Tongue Tie (Ankyloglossia)

Also called: Ankyloglossia

What Is Tongue Tie?

Tongue tie is when a tight band of tissue connects the underside of the tongue to the floor of the mouth, keeping it from moving freely. Normally, the tongue can move out past the lower lip and reach up to the hard palate (roof of the mouth) and upper teeth.

The fold of tissue under the tongue where it’s attached is called the frenulum (FREN-yuh-lum).

What Happens in Tongue Tie?

Tongue tie — also called ankyloglossia (ang-kuh-low-GLOSS-ee-uh) — forms before a baby is born. Usually, as the baby develops, the front of the tongue and the floor of the mouth grow apart. The back of the tongue stays attached.

Sometimes, the frenulum might be too short or too tight. It might stay near the front of the tongue and tie the tip of the tongue to the floor of the mouth.

Tongue tie can range from mild (only a tiny fold of tissue holds the tip of the tongue) to severe (the entire bottom of the tongue connects to the floor of the mouth). Sometimes a thick, tight frenulum near the base of the tongue limits its motion.

What Causes Tongue Tie?

Doctors don’t know what causes the tongue and frenulum to form differently in a child with tongue tie. The condition sometimes runs in families and is more common in boys than girls.

What Are the Signs & Symptoms of Tongue Tie?

Usually, tongue tie doesn't cause symptoms. When it does, the signs look different depending on the child's age.

Babies with tongue tie might:

• lose their latch while breastfeeding or bottle-feeding
• struggle to get a good nursing position
• make a clicking sound while feeding, especially from a bottle

Most newborns with tongue tie feed well from a bottle. But growth can be affected if a baby has trouble feeding. See a doctor right away if you don't think your baby is eating enough.

Older kids with tongue tie might:

• have trouble speaking clearly and saying certain sounds (like d, l, t, or th)
• have trouble licking their lips, or licking an ice cream cone
• not be able to stick their tongue out past their teeth
• get cuts under the tongue when the frenulum gets caught between the lower front teeth
• have tooth decay because they can't use their tongue to clear food from their teeth or the roof of their mouth
• have trouble playing wind instruments

How Is Tongue Tie Diagnosed?

To diagnose tongue tie, doctors will check to see if the frenulum is limiting the movement of the tongue. For kids who are old enough to talk, the doctor will listen to them speak to see if they struggle to make certain sounds.

Sometimes a child might need to see a specialist who can help diagnose and treat tongue tie, such as:

• an ear, nose, and throat specialist (ENT)
• a pediatric dentist
• an oral surgeon
• a lactation nurse or consultant
• a speech-language therapist

How Is Tongue Tie Treated?

Kids who don’t have problems from tongue tie don’t need treatment. The frenulum stretches as a child grows, and this usually gives the tongue enough freedom to move normally.

If surgery is needed, the ENT, dentist, or oral surgeon can do a:

• frenotomy (freh-NOT-uh-mee) or frenulectomy (fren-yuh-LEK-tuh-mee): The doctor makes a small cut in the frenulum with a scalpel, laser, or scissors. This helps lengthen the frenulum. The procedure is quick but may hurt a little. It can be done at a doctor's office if the baby is young enough to be swaddled and safely held still for the procedure. Older infants and children may need anesthesia if they can't stay still.
• frenuloplasty (FREN-yuh-lo-plass-tee): For older kids, or if the frenulum is too thick for a simple frenotomy, the doctor will do surgery to divide and lengthen the frenulum to free the tongue. Kids get anesthesia to sleep through the surgery so they don't feel any pain.

How Soon Do Kids Recover From a Tongue Tie Procedure?

Babies recover very quickly, and often can start feeding shortly after a frenotomy. While many babies improve their feeding quickly, some may need time to adjust. A lactation consultant or feeding specialist can help you with any feeding problems.

Older kids might have some soreness for a week or two, but this will go away on its own.

What Else Should I Know?

Tongue tie may leave a scar after it's treated. It's also possible for tongue tie to come back after treatment. Your doctor may give you suggestions on how to keep this from happening.

Talk to the doctor if you're worried that your child's condition is getting worse. Ask if they can refer you to a speech-language pathologist if your child has trouble speaking clearly.