Tongue-Tie in Babies

Medically Reviewed by Poonam Sachdev on November 29, 2023
7 min read

Tongue-tie, also known as ankyloglossia, is a condition some babies are born with that limits their tongue movements. To do its job well, your tongue needs to be able to reach almost every part of your mouth. That full range of motion lets you make different sounds when you speak. It also helps you swallow and sweep away bits of food to keep your mouth clean.

Tongue-tie means there’s a problem with the lingual frenulum. That’s the small stretch of tissue that connects the underside of your tongue to the bottom of your mouth. It might be too short and tight, or attached way up near the tip of the tongue.

In mild cases, there might be only a tiny fold of tissue holding the tip of the tongue in place. In more extreme cases, the entire bottom of the tongue is attached to the floor of the mouth.

About 10% of newborns have ankyloglossia.

What does tongue-tie look like?

If you want to know if your baby's tongue is tied, look at the shape of their tongue when they're crying or lifting their tongue. The tip might look like a little heart. You might also notice that your baby’s tongue:

  • Can’t move far from side to side
  • Can’t reach the upper gums or roof of the mouth
  • Can’t stick out past the gums
  • Can't curl toward their nose or lick their lips

You could also look for the frenulum. When your baby cries or yawns, their tongue will draw back and you can see whether the frenulum (the thin stretch of tissue) is tight and short.

Normal tongue vs. tongue-tie

Normally, the lingual frenulum is attached to the bottom of your tongue, but you're able to move your tongue freely. In the case of tongue-tie, the frenulum is shortened or thickened, making free movement of the tongue difficult.

Adult tongue-tie

Adults can have tongue-tie if they never got treated for it as children. For some adults, tongue-tie doesn't affect their daily lives much. But others can have problems such as:

  • Poor oral hygiene. Your tongue has limited mobility, so it can't remove food from between your teeth.
  • Speech issues. You could have problems pronouncing words with letters such as “t,” “th,” “d”, “r,” “l” and “s.”
  • Reduced quality of life. You could have trouble eating certain foods, kissing, licking your lips, or playing a wind instrument.

Tongue-tie in babies

For some babies, tongue-tie isn't much of an issue. For others, it can lead to problems during breastfeeding. If the baby can't move their tongue properly, they may chew on the nipple instead of sucking. Not only does this cause pain to the parent feeding them but also keeps the baby from getting enough milk. A tongue-tie baby seems able to bottle-feed successfully, though.

Doctors don’t always check for tongue-tie, and it’s not always easy to notice. But even if your child’s pediatrician doesn’t find it until later, it can be treated.

Anterior tongue-tie

This is when the entire bottom of the tongue is attached to the floor of the mouth. You can usually see this in the front of the mouth just behind the lower teeth and gums. It may look like a thin web or membrane. Most babies with tongue-tie have anterior tongue-tie.

Posterior tongue-tie

In this case, there's a short, tight frenulum near the base of the tongue, restricting its motion. It's often hard to see and is usually detected by feel. The term itself is controversial. The American Academy of Otolaryngology says that many ear, nose, and throat doctors (ENTs) believe that posterior tongue-tie “does not exist as an anatomic entity.” Britain's National Health Service doesn't treat it as it believes there's no evidence that posterior tongue-tie causes problems with breastfeeding.

During a fetus' development in the womb, the lingual frenulum is stuck to the tongue. But at some point before your baby is born, the membrane usually thins and separates from the tongue, so there's free range of motion. Sometimes, the separation doesn’t happen. Doctors aren’t sure why. It may run in families. Studies show that male infants are about twice as likely to be tongue-tied as female ones, and it's more common in first-born babies. The baby's race or ethnicity doesn't seem to make any difference.

The condition is often found because of problems breastfeeding. You may notice that your tongue-tie newborn:

  • Can’t latch well
  • Tends to chew more than suck
  • Doesn’t gain weight the way you’d expect
  • Feeds for a long time, takes a short break, and then feeds for another long stretch
  • Is fussy when trying to feed
  • Makes a clicking sound while feeding
  • Seems hungry all the time

Along with your baby’s symptoms, you may have:

  • Pain during and after breastfeeding
  • Sore or cracked nipples
  • Mastitis, or inflammation or infection of the breast
  • Low milk supply

But tongue-tie isn’t the only reason behind breastfeeding problems. So if you’re having them, talk to your doctor.

In children, you should look for signs such as:

  • Not pronouncing certain sounds like “t,” “th,” “d,” “r,” "l,” and “s"
  • Trouble swallowing or moving their tongue from side to side
  • Trouble licking an ice cream cone
  • Trouble playing a wind instrument

Does tongue-tie affect speech?

Tongue-tie doesn't delay your child's progress in learning to speak but may result in difficulties pronouncing certain letters. But tongue-tie may not be the reason for your child's speech problem. At least one study found “no difference” in speech for young children who'd been treated for tongue-tie vs. those who had not.

A physical exam is all it takes to see what’s going on. The doctor will:

  • Ask how feeding is going
  • Check your child’s tongue, mouth, and teeth
  • Use a wooden stick called a tongue depressor to look under your child’s tongue and check the range of motion

The doctor may ask an older kid to move their tongue around and make certain sounds.

Some doctors will want to treat tongue-tie right away. Others prefer a wait-and-see approach. The frenulum might loosen on its own, or it may not cause any long-term issues. A doctor may also suggest trying a speech therapist or a lactation consultant to help with speech or breastfeeding issues before moving on to surgery.

Tongue-tie surgery

There are three ways to take care of tongue-tie surgically:

Frenotomy. This basic procedure happens in a doctor’s office. Sometimes, you don't even need numbing drugs. The doctor takes a pair of specially cleaned scissors and clips the frenulum, which doesn’t have many nerves or blood vessels. That means there’s not much pain. And if there’s any blood, it’s a drop or two at most. Your baby can breastfeed right away, which can be soothing and healing.

Frenectomy. This is similar to a frenotomy except instead of clipping the frenulum, the doctor completely removes it.

Frenuloplasty. When the frenulum is too thick for a quick snip or if other repair is needed, your pediatrician will choose this option.

Your doctor will:

  • Give your child drugs so they sleep through the whole thing
  • Use special tools to cut the frenulum
  • Put in a few stitches that dissolve on their own as the wound heals

Some hospitals may use a laser instead. In that case, your child won’t need stitches.

Your doctor might also recommend tongue exercises for your baby to prevent the frenulum from reattaching and to enhance tongue movement. With older children, this is not usually needed.

Surgery for tongue-tie has exploded in the last 20 years, driven mainly by parental awareness and demand. Many doctors feel that the surgery is often not needed. On the other hand, a review of five clinical trials found that frenotomy was associated with breastfeeding improvements. More research needs to be done on this topic.

What happens if your child's tongue-tie is left untreated?

It depends on the child. In some cases, there are no problems if tongue-tie is untreated. In other cases, it may cause problems with breastfeeding, and later on, with speech, eating certain foods, and dental hygiene.

Surgical treatments are usually very successful. It’s rare for them to cause issues.

There are disadvantages to clipping a tongue, as with any medical procedure. These risks include:

  • Bleeding
  • Damage to the tongue or the glands that make saliva
  • Infection

A frenuloplasty can also lead to scarring that affects the tongue's movement. And your child could have a reaction to the drugs used to help them sleep. There is also the risk that the surgery doesn't fix the problem.

There’s no way to know whetherornot treating a baby's tongue-tie will lead to complications. But in some cases, untreated tongue-tie can lead to these complications as they get older:

  • Dental problems such as tooth decay, swollen and irritated gums, and a gap between the lower two front teeth, due to limited tongue movement to remove food debris
  • Excessive dribbling and mouth soreness
  • Gagging or choking on foods as your child starts to eat solids
  • A hard time with basic things, such as licking an ice cream cone and kissing
  • Trouble with certain sounds when speaking (rolling an “r” can be especially hard)

Talk it through with your doctor to learn what’s best for you and your baby.

A simple surgical procedure can treat tongue-tie in babies. But it may not always solve problems with breastfeeding or speech. Talk to your doctor to see whether surgery is necessary.

Does tongue-tie need to be corrected?

Not always. Sometimes it doesn't impact a baby or child's life. Each case is different.

At what age should a tongue-tie be cut?

Usually, the procedure is done between the ages of 6 months and 6 years. Some doctors and dentists believe in doing it as early as possible, even at 2-6 weeks. But adults can also have a frenectomy. Speak with your doctor to see whether your child should have the procedure or if you should wait and see what happens.