Tongue-tie, Lip-tie, and Nipple Pain: Why your baby’s mouth may be the reason breastfeeding hurts — and what can help
Breastfeeding should not feel like torture. If you’re getting cracked, bleeding, or burning nipples and nobody can explain why — even with good latch teaching and support — an oral tie (tongue-tie or lip-tie) may be a hidden piece of the puzzle. This post explains the connection in plain language, summarizes what the medical literature says, and gives practical next steps so you can get comfortable nursing again.
What is an oral tie — and how can it cause nipple pain?
Ankyloglossia (tongue-tie) and restrictions of the upper lip (lip-tie) are when a band of tissue limits normal movement of the tongue or lip. If a baby can’t lift, extend, or flange the tongue properly, or can’t out-flare the upper lip, they often can’t form a wide, deep latch. Instead the nipple can get compressed against the hard palate or rub along the front of the areola — and that pressure and friction is what causes raw, cracked, or bleeding nipples. Several clinical reviews and patient studies describe this chain: limited tongue/lip movement → poor latch mechanics → nipple pain. PMC+1
What does the research say about ties and nipple pain?
Short summary of the evidence:
Multiple systematic reviews and recent large reviews report that releasing a tongue-tie (frenotomy) is associated with reduced maternal nipple pain in the short term. However, the quality of the evidence is mixed — some studies are small or have bias — so the magnitude and durability of benefit can vary. PubMed+1
Large reviews and clinical practice guidance note that mothers often report rapid pain relief after frenotomy and that breastfeeding measures (latch scores, maternal satisfaction) often improve in the days to weeks after release. Still, reviewers urge careful patient selection and pairing the procedure with breastfeeding support. PubMed+1
Professional bodies (for example, pediatric and breastfeeding medicine groups) acknowledge frenotomy can help relieve pain for some mothers, but they recommend evaluation by a team experienced in assessing mechanics and breastfeeding before deciding on surgery. AAP Publications+1
How much pain relief should I expect?
Studies report a statistically significant drop in pain scores after frenotomy for many mothers — often noticed within 24–72 hours — but researchers also point out variability. Some mothers experience dramatic relief and are able to continue exclusive breastfeeding; others have smaller improvements or need additional lactation support and latch coaching to get the full benefit. Because every baby and dyad is different, outcomes are best when the procedure is part of a plan: assessment, possible release, and post-procedure feeding support. PubMed+1
Signs that an oral tie might be causing your nipple pain
Consider evaluation if you have painful nursing despite good positioning and help from a lactation consultant, especially if you have any of the following:
Pain described as pinching, cutting, or burning that begins immediately with latch.
Recurrent cracked, bruised, or bleeding nipples.
Baby has poor weight gain, clicking noises at the breast, colic or reflux-like symptoms, or trouble staying latched.
Baby’s tongue looks heart-shaped, cannot lift to the palate, or the upper lip won’t flange out.
These signs aren’t definitive on their own but are reasons to get a skilled oral/feeding assessment. PMC+1
What does the evaluation look like?
A thorough assessment includes watching a feeding (in person or via video), examining tongue and lip function (not just appearance), and using validated latch or breastfeeding assessment tools. Good clinicians evaluate the whole feeding dyad — baby’s mouth mechanics and the mother’s pain and breast anatomy — before recommending any intervention. If a tie is thought to be causing problems, options are discussed (conservative support vs. frenotomy). AAP Publications+1
What is a frenotomy and is it safe?
A frenotomy (division of the frenulum) is a short procedure to release restrictive tissue. In infants it’s usually quick, performed in the office, and complications are uncommon when done by experienced providers. Most studies report low rates of adverse events, and many mothers notice early improvement in pain and latch. As with any procedure, careful technique and appropriate aftercare (wound care and feeding support) matter. PubMed+1
Practical next steps for mothers experiencing nipple pain
Get specialist feeding support first. A lactation consultant who knows how to evaluate for ties is a good first move — many latch problems improve with positioning and technique adjustments. PMC
If pain persists, seek an oral/feeding evaluation. Ask for an assessment that tests function (tongue movement), not just looks.
If a tie is suspected, choose a clinical team that offers both release and post-release feeding follow-up. Studies show the best outcomes combine procedure + lactation support. PubMed
Keep yourself safe and supported. If pain is severe or you’re at risk of stopping breastfeeding against your wishes, get help quickly — unresolved pain is a leading reason mothers stop nursing. PMC
Real mothers’ experience
Clinical reviews include many patient-reported outcomes: some mothers describe almost immediate relief and renewed confidence to continue breastfeeding after frenotomy, while others require more time and coaching. That’s why individualized care is essential — your situation is unique. PMC+1
Want help? About Dr. Brian Hatch and the Oral Tie Center
Dr. Brian Hatch specializes in assessing and treating lip and tongue ties with an emphasis on function and teamwork. He was trained and certified through The Breathe Institute and uses an interdisciplinary model — combining careful oral function assessment, skilled frenuloplasty/frenotomy, and coordinated lactation support — so families get the full pathway from diagnosis to comfortable nursing. If you’re struggling with nipple pain or feeding problems, we can evaluate your baby’s oral mechanics and build a personalized plan.
Call to action: If you’re a mother experiencing persistent nipple pain despite good latch teaching, please contact the Oral Tie Center for a feeding assessment. Early evaluation can often save breastfeeding relationships and reduce pain quickly. [Contact us at www.oraltiecenter.com] — ask about a combined oral function and lactation visit.
Selected references and further reading (for moms who want the science)
Albertsen LN, et al. The effect of frenotomy in infants with ankyloglossia on maternal nipple pain — systematic review. PubMed. 2024. PubMed
Ghaheri BA, Lincoln D, et al. Breastfeeding improvement following tongue-tie and lip-tie division. Clin studies / reviews. 2016–2017. PMC+1
American Academy of Pediatrics — Identification and management of ankyloglossia (policy/guidance). 2024. AAP Publications
Hill RR, et al. Effect of Frenotomy on Maternal Breastfeeding Symptoms. 2022. PMC
Segal LM, et al. Prevalence, diagnosis, and treatment of ankyloglossia. 2007 (classic review on ties and breastfeeding). PMC
