Tongue Tie (Ankyloglossia )

What Is Tongue Tie?

Tongue tie is when a band of tissue connects the underside of the tongue to the floor of the mouth, which keeps it from moving freely. Normally, the tongue can move out past the lower lip and reach up to the hard palate (roof of the mouth).

The fold of tissue under the tongue where it’s attached is called the frenulum (FREN-yuh-lum).

What Happens in Tongue Tie?

Tongue tie, also called ankyloglossia (ang-kuh-loe-GLOSS-ee-uh), forms before a baby is born. Usually, as the baby develops, the connection between the front of the tongue and the floor of the mouth goes away. The back of the tongue stays attached.

Sometimes, the frenulum might be too short or too tight. It might stay near the front of the tongue and tie the tip of the tongue to the floor of the mouth.

Tongue tie can range from mild, with only a tiny fold of tissue holding the tip of the tongue, to severe, in which the entire bottom of the tongue connects to the floor of the mouth. This is called an anterior tongue tie. There can also be posterior tongue ties where a thick, tight frenulum near the base of the tongue restricts its motion.

What Causes Tongue Tie?

Doctors don’t know what causes the tongue and frenulum to form differently in a child with tongue tie. The condition sometimes runs in families, and is more common in boys than girls.

What Are the Signs & Symptoms of Tongue Tie?

Problems with tongue tie can vary depending on a child’s age. Newborns may have trouble breastfeeding because they can’t get a good latch onto the breast or nurse well. Symptoms of tongue tie can include a weak latch, easy loss of latch, gumming or biting the nipple, and nipple pain or injury in breastfeeding moms.

Older kids may have trouble speaking clearly and can’t stick their tongue out past their teeth.

Kids with tongue tie may also:

• get cuts under the tongue when the frenulum gets caught between the lower front teeth
• have tooth decay because they can’t clear food from their teeth with their tongue
  

Tongue tie can make it hard for kids to:

• speak clearly or say certain sounds (d, l, t, th, etc.)
• lick their lips
• move their tongue to do things like lick an ice cream cone
• play wind instruments

How Is Tongue Tie Diagnosed?

To diagnose tongue tie, doctors will check to see if the frenulum is restricting how well the tongue can move and listen to the child speak.

How Is Tongue Tie Treated?

Kids who don’t have any symptoms or problems from tongue tie don’t need treatment. The frenulum can stretch as a child grows. The stretching may give the tongue enough freedom to move normally and let the child speak clearly.

If a baby with tongue tie has trouble breastfeeding, the care team will try to solve the problem without surgery. The team may include:

• the child’s pediatrician
• an ear, nose, and throat specialist (ENT)
• a lactation nurse or consultant
• a speech-language therapist

If surgery is needed, the ENT can do a:

• frenotomy (freh-NOT-uh-mee) or frenulectomy (fren-yuh-LEK-tuh-mee): The doctor snips the frenulum with a scalpel, laser, or scissors. This simple, quick procedure often is done without anesthesia in young babies because the area has few nerve endings or blood vessels. It's safe to do this in an outpatient office setting.
• frenuloplasty (FREN-yuh-lo-plass-tee): For older children or if the frenulum is too thick for a simple frenotomy, the doctor will do surgery to free it. The child gets general anesthesia to sleep through the procedure and not feel pain. If stitches are used to close the incision, they will dissolve on their own.

What Else Should I Know?

Tongue tie won’t prevent a child from speaking, but it can make it hard for them to speak clearly. For example, a child's vocabulary might be age-appropriate, but their speech is hard to understand.

A speech-language pathologist can work with a child who has trouble speaking clearly. Sometimes, kids can work through a problem or it might go away as they grow. In some cases, surgery is the best option.

Symptoms can come and go as kids grow. A tongue tie that caused no trouble through early childhood may become a problem for older kids or teens who want to play a wind instrument or are frustrated or embarrassed because they can’t stick out their tongue.