate tongue ties.
  • No true randomized controlled trials exist for frenectomy as all babies in trials are provided the procedure within 15 minutes to 5 days.
  • Many studies supporting the benefit have upwards of a 40% dropout rates
  • The remaining subjects have 20-40% reporting no change or improvement
  • Research shows minimal to no benefit on infant breastfeeding ability or reflux

Might Your Baby Benefit From A Frenectomy?

The Bristol Tongue Assessment Tool (BTAT) is the only screening tool that has been validated in research to identify babies who do not need a frenectomy. When following the BTAT babies who are identified with a score of 4 or less and have a frenectomy have similar rates of breast, bottle, and mixed feeding as those who were not provided the procedure. The BTAT considers functional movement and fixation. The 4 questions are: what does the tongue look like, where does the frenulum attach to the gum, how high can it lift (with a wide open mouth), and how far can it stick out? The TABBY Tongue Assessment Tool has been found consistent with BTAT and is easy for providers to use. Parents find it helpful in making a decision on supporting their child.

Images were taken from the tool Design and Illustration: Hanna Oakes | and the University of Bristol

How To Score:

The BTAT is scored 0 to 8  points

4 points or less warrant a consult for frenectomy

Each section can be scored 0, 1, or 2

What does the tongue-tip look like?

Tongue looks like a heart
Tongue looks like a hill
Tongue is rounded

Where it is fixed?

Tongue fixed to top of gum
Tongue fixed to base of gum
Tongue fixed to bottom of mouth

How high can it lift (wide open mouth)?

Tongue can't reach mid mouth
Corners of tongue can reach mid mouth
Entire tongue can lift to mid mouth

How far can it stick out

Tongue behind gum
Tongue past gum
Tongue past lips


Many babies do not need a frenectomy however babies with severe restrictions may benefit. For babies that have scored a 4 or less an assessment for frenectomy may be warranted. If you have questions please reach out as I know the difficulty and challenge involved with making the decision on whether a frenectomy is warranted. 

Of the available research, it all falls between expert opinion and a weak effect. The only research on frenectomy that has strong evidence is that of the Bristol Tongue Assessment Tool and by extension the above TABBY.

My personal bias against body modification without the consent of the individual weighs heavily and may bias my reading of the studies. If I have gotten something incorrect or if there is new research please share it with the email at the bottom of this page.