Tongue-tie is difficulty moving the tongue because of attachment of tissue too close to the tip of the tongue or tight tissue under the tongue. The limited movement can make it difficult to breast feed. The degree of limitation can vary from infant to infanton.
Tongue-tie is present at birth.
A tissue called the frenulum helps the development of the mouth before and shortly after birth. This frenulum is attached to the underside of the tongue. After birth the frenulum should start to shrink and loosen its hold on the tongue.
In some, the frenulum does not shrink as expected. The exact reason is not clear but it may be associated with genetics.
Tongue-tie is more common in boys. It may also be more likely if other family members have had it.
Symptoms will depend on the degree of limitation. Most children with tongue-tie won’t have symptoms.
In those that have symptoms, tongue-tie may cause problems with latching on to the nipple during breast feeding.
Tongue-tie can be diagnosed with a routine physical exam. There are also ways to estimate how severe it is.
Discuss your treatment preferences and options with your child’s doctor.
If there are no severe functional issues, your child’s doctor may recommend watchful waiting. Over time, the frenulum will loosen on its own.
The frenulum may be surgically corrected if there is very limited movement in the tongue associated difficulty breast feeding and gaining weight. Options include:
These surgeries can often be done in the doctor’s office.
American Academy of Otolaryngology—Head and Neck Surgery
Healthy Children—American Academy of Pediatrics
Canadian Society of Otolaryngology—Head and Neck Surgery
Caring for Kids—Canadian Paediatric Society
Ballard JL, Auer CE, et al. Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110(5):e63.
Hathaway A, McCauley R. Assessment and management of tongue-tie in children: A survey of related professionals. American Speech Language Hearing Association website. Available at: http://search.asha.org/default.aspx?q=tongue-tie. Accessed November 10, 2015.
Kummer A. Ankyloglossia: To clip or not to clip? That’s the question. American Speech Language Hearing Association website. Available at: http://www.asha.org/Publications/leader/2005/051227/f051227a.htm. Published December 27, 2005. Accessed November 10, 2015.
Lalakea ML, Messner AH. Ankyloglossia: Does it matter? Pediatr Clin North Amer. 2003;50(2):391-397.
Neonatal ankyloglossia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114501/Neonatal-ankyloglossia. Updated April 17, 2017. Accessed April 24, 2017.
Tongue-tie. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/?q=node/1413. Accessed November 10, 2015.
4/24/2017 DynaMed Plus Systematic Literature Review http://www.dynamed.com/topics/dmp~AN~T114501/Neonatal-ankyloglossia: O'Shea JE, Foster JP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017 Mar 11;3:CD011065.
Last reviewed April 2017 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.