A tongue tie (ankyloglossia) is a condition some babies are born with that restricts the tongue’s range of motion. Examples include being unable to push the tongue past the lower teeth or having trouble moving the tongue side to side.

The term describes any band of tissue underneath the tongue that is short, tight, or stiff. Tongue ties sometimes prevent a baby’s tongue from latching properly to their mother’s breast.

Anterior tongue ties are easy to locate and see because they are near a baby’s gumline when they raise their tongue.

A posterior tongue tie is located deeper in the mouth, further underneath the tongue. A posterior tongue tie can cause the same problems as an anterior tongue tie, even though it isn’t as easily visible.

Some doctors use a classification system when referring to tongue ties. Anterior tongue ties may be referred to as type I and type II. Posterior tongue ties may be referred to as type III or type IV.

Tongue tie affects up to 11 percent of newborn babies. Many babies born with tongue tie don’t have any symptoms or complications. Others need speech therapy or an outpatient surgical treatment to release the tongue tie.

Posterior tongue tie is sometimes more difficult to see underneath the tongue than anterior tongue tie. Otherwise, the symptoms for both types of tongue tie are the same. By gently lifting the tongue up with a flashlight while you hold your baby’s head still, you may be able to spot a thin band of red tissue that holds the tongue close to the bottom of your baby’s mouth.

Another possible symptom is difficulty breastfeeding, as indicated by:

  • trouble latching on to the breast
  • constant hunger
  • colic
  • fussiness
  • slow weight gain or lack of weight gain

Painful breastfeeding may affect a mother who is breastfeeding a baby with a tongue tie, leading to:

Other symptoms of a tongue tie may appear after a baby has been weaned. The baby may have delayed speech or difficulty making certain sounds, challenges eating certain foods (like licking ice cream), and issues in maintaining oral hygiene.

Researchers don’t know if there is a direct cause of tongue tie. But there are some known risk factors.

Tongue tie may run in families, so there could be a genetic component, as demonstrated by researchers on a .

Tongue tie is more common in newborn boys than girls.

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Image via Kumar RG, associate professor, Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India

Feeding

The main complication of a tongue tie is difficulty breastfeeding. Children with a tongue tie may have difficulty getting a strong latch on their mother’s breast. A baby has a natural-born instinct to use suction to attach to a mother’s nipple. But when tongue mobility is limited, this suction can be hard to achieve.

Even bottle-feeding can be difficult for children with a tongue tie. As your baby starts to eat solid foods using a baby spoon, foods that require licking or slurping can present an obstacle.

Speech and dental problems

After a child grows older, a tongue tie can still create complications. A tongue tie can affect development, changing the way that a baby learns to speak and swallow.

A tongue tie keeps the tongue in a position closer to the bottom of the mouth. For that reason, children with a tongue tie may be more likely to develop a gap between their lower front teeth as they mature.

The most common symptom of tongue tie, trouble feeding, can have numerous other underlying causes.

In addition to seeing your child’s pediatrician, speak with a lactation consultant. Many feeding problems are related to causes other than tongue tie, so the first step should be an overall evaluation of feeding and latch.

A doctor may suspect a tongue tie right away if your child is having trouble gaining weight or if you’re having trouble breastfeeding. But some pediatricians might need you to specifically suggest the possibility before they evaluate your child for tongue tie.

A pediatrician, midwife, or lactation consultant should be able to diagnose a tongue tie with a simple in-office observation.

If your child has a tongue tie, there are several treatment options.

A lactation consultant may be able to help you work around the tongue tie using breastfeeding positions or techniques that minimize your pain and help your child get the nourishment they need.

Your child’s pediatrician may recommend supplementing with formula to help with weight gain while you attempt to breastfeed around the tongue tie.

A speech language pathologist may be able to recommend certain exercises to release the tongue tie gradually, stretching the connective tissue (frenulum) until tongue mobility is reached.

The most common treatment option is a surgical procedure called a frenotomy. When performed on a child younger than 6 months old, a frenotomy doesn’t even require anesthesia. Using a surgical knife or a sterilized scissor, the tongue tie is “released” by clipping the tissue underneath the tongue. This procedure is simple and presents very little risk.

In one study of children with anterior and posterior tongue ties who had a frenotomy, were able to successfully breastfeed after the procedure.

As children reach 4 or 5 years of age, the shape of their mouths starts to change dramatically. At that point, any symptoms of a tongue tie may begin to disappear. If you elect not to have a frenotomy for your child, chances are that they won’t have lasting side effects beyond infancy and early childhood.

If you experience significant ongoing pain while breastfeeding or your baby isn’t gaining weight at the recommended rate, it’s time to seek medical help.

See a doctor if:

  • you suspect you may have an undiagnosed tongue tie
  • your older child complains of difficulty moving their tongue, eating, swallowing, or speaking
  • your baby is showing symptoms of a tongue tie, including colic and slow weight gain
  • breastfeeding your baby is difficult or painful every time you nurse

A tongue tie isn’t uncommon in newborn babies. Though many babies with tongue tie have no symptoms, this congenital condition can sometimes make breastfeeding difficult and may contribute to speech difficulties later in life.

Tongue ties in babies are easy to correct, and most babies who have frenotomies are able to breastfeed successfully afterward.

Speak to a doctor if you have any concerns about breastfeeding, your baby’s ability to breastfeed, weight gain, or speech delays.