A tight restricting frenulum may not be obvious in the newborn. Often there is a notch in the midline when the baby tries to protrude the tongue. One should check all newborns for tongue-tie by sweeping the index finger across the mouth, under the tongue.

Typically, a tongue-tied baby's tongue will assume a heart shape when the baby is crying. This is because the frenulum is limiting upward and forward motion of the tongue.

These mothers and babies present to the doctor or lactation consultant with:

• painful or damaged nipples
• slow weight gain or failure to thrive
• very long feeds
• inability to latch
• inability to sustain and suck for long

If the frenulum is not clipped in infancy, it may cause speech problems and interfere with normal oro-facial development.