Tongue-Tie in Newborns and Babies

Tongue-tie is a condition that's present at birth and affects the tongue’s range of motion. In some cases, it may clear up on its own, but in other cases, it may require a small medical procedure. Find out more about tongue-tie, including how it can affect breastfeeding and other aspects of your baby’s well-being, and discover how the condition can be resolved with or without medical intervention.

What Is Tongue-Tie (Ankyloglossia) and What Causes It?

The tongue and the mouth are fused together in the early stages of prenatal development. Before birth, the tongue and mouth typically separate, which allows the tongue to move freely. Tongue-tie (ankyloglossia) is the condition that results when the tongue stays attached to the floor of the mouth, restricting the tongue’s movements. This can occur if the lingual frenulum — a thin piece of tissue connecting the tongue and mouth — is unusually short, thick, or tight. It’s not known exactly what causes tongue-tie, but it is thought that certain genetic and hereditary factors play a role. Up to 10 percent of babies are born with tongue-tie, which tends to be more common in boys than in girls.

What Are the Signs and Symptoms of Tongue-Tie?

Wondering how to tell your baby is tongue-tied? If her tongue appears to be heart-shaped or notched when she sticks it out, it’s the result of tongue-tie. But you may not notice this immediately after birth. You may be able to spot or feel firm tissue at the point where your baby's tongue meets the floor of her mouth. If you think your baby has tongue-tie, see her healthcare provider. Some signs and symptoms of tongue-tie in newborns or babies can include:

• Difficulty breastfeeding, which can include latching issues or breastfeeding for an extended period

• Clicking sounds while breastfeeding

• Constant hunger or having trouble gaining weight.

Some signs and symptoms of tongue-tie that show up later in childhood can include:

• problems with eating, speaking, and swallowing

• difficulty raising the tongue to meet the upper teeth or roof of the mouth

• difficulty moving the tongue from side to side

• difficulty sticking the tongue out past the front bottom teeth.

How Can Tongue-Tie Affect Your Baby When Breastfeeding?

Depending on the severity of your baby’s tongue-tie, the condition may affect how your baby breastfeeds. Usually, the shorter and tighter the tongue-tie, the more difficult feeding will be. Normally, your baby will be able to extend her tongue over her lower gums with her mouth wide open in order to latch effectively, but with tongue-tie this can be very difficult to achieve. Your baby’s tongue-tie may affect breastfeeding in the following ways:

• Trouble latching onto your breast

• Difficulty staying on your breast

• May make a clicking sound when losing suction on your breast

• May splutter or choke on fast-flowing milk

• May try to breastfeed constantly to get enough milk

• Doesn’t gain weight adequately

• May develop jaundice

• Fusses when your breast milk flow slows

• Can develop colic.

As a nursing mother, you may experience some of the following due to your baby’s tongue-tie condition:

• Pain during breastfeeding

• Damage to the nipples that may include compression or distortion of the nipple shape

• Engorgement, blocked milk ducts, or mastitis due to the breast milk not being adequately removed during breastfeeding

• Less breast milk production

• Oversupply of breast milk if your baby feeds too frequently

• Fatigue, frustration, and discouragement

• Ending breastfeeding early.

If you’re having any of the above breastfeeding difficulties with your tongue-tied baby, speak to your healthcare provider or a lactation consultant for advice.

What Is the Treatment for Tongue-Tie?

Medical experts don’t always agree on the best treatment for tongue-tie. Some clinicians believe that the issue should be corrected right away, even before your newborn leaves the hospital. Others recommend waiting to see what happens, as sometimes the condition resolves itself as the lingual frenulum loosens over time. The good news is that tongue-tie can be treated at any age, so it’s up to you and your healthcare provider to figure out the best way forward for your little one. In some cases, surgery may be necessary. There are two different medical procedures for correcting tongue-tie:

• Frenotomy. This procedure is so simple it doesn’t even need anesthesia. It can typically be administered in the hospital’s nursery or in a healthcare provider’s office. The provider will use scissors to snip the frenulum free. Typically, the procedure isn’t painful, and the bleeding may be no more than a few drops of blood. Your baby can breastfeed immediately afterward.

• Frenuloplasty. If the lingual frenulum is too thick for a frenotomy, your baby’s healthcare provider may recommend a frenuloplasty, which is done under general anesthesia. Using surgical tools, the surgeon will release the frenulum and close the wound with sutures that absorb on their own as your baby’s tongue heals. Your baby’s healthcare provider may recommend specific tongue exercises to help encourage movement and reduce scarring.

What Can Happen If You Don’t Fix Tongue-Tie?

If tongue-tie goes uncorrected, it can cause some issues as your child grows older, such as:

• Poor oral hygiene. Tongue-tie may make it difficult for your child to sweep remnants of food from around his teeth. This can lead to tooth decay and gum inflammation (gingivitis).

• Teeth malformation. Your child may have a gap between his two frontal bottom teeth.

• Everyday challenges. Your child may have trouble doing things like licking an ice cream cone, licking his lips, kissing, or playing a wind instrument such as the flute.

• Difficulty in pronouncing certain letters. Although tongue-tie isn’t linked to speech delay, it can make it difficult for your child to pronounce certain letters such as t, d, z, s, th, r, and l.

The Bottom Line

If your baby is born with tongue-tie, rest assured that this is a minor condition that oftentimes resolves on its own or with a simple medical procedure. Ask your child’s healthcare provider to weigh in on whether the wait-and-see approach is best, or whether a frenotomy or frenuloplasty is recommended. If you’re breastfeeding, you may find that your tongue-tied baby has a difficult time latching. If this is the case, reach out to a lactation consultant or your healthcare provider to see if there are things you can do to make breastfeeding easier. Whether your baby’s tongue-tie resolves itself or whether a small procedure is needed to remedy it, know that your baby will soon be able to use her tongue freely and that tongue-tie won’t have any lasting effects.

_{How We Wrote This Article The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.}