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Tongue-Tie (Ankyloglossia)

Front view of open mouth showing underside of tongue.Tongue-tie (ankyloglossia) is a problem with a thin strip of tissue under the tongue. This tissue is called the frenulum. It connects from the underside of the tongue to the floor of the mouth. You can see it if you look under your tongue in a mirror. Some children are born with a frenulum that is too short and tight. This can cause problems with speech and eating. In other cases, it causes few problems.

Understanding tongue-tie

The frenulum may attach to the tip of the tongue instead of lower down under the tongue. The tongue then can’t move normally. Your child may have trouble sticking his or her tongue out, moving it from side to side, or bending it to touch the upper teeth. The tongue often has a notch at its tip. These problems can cause trouble with speaking and eating.

Tongue-tie is different in each child. The condition is divided into classes. They are based on how well the tongue can move. Class I is mild, class II is moderate, class III is severe, and in class IV the tongue can hardly move at all.

What causes tongue-tie?

Doctors aren’t sure exactly what causes the frenulum to form this way. Tongue-tie runs in some families. Your child may have a higher risk for tongue-tie if you or other family members had it.

Symptoms of tongue-tie

Many children don’t have any problems from tongue-tie. Others may have problems such as:

  • Trouble latching on during breastfeeding

  • Nipple pain in the mother during breastfeeding

  • A gap between the bottom 2 front teeth

  • Problems keeping the mouth healthy. This can cause tooth decay.

Tongue-tie usually doesn’t keep babies from learning to speak. Your child may just have trouble making certain sounds, such as “t,” “d,” “z,” “s,” “th,” “n,” and “l.”

In rare cases, a child with tongue-tie may have other problems, like cleft lip or cleft palate. These can cause other symptoms.

In later years, tongue-tie can make it hard for your child to do some activities, such as lick an ice cream cone, play a wind instrument, or kiss. It may cause embarrassment or social problems for some children.

Diagnosing tongue-tie

Tongue-tie may be found when looking for causes of a baby’s breastfeeding problems. A health care provider will ask about your child’s medical history and give him or her a physical exam. The health care provider will carefully check your child’s tongue and its movements. He or she might advise that your child see an ear, nose, and throat doctor after diagnosis.

Treatment for tongue-tie

Your child may not need treatment if he or she has no symptoms or mild symptoms. In some children, most or all symptoms go away over time. Between ages 6 months and 6 years, the frenulum naturally moves backward. This may solve the problem of mild tongue-tie. Or, your child may find ways to work around the problem. Symptoms may be less likely to go away if your child has more serious tongue-tie.

If your child has trouble breastfeeding, your health care provider may advise working with a breastfeeding specialist (lactation consultant). If that doesn’t work, your child may need surgery.

Your child may need to see a speech specialist. This specialist will test your child’s speech. The specialist may advise speech therapy. Or he or she may advise surgery.

A simple surgery called a frenotomy is an effective treatment for many children. A health care provider can often do this procedure in the office. A cut is made in the frenulum, allowing the tongue to move normally. Your child might need to see a speech therapist after a frenotomy. This can help him or her learn how to retrain the muscles of the tongue.

Some children need a slightly more complex surgery called a frenectomy. This completely removes the frenulum. Another option is frenuloplasty, which uses several other methods to release the tongue-tie. Your child might need this if a frenotomy was unsuccessful, or if your child’s frenulum is very thick.

When to call the health care provider

Call your child’s health care provider or a breastfeeding specialist if your child is having trouble breastfeeding. If you believe your child is having problems making sounds, see your child’s health care provider or a speech pathologist.

© 2000-2017 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.