Tongue-Tie

Topic Overview

What is tongue-tie?

Tongue-tie (ankyloglossia) is a birth defect in which the tissue that attaches the tongue to the bottom of the mouth (lingual frenulum) is abnormally short. Movements of the tongue may be restricted, depending on the degree of attachment to the mouth.

See a picture comparing a normal lingual frenulum with tongue-tie.

What causes tongue-tie?

Tongue-tie is an inherited birth defect. Usually the mother or father or a close relative also had the condition.

Most often a baby with tongue-tie does not have other birth defects. But tongue-tie occurs more frequently in babies whose mothers abused cocaine during pregnancy and in babies with other congenital conditions that affect the mouth and face, such as cleft palate.

What are the symptoms?

Many babies with tongue-tie do not have symptoms. The lingual frenulum stretches as the child grows or adapts to the tongue restriction. But some children with tongue-tie have:

  • Trouble latching on to the mother's breast and sucking, because the tongue cannot move milk from the milk glands of the breast to the nipple. Bottle-fed babies usually do not have feeding problems, because it is easy to get milk from the nipple of a bottle.
  • Speech problems, because the tip of the tongue cannot rise high enough to make (articulate) some sounds clearly, such as t, d, z, s, th, n, and l.
  • Personal or social problems related to the restricted tongue movement. The restricted tongue can make it difficult to play a wind instrument or to clean food off of the teeth with the tongue. A child with tongue-tie may be ridiculed by peers.

How is tongue-tie diagnosed?

Tongue-tie usually is diagnosed by a physical exam of the mouth and by the baby's symptoms. The health professional lifts the baby's tongue to see whether the lingual frenulum is short and to see how far it extends to the tip of the tongue. In an older child or adult, the health professional observes the shape and movements of the tongue when it is protruded.

How is it treated?

Many children with tongue-tie adapt to the tongue restriction, or the lingual frenulum stretches as they grow. If your child has tongue-tie, you may choose to wait and see whether his or her lingual frenulum stretches on its own or whether surgery may be needed to release the tongue.

Surgery may be needed if your child has significant breast-feeding, speech, or personal or social problems caused by the tongue restriction. If surgery is done before 1 year of age, a procedure to clip the lingual frenulum (frenotomy) is usually all that is needed to release the tongue. If surgery is done after 1 or 2 years of age, a procedure that clips the lingual frenulum and closes the wound with stitches (frenuloplasty) may be required.

Frequently Asked Questions

Learning about tongue-tie:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with a child with tongue-tie:

Symptoms

Some experts believe that tongue-tie does not cause symptoms. Others believe that it can lead to feeding difficulties, changes in speech, and personal or social problems related to restricted tongue movements.

Babies

A breast-fed baby with tongue-tie may have:

  • Difficulty latching on to the breast and sucking, which may cause your nipples to become sore.
  • Poor weight gain, because the baby gets tired and stops sucking before he or she is full.

A breast-fed baby must use his or her tongue to move the milk from the milk glands of the breast into the nipple. A bottle-fed baby with tongue-tie usually does not have any feeding problems, because it generally is easy to get milk from the nipple of a bottle.

When on solid food, a baby with tongue-tie usually does not have any feeding problems.

Children

Children with only partial attachment of the tongue to the bottom of the mouth may have no problems related to tongue-tie. The lingual frenulum may stretch as the child grows, or the child may adapt well to the restricted tongue movements.

Some children with tongue-tie develop speech problems. They may have difficulty making (articulating) the sounds that require the tip of the tongue to rise, such as t, d, z, s, th, n, and l. To articulate these sounds, your child may keep his or her mouth opening small and alter the tongue placement.

You also may notice that your child with tongue-tie:

  • Has a space between the front lower teeth where the lingual frenulum protrudes during speech.
  • Cannot lick his or her lips, lick an ice cream cone, or use the tongue to remove food from the teeth.
  • Complains of discomfort or cuts under the tongue.
  • Has a notched or heart-shaped tongue when it protrudes.
  • Has difficulty playing a wind instrument.

Your child may feel embarrassed or be ridiculed by other children because of this condition.

Adults

Tongue-tie is rarely seen in adults, and it generally does not cause problems. An adult with tongue-tie may:

  • Not be able to protrude the tongue beyond the lower teeth.
  • Have difficulty wearing dentures because of poor fit.

Exams and Tests

Diagnosis of tongue-tie is usually based on a physical exam and any symptoms your baby may have. To check for tongue-tie, the health professional may:

  • Lift your baby's tongue and examine the tissue that attaches the tongue to the bottom of the mouth (lingual frenulum). The lingual frenulum may be thick or thin and may extend to the tip of the tongue.
  • Measure the strength of your baby's suck by inserting a finger into the baby's mouth and noting how hard he or she sucks on it.
  • Weigh your baby and determine whether he or she weighs less than expected.
  • Ask whether you have sore nipples.
  • Watch you breast-feed to see how well your baby latches on and sucks.

Older children or adults

To diagnose tongue-tie in an older child or an adult, the health professional examines the mouth for:

  • Restricted tongue movement. The health professional may measure the tongue's protrusion beyond the lower teeth. This measurement may be used as a comparison after tongue-tie surgery. The health professional looks for difficulty lifting the tongue to the upper teeth and upper lip and for limited side-to-side tongue movement.
  • Abnormal spacing between the front lower teeth. The space may be caused by rubbing of the lingual frenulum during protrusion of the tongue.
  • A notched or heart-shaped tongue when protruded. The tongue may roll or curl when the person tries to protrude it.

Other tests

  • If your baby is primarily having breast-feeding difficulties, evaluation by a lactation consultant may be required. The lactation consultant may be able to help teach you how to assist your baby in latching on and sucking effectively.
  • If your child is having speech problems, evaluation by a speech therapist may be required. The speech therapist may be able to rule out other conditions that could be causing the speech problem.

Treatment Overview

Many children with tongue-tie do not need treatment, because the tissue underneath the tongue (lingual frenulum) stretches as the child grows and adapts to the tongue restriction. But some children with tongue-tie may need surgery to release the tissue.

What can be done?

If your child has been diagnosed with tongue-tie, you can choose to wait and see if the lingual frenulum stretches or if your child adapts to the tongue restriction. You can:

  • Talk to a lactation consultant if you are having breast-feeding problems. The consultant can teach you techniques to help your baby latch on and suck effectively.
  • Try speech therapy if your child is having difficulty making (articulating) the t, d, z, s, th, n, and l sounds. A speech therapist may help your child learn to make these sounds more clearly, but speech therapy will not correct tongue-tie.

When is surgery indicated?

Surgery is recommended if tongue-tie causes:1

  • Significant latching on and sucking problems in your breast-fed baby.
  • Difficulty making (articulating) the t, d, z, s, th, n, and l sounds as your young child learns to speak.
  • Personal or social difficulties, such as if your school-aged child is being ridiculed by other children or if an adult is having difficulty wearing dentures.

Two types of surgery can be done for tongue-tie. The surgeries are:

  • A procedure called frenotomy to release the lingual frenulum. Frenotomy can be done without anesthesia or with local anesthesia. This is the preferred surgery for babies with tongue-tie.
  • The complete release and repair of the attached tongue (frenuloplasty). Frenuloplasty requires local or general anesthesia. This procedure is preferred for children older than 1 to 2 years.

What To Think About

The appropriate age for a child to have surgery for tongue-tie is controversial.1

  • Some experts believe that surgery should be done before speech problems develop.
  • Others believe that surgery should be delayed until the child is 4 years old and should be done only on children with speech difficulties. But delaying surgery may result in the child needing speech therapy after surgery to correct any altered speech patterns.

Home Treatment

Home treatment may be all that is needed for your child with tongue-tie. The tissue underneath the tongue (lingual frenulum) may stretch on its own, or your child may adapt to the restricted tongue movement.

For breast-feeding problems

If you are breast-feeding your baby, talk with a lactation consultant to learn how to help your baby latch on and suck effectively. You also will want to be sure that your baby is getting enough milk and growing well.

If your breast nipples are sore or tender:

  • Apply cool compresses to your nipples before nursing, or take a small amount of acetaminophen (Tylenol) about 30 minutes before nursing your baby.
  • Start nursing on the side that is less sore for the first few minutes, then switch to the other side. The first sucking is the most active.
  • Change your baby's position with each feeding. This may reduce pressure from the baby's mouth on the same part of the breast.

For speech problems

If your child develops speech problems, ask your health professional about having him or her evaluated by a speech therapist. If the speech difficulty is believed to be caused by tongue-tie, you may want to consider surgery to release the tongue. Some experts believe that tongue-tie surgery should not be done until the child is 4 years old. Others believe that surgery should be done earlier to prevent speech problems and the possible need for speech therapy after surgery.

For your child following surgery

If your baby has a release of the lingual frenulum (frenotomy), you may notice some slight bleeding after the procedure. You can give your baby acetaminophen (Tylenol) for any discomfort. Follow all instructions on the label. If you give medicine to your baby, follow your doctor’s advice about what amount to give.

If your child has frenuloplasty, he or she will have stitches on the underside of the tongue. After surgery, your child may be instructed to do some tongue exercises several times a day for 4 to 6 weeks. These will help improve tongue mobility and prevent scar tissue formation.

Even children who have not had surgery may be taught tongue exercises if they have mild problems from tongue-tie.

Other Places To Get Help

Organizations

American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)
1650 Diagonal Road
Alexandria, VA  22314-2857
Phone: (703) 836-4444
Web Address: www.entnet.org
 

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) is the world's largest organization of physicians dedicated to the care of ear, nose, and throat (ENT) disorders. Its Web site includes information for the general public on ENT disorders.


KidsGrowth.com: Pediatric Health Care Alliance, P.A.
P.O. Box 1068
Oldsmar, FL  34677
Phone: (813) 854-2003
Web Address: www.kidsgrowth.com
 

The KidsGrowth Web site, created by pediatricians, has children's health resources for parents and teens. It offers a free newsletter and information about child development, behavioral issues, and illnesses. The TeenGrowth interactive Web site (www.teengrowth.com) offers a secure environment for teens to get valuable information on topics such as alcohol, drugs, emotions, health, family, friends, school, sex, and sports.


La Leche League International (LLLI)
P.O. Box 4079
Schaumburg, IL  60168-4079
Phone: 1-800-LA-LECHE (1-800-525-3243)
(847) 519-7730
Fax: (847) 969-0460
TDD: (847) 592-7570
Web Address: www.llli.org
 

La Leche League International (LLLI) offers information and encouragement—mainly through personal help—to all mothers who want to breast-feed their babies. It also offers support and information about breast-feeding babies with various disabilities, such as cleft lip or cleft palate. Call for information about a chapter in your area.


References

Citations

  1. Lalakea ML, Messner AH (2003). Ankyloglossia: Does it matter? Pediatric Clinics of North America, 50(2): 381–397.

Other Works Consulted

  • Breward S (2006). Tongue tie and breastfeeding: Assessing and overcoming the difficulties. Community Practice, 79(9): 298–299.
  • Hall DMB, Renfrew MJ (2005). Tongue tie. Archives of Disease in Childhood, 90(12): 1211–1215. [Erratum in Archives of Disease in Childhood, 91(9): 797.]

Credits

Author Debby Golonka, MPH
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Terrina Vail
Primary Medical Reviewer Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
Last Updated August 20, 2009

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