What is tongue tie? Types, symptoms and treatment

We rely on our tongues for a lot of things, including swallowing food, speaking clearly and having good oral hygiene. But some babies are born with a condition that restricts tongue movement, making these important tasks more difficult. This is called tongue tie, which is clinically known as ankyloglossia.

For newborn babies, difficulty breastfeeding, chest feeding or taking a bottle can be the earliest signs of tongue tie. In older babies and young kids, speech issues may be the first noticeable symptom. So if you’ve noticed any latching, eating or speech issues, it’s important to speak with a pediatrician or another kids’ health specialist.

Below, we explain more about what tongue tie is, general and baby-specific symptoms, how and when it’s treated, and more.

What is tongue tie (ankyloglossia) exactly?

Tongue tie is when the lingual frenulum, the band of tissue that connects the tongue to the bottom of the mouth, is too short, thick or tight. When this happens, it can restrict the tongue’s range of motion and impact the way a child eats and speaks. But depending on the severity and type of tongue tie, symptoms and treatment recommendations can vary – which we’ll talk more about below.

Defining different types of tongue tie

Tongue tie is usually described as either anterior or posterior:

• Anterior tongue tie is when the frenulum connects to or near the tip of the tongue.
• Posterior tongue tie is when the frenulum connects toward the middle or back of the tongue.

Recognizing symptoms of tongue tie

Tongue tie symptoms depend on a child’s age and the severity of their case. Some children with tongue tie may never show symptoms, while others may show signs early if they have difficulty breastfeeding, chest feeding or taking a bottle, or later on as they’re learning to talk.

What tongue tie looks like in kids

In some cases, tongue tie can make a child’s tongue look slightly forked or heart shaped. However, most tongue tie symptoms come from the tongue’s restricted movement, which can make it difficult for a baby or child to:

• Stick their tongue out past their teeth
• Touch their tongue to the roof of their mouth
• Move their tongue side-to-side
• Swallow
• Clear food off of their teeth (which can contribute to tooth decay)
• Talk clearly, particularly sounds like “t,” “d,” “s,” “z,” “l,” “r” or “th”

Tongue tied babies and breast or bottle feeding

In babies, feeding challenges are often the first sign of ankyloglossia, as they show up within a few days or weeks of birth. For breastfed babies, this is because a baby needs to stick their tongue out over their bottom gum in order to latch and nurse. Tongue tie symptoms in breastfed babies can include:

• Breastfeeding for long periods of time
• Weak or easily lost latches
• Chewing on the nipple
• A clicking sound during feeding

Tongue tie can also affect a baby’s ability to take a bottle. If they can’t move their tongue enough to control the flow of liquid through their mouth, a bottle-fed baby with tongue tie may show similar symptoms to the above, as well as:

• Be slow or hesitant to feed
• Push the nipple out of their mouth frequently
• Dribble a lot
• Gag, cough or hiccup frequently

Along with these symptoms, there may be signs that your baby isn’t getting enough breastmilk or formula, like slow weight gain or seemingly constant hunger. However, tongue tie is only one possible cause, so it’s important to talk to your child’s doctor or clinician if you’re noticing these symptoms.

How tongue tie is diagnosed

Most often, a child’s primary care doctor or clinician diagnoses tongue tie with a physical examination. They’ll look at the tongue’s shape and assess its ability to move. If appropriate, a doctor will also listen to your child speak.

A lactation consultant may also identify a potential tongue tie and recommend you make an appointment with your child’s doctor.

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How and when ankyloglossia is treated

Generally, a doctor or clinician will recommend treating a baby’s ankyloglossia if it seems like it will significantly interfere with eating, oral hygiene or speech. However, parents may decide to pursue treatment right away or wait to see if anything changes. Treatment isn’t always necessary – the frenulum may stretch naturally as your child grows, and the tongue tie may go away on its own.

Nonsurgical tongue tie treatments

If you’re breastfeeding or chest feeding and your child has a milder case of tongue tie, a lactation consultant can work with you on latching techniques, oral exercises and feeding positions to help your child nurse more efficiently, as well as manage any discomfort you may feel.

Similarly, a speech pathologist can help develop a baby’s ability to breast or bottle feed, as well as their early communication skills. If you have a toddler or older child, a speech pathologist can work with them to improve their pronunciation of difficult sounds.

Surgeries for tongue tie

Surgical tongue tie treatments involve clipping the lingual frenulum to improve the tongue’s freedom of movement. Frenotomy is the most common and is the treatment that’s usually used for tongue tied babies. It typically causes minimal discomfort and bleeding, and a baby can breastfeed or take a bottle immediately afterwards. Depending on a child’s age and the severity of their tongue tie, a slightly more involved treatment called frenuloplasty may be used.

Speak with a doctor if you notice tongue tie symptoms

If your child has difficulty feeding or swallowing, or is showing other possible symptoms of tongue tie, getting a diagnosis is your next best step. Following that, your child’s doctor can explain the pros and cons of treatment versus waiting, offer recommendations and refer you to other specialists if necessary.