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Keywords: ankyloglossia, lingual frenum, tongue
What Is Tongue Tie?
Tongue-tie is when the lingual frenulum is too tight.
The frenulum is the normal band of tissue that connects the tongue to the floor of the mouth.
In tongue-tie, it connects to the tip of the tongue and limits tongue movement.
The medical name for tongue-tie is ankyloglossia.
Health Information
Normal Lingual Frenulum
All babies are born with a band of tissue that connects their tongue to the floor of the mouth. This band of tissue is called the lingual frenulum.
Most often the lingual frenulum connects under the middle of the tongue.
Sometimes it connects under the front of the tongue. This is normal. It does not cause any symptoms.
In 1% of newborns, the frenulum connects to the tip of the tongue. This is considered abnormal and called tongue-tie. This limits tongue movement.
Some people with short tongues have a frenulum that looks closer to the tip. This is not a tongue-tie. Shorter tongues can easily stick out past the gumline.
Tongue-Tie: How It's Diagnosed
To have a true tongue tie, the child must have:
Lingual frenulum attached to the tip of the tongue.
Tongue notched or indented at the tip.
Tongue that can't stick out past the gumline.
Tongue can't be moved side to side.
Tongue-Tie Symptoms
Many children with tongue-tie have no symptoms.
More than half of babies with tongue-tie have no trouble nursing. They don't have any problems bottle feeding.
Sometimes tongue-tie can cause problems with breastfeeding. Examples are trouble keeping a latch, nipple pain and poor weight gain.
Severe tongue-tie may cause some problems with speech clarity at age 3 or 4. Can't predict in advance and it gets better with speech therapy.
Cause of Tongue-Tie
The cause of tongue-tie is probably genetic. It can run in families.
It's a normal variation in mouth anatomy.
Occurs normally in about 1% of newborns.
In the last 20 years, it's being diagnosed more often than before. Now up to 10% of newborns are reported to have it. This is called "over-diagnosis".
Social media has made people more aware of the lingual frenulum.
Care Advice
Key Points
Sometimes true tongue-tie can cause breastfeeding problems.
It does not affect bottle feeding.
For any nursing issues, seek help from a lactation specialist.
Consider frenulum clipping only if symptoms do not improve with lactation support.
Here is some information that should help.
Normal Shorter Tongue: No Treatment Needed
Some babies have normal shorter tongues.
The lingual frenulum is shorter than average. It attaches to the front half of the tongue (but not the tip).
This frenulum normally stretches some with time, movement, and growth of the tongue.
Shorter tongues do not cause any symptoms. They do not cause trouble nursing, swallowing or breathing.
Breastfeeding Problems: Seek Lactation Consultation First
Breastfeeding challenges are common and have many causes.
Most nursing problems are not caused by tongue-tie.
Always seek help from your child's doctor or a lactation specialist.
Consider frenulum clipping only if symptoms do not improve with lactation support.
Tongue Tie: Frenulum Clipping Option
Clipping is making a small cut in the frenulum with scissors. This is called frenulum release or "frenotomy".
The cut is squeezed for a minute to stop any bleeding.
A nerve block or anesthesia is not needed. Reason: there aren't many nerves in the frenulum.
The procedure should only be performed by a health care professional or pediatric dentist.
This quick procedure is safe. It's covered by health insurance.
Misinformation About Tongue-Tie
Normal short frenulum. This is being over-diagnosed as tongue-tie. The lingual frenulum comes in a range of sizes. Having a shorter than average frenulum does not cause any symptoms. See the requirements for an accurate diagnosis of tongue-tie above.
Breastfeeding problems. These are common. The mother and baby need time to learn how to work together achieve good milk transfer. Tongue-tie clipping is not a magic solution.
Preventing future problems. Future speech or other problems is never a medical reason to perform frenulum clipping in a baby.
Perspective. If you are not breastfeeding, don't worry about your baby's frenulum. It causes few if any symptoms or problems.
Caution. Lots of unnecessary frenulum clipping is being done. Tongue-tie treatment is controversial. For more information, see the American Academy of Pediatrics (AAP) August 2024 report on ankyloglossia.
What to do. Don't agree to any tongue-tie treatment until you have discussed it with your baby's healthcare provider.
Other Tongue-Tie Treatments to Avoid
Here are some treatments that don't help, but will cost you money.
Tongue stretching exercises.
Labial (lip) frenulum release or buccal (cheek) tie release.
Laser treatments instead of clipping with a scissors. Some dentists are using lasers to remove the frenulum. This is not advised by the AAP.
Trusted Resource
American Academy of Pediatrics parent website. www.healthychildren.org. See the article "Tongue Tie in Babies".
Call CPCMG If
You are having problems breastfeeding
You think your child needs to be seen
You have other questions or concerns
You would like a referral to the CPCMG Lactation Program
Author: Barton Schmitt MD, FAAP