Tongue tie

The tongue is connected to the bottom of the mouth by a band of tissue called the lingual frenulum. In people with tongue tie, this band is overly short and thick. The exact cause of tongue tie is not known. Your genes may play a role. The problem tends to run in some families.

In a newborn or infant, the symptoms of tongue tie are similar to the symptoms in a child who is having problems with breastfeeding. Symptoms may include:

• Acting irritable or fussy, even after feeding.
• Difficulty creating or keeping suction on the nipple. The infant may become tired in 1 or 2 minutes, or fall asleep before eating enough.
• Poor weight gain or weight loss.
• Problems latching onto the nipple. The infant may just chew on the nipple instead.
• There may be speech and pronunciation difficulties in older children.

The breastfeeding mother may have problems with breast pain, plugged milk ducts, or painful breasts, and may feel frustrated.

Most experts do not recommend that health care providers examine newborns for tongue tie unless there are breastfeeding problems.

Most providers only consider tongue tie when:

• The mother and baby have had problems starting breastfeeding.
• The mother has received at least 2 to 3 days of support from a breastfeeding (lactation) specialist.

Most breastfeeding problems can be managed easily. A person who specializes in breastfeeding (lactation consultant) can help with breastfeeding issues.

Tongue tie surgery, called a frenulotomy, is rarely needed. The surgery involves cutting and releasing the tethered frenulum under the tongue. It is most often done in the surgeon's office. Infection or bleeding afterward is possible, but rare.

Surgery for more severe cases or for older children is done in a hospital operating room. A surgical procedure called a z-plasty closure may be needed to prevent scar tissue from forming.

On rare occasions, tongue tie has been linked to problems with tooth development, swallowing, or speech.

Ankyloglossia

Dhar V. Common lesions of the oral soft tissues. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 341.

Lawrence RA, Lawrence RM. ABM clinical protocol #11: guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad: The Academy of Breastfeeding Medicine: ABM Protocols. In: Lawrence RA, Lawrence RM, eds. Breastfeeding: A Guide for the Medical Profession. 9th ed. Philadelphia, PA: Elsevier; 2022:870-873.

Newkirk GR, Newkirk MJ. Tongue-tie snipping (frenotomy) for ankyloglossia. In: Fowler GC, eds. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 169.

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.