What is Tongue Tie (ankyloglossia)

Tongue tie is when the tongue cannot move freely in the mouth. This is because the band of tissue that connects the tongue to the floor of the mouth (lingual frenulum or frenulum) is too short or too tight.

This band of tissue should be thin enough and long enough to allow the tongue to move freely in all directions. When this band is too thick or too short, it can prevent the tongue from moving normally.

What are the causes?

It is not known why the tongue develops this way.

What increases the risk?

Your child is more likely to have tongue tie if there is a family history of the condition.

What are the signs or symptoms?

Symptoms of tongue tie look different for infants than they do for older children. An infant may have:

• Problems sucking during breastfeeding or bottle-feeding.
• Problems latching onto the nipple.
• Irritability during or after feeding.
• Poor weight gain due to difficulty feeding. Weight loss may occur in severe cases.

The infant’s mother may have pain, bleeding, or sores on her nipples from breastfeeding.

An older child may:

• Have problems learning to speak.
• Have difficulty being understood while speaking. This may be due to:
  • An inability to pronounce certain sounds or letters.
  • Slurred speech.
• Have a large gap between the bottom front teeth.
• Have a small nick or notch at the tip of the tongue.
• Have difficulty chewing certain foods.
• Gag, choke, or vomit while eating certain foods.
• Have limited motion of his or her tongue. Your child may not be able to:
  • Move the tongue from one side to the other.
  • Stick out the tongue.
  • Touch the roof of the mouth with the tongue.

How is this diagnosed?

This condition is diagnosed based on:

• Your child’s symptoms and medical history.
• A physical exam.

How is this treated?

Many children with tongue tie are able to eat normally, so they may not need treatment. However, children with severe symptoms may need a procedure to make a small cut in the frenulum (frenulotomy). This allows the tongue to move freely. Your child’s health care provider may also recommend:

• Speech therapy.
• Feeding therapy. This may include working with a lactation consultant to help with breastfeeding.

Follow these instructions at home:

• Make sure that your child is eating enough to stay healthy. To do this:
  • Work with a dietitian or lactation consultant as recommended by your child’s health care provider.
  • Know how much your child should weigh for his or her age, and how much weight gain to expect. Ask your child’s health care provider for this information.
  • Keep a journal of your child’s eating habits. This will help you watch for any sudden changes.
  • Know how often your child should be wetting or soiling diapers or going to the bathroom. Ask your child’s health care provider for this information.
• Keep all follow-up visits as told by your child’s health care providers and therapists. This is important.

Contact a health care provider if your child:

• Is not gaining enough weight or loses weight.
• Has difficulty eating.
• Chokes, gags, or vomits when eating food.

Get help right away if your child:

• Will not feed.
• Is not wetting or soiling diapers as often as your health care provider told you to expect.

Summary

• Tongue tie (ankyloglossia) is when the tongue cannot move freely in the mouth because the band of tissue that connects the tongue to the floor of the mouth (lingual frenulum or frenulum) is too short or too tight. This keeps the tongue from moving normally.
• This condition is diagnosed based on a physical exam as well as your child’s symptoms and medical history.
• Many children with tongue tie will not need treatment if they can eat properly.
• For children with a more severe case, a health care provider may make a small cut in the frenulum so the tongue can move freely.