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Understanding Tongue-Tie: Causes, Symptoms, and Treatment Options

Oghenefejiro Okifo | MD

Medically reviewed by Oghenefejiro Okifo | MD, Harvard Medical School | Henry Ford Hospital - Detroit, MI on November 16th, 2023.

Key Takeaways

  • The lingual frenulum—tissue connecting tongue to mouth floor—is abnormally short or thick in 4-11% of newborns, with males affected twice as often as females.
  • Infants may feed for over 45 minutes per session, fail to gain weight properly, or cause maternal nipple pain and damage due to poor latch mechanics.
  • Speech difficulties typically emerge around age 3-4, particularly with sounds requiring tongue-tip elevation like "t," "d," "l," and "r"—though many children compensate naturally.
  • Frenotomy, a simple 2-minute office procedure using scissors or laser, provides immediate relief in 80-90% of cases with minimal bleeding or discomfort.
  • Watchful waiting is appropriate for mild cases since many resolve by age 3 as the frenulum naturally stretches and oral motor skills develop.

Tongue-tie, also known as ankyloglossia, is a condition some babies are born with that limits their tongue movements. The tongue is attached to the floor of the mouth by a thin stretch of tissue called the lingual frenulum. In tongue-tie, this frenulum is unusually short, thick, or tight, restricting the tongue's range of motion.

What Causes Tongue-Tie?

During fetal development, the lingual frenulum is stuck to the tongue. Normally, the membrane thins and separates from the tongue before birth, allowing free range of motion. In some cases, this separation doesn't occur, leading to tongue-tie. The exact cause is unknown, but it may run in families. Male infants are about twice as likely to be tongue-tied as female ones, and it's more common in first-born babies.

Symptoms of Tongue-Tie

Tongue-tie is often discovered due to breastfeeding problems. Signs of tongue-tie in babies include:

  • Difficulty latching

  • Chewing instead of sucking

  • Poor weight gain

  • Prolonged feeding sessions

  • Fussiness during feeding

  • Clicking sounds while feeding

  • Seeming constantly hungry

Mothers may experience painful breastfeeding, sore or cracked nipples, mastitis, and low milk supply.

In children, tongue-tie may cause:

  • Difficulty pronouncing certain sounds (t, th, d, r, l, and s)

  • Trouble swallowing or moving the tongue from side to side

  • Difficulty licking an ice cream cone or playing a wind instrument

Understanding Tongue-Tie: Causes, Symptoms, and Treatment Options

Diagnosing Tongue-Tie

A physical exam is sufficient to diagnose tongue-tie. The doctor will ask about feeding, check the baby's tongue, mouth, and teeth, and use a tongue depressor to assess the range of motion. In older children, the doctor may ask them to move their tongue and make certain sounds.

Treatment Options for Tongue-Tie

Treatment for tongue-tie depends on the severity and the child's age. Some doctors prefer a wait-and-see approach, as the frenulum may loosen on its own. Others recommend immediate treatment. Surgical options include:

  • Frenotomy: A simple procedure where the frenulum is clipped using scissors.

  • Frenectomy: Similar to a frenotomy, but the frenulum is completely removed.

  • Frenuloplasty: A more complex procedure for thicker frenulums or when additional repair is needed.

In some cases, doctors may recommend speech therapy or lactation consultation before considering surgery.

Risks and Complications

Surgical treatments for tongue-tie are generally successful, with rare complications such as bleeding, infection, or damage to the tongue or salivary glands. Untreated tongue-tie may lead to dental problems, excessive drooling, gagging or choking on foods, difficulty with basic activities like licking an ice cream cone or kissing, and speech issues.

When to Seek Help

If you suspect your baby has tongue-tie or are experiencing breastfeeding difficulties, consult your pediatrician. They can assess your child's condition and recommend the appropriate treatment. Remember, each case is unique, and not all instances of tongue-tie require correction.

For more information on tongue-tie, visit:

The Bottom Line

Most feeding difficulties from tongue-tie resolve within days of frenotomy, while untreated severe cases can lead to persistent speech therapy needs and dental problems. Early evaluation by a pediatrician or lactation consultant helps determine if intervention is necessary. If you're struggling with breastfeeding issues or concerned about your child's speech development, Doctronic can connect you with specialists for proper assessment.

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