Tongue Tie (ankyloglossia)

Tongue Tie (ankyloglossia)

What do we know?

The tongue is actually fused, or fully attached, to the floor of the mouth early in pregnancy.  As the fetus develops, the tongue separates from the floor of the mouth.  Only the frenulum is left.  This is the thin band of tissue attaching the bottom of the tongue to the floor of the mouth.  Its full name is lingual frenulum.

Beginning at about 6 months of age, the mouth begins to develop further.  Teeth begin to break through. At this point, the frenulum usually becomes thinner and less prominent.

However, for some, the frenulum remains short, or thick, or both.  This is called a tongue tie.  Why this happens in some babies and not others is unclear.

How does tongue tie affect feeding?

During feeding, an infant latches using the upper gum, tongue, and lower jaw.  The lower jaw squeezes milk into the mouth, and the tongue moves the milk backwards to the throat.

With a tongue tie, limited movement of the tongue can affect latch, and movement of the milk to the throat.

What are the symptoms of a problem tongue tie?

Not all tongue ties cause problems.  Some infants with a tight frenulum are able to feed well.

When tongue tie causes problems, however, symptoms include:

  • Problems latching – an infant may chew at the nipple or show other problems with latch
  • Difficulty maintaining latch and suction – when an infant is able to latch, he or she may have problems creating suction needed for successful feeding
  • Irritability or fussiness with feeds, or falling asleep quickly after starting a feed
  • Poor weight gain, or weight loss
  • Breastfeeding moms may experience nipple pain or painful breasts as the infant does not draw out milk produced for each feed

In older children, a tongue tie can produce speech problems, including difficulty with “t,” “d,” “z,” “s,” “th” and “l.”

What else can cause these symptoms?

There are several important problems that can affect latch, suction and feeding other than a tongue tie.

  1. Problems with the structure of the jaw including a small jaw and an overbite.  These structural differences can produce symptoms which are identical to the symptoms of a problem tongue tie.
  2. The roof of the mouth, called the palate, may be high and arched.  It may also have a gap called a cleft.  Arching or a cleft both create problems with how the infant moves milk back to the throat.  This can affect all parts of the feeding process.
  3. Low muscle tone can affect the mouth and delay feeding as much as it delays other motor milestones including neck strength, ability to kick the feet, roll, sit, stand and walk.
  4. Some infants can have increased sensitivity in the mouth, called oro-motor sensitivity.  This can affect an infant’s willingness to feed, and his or her ability to manage milk in the mouth.

What is the treatment for tongue tie?

Infants with feeding problems should first be seen by their doctor or nurse practitioner.  A careful examination of the infant’s mouth, as well as neurologic and motor development is needed to properly diagnose the feeding problem.

When tongue tie is the problem, the next step is to work with a certified lactation consultant.  The lactation consultant works with parents and babies to help the infant latch, create good suction, and continue feeding long enough for good nutrition.

When these steps are not enough, the tongue tie can be released in a surgical procedure called a frenotomy.  Pain management is important when releasing a tongue tie.  Complications can include bleeding and infection.

Some health care professionals and parents advocate to have a tongue tie clipped as soon as it is found.  The timing of a frenotomy is controversial, and there is not currently agreement or support in the medical literature for one position over the other (early surgery, or waiting).


– Dr G Paul Dempsey

Image Credit: Klaus D. Peter


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