What Is Tongue-Tie in Babies and How Is It Treated?

Tongue-tie, also called ankyloglossia, is a condition where the tissue under the tongue limits how well the tongue can move.¹ In babies, this can sometimes affect breastfeeding, especially latch, milk transfer, and nipple pain for the breastfeeding parent.^1,4

Over the last decade, increased awareness of the benefits of breastfeeding has also brought more attention to tongue-tie and its potential impact on feeding.³ While many lactation consultants identify tongue-tie as a possible contributor to breastfeeding challenges, pediatricians, breastfeeding medicine physicians, and otolaryngologists (ENTs) do not always agree on when tongue-tie is the primary cause or when treatment is necessary.⁶

Not every baby with tongue-tie needs treatment. Some babies breastfeed well with positioning and latch support, while others may benefit from evaluation by a pediatrician, IBCLC, pediatric dentist, or ENT.¹ Here’s what to know about tongue-tie in babies, what it can look like, how it may affect feeding, and when treatment may be recommended.

What Is Tongue-Tie?

The lingual frenulum is a piece of flexible tissue that connects the underside of the tongue to the floor of the mouth. Tongue-tie (or ankyloglossia) is when the ordinarily present lingual frenulum limits the function and mobility of the tongue to some degree.¹

The frenulum’s shortness and tightness will determine the tongue-tie severity.³ This condition may be identified during infancy or remain unevaluated or discovered later in life. Approximately 10% of newborns have some degree of tongue-tie at birth. Interestingly, only up to 2% of adults have it, suggesting that it may resolve independently.¹

Related: 7 Breastfeeding Discomforts and How To Manage Them

What Does Tongue-Tie Look Like?

Currently, there’s no standard tool for assessing and classifying tongue-tie, but several suggestions exist. Whatever assessment tool your doctor uses, impaired mobility and tongue function are defining features. Clinicians lack agreement on when and what treatment is necessary.¹ Additional research is in the works to establish a consistent system for the future.

Classic (or anterior) ankyloglossia is when the lingual frenulum attaches at or close to the tip of the tongue. In posterior tongue-tie, the frenulum tightly attaches further back on the tongue.¹ Both situations limit the tongue’s range of motion.

What Causes Tongue-Tie?

Experts don’t actually know the cause of ankyloglossia. While this condition can be associated with some rare syndromes, most ankyloglossia cases are seen in children and adults regardless of illness or disorder. Treatment is often recommended if tongue-tie is causing issues with breastfeeding, speech, licking, or kissing, or causing mouth discomfort.¹

Possible Complications of Tongue-Tie

Tongue movement plays a role in feeding, swallowing, speech, and oral comfort, so tongue-tie may cause problems for some babies and children. The tongue is a muscle that’s critical for breathing, taste, speech, digestion, and swallowing. Untreated tongue-tie can cause complications in these areas.²

Related: 6 Rules for a Better Breastfeeding Latch

How Tongue-Tie Can Affect Breastfeeding

Breastfeeding problems are one of the most common reasons parents first hear about tongue-tie. During breastfeeding, a baby must stretch their tongue over the lower gum with their mouth wide open.4 Once the baby is suckling, the jaw muscles move rhythmically. Meanwhile, the tongue cups the breast to massage and compress the milk ducts, creating a vacuum that delivers milk into the baby’s mouth.⁵

Tongue-tie may result in breastfeeding difficulties. However, it’s important to note that many infants with this condition can successfully breastfeed with correct positioning and latch.⁴

A lactation consultant, pediatrician, pediatric dentist, or ENT can help determine whether tongue-tie is contributing to feeding challenges and what support may be appropriate.¹ Your provider(s) will thoroughly evaluate your breastfeeding experience to determine the impact of your baby’s tongue-tie.

Newborns may have the following symptoms:^2,4

• Unable to latch or poor latch
• Short intervals between feedings or seemingly constant feeding
• Clicking sounds during feeding due to lost suction
• Feeding irritability
• Inability to breastfeed

The breastfeeding parent may experience:⁴

• Pain during breastfeeding related to damaged nipples
• Engorgement that can lead to mastitis
• Decreased or increased milk production
• Discontinuation of breastfeeding

Related: Engorgement and Cracked Nipples: 11 Ways To Find Relief

How Is Tongue-Tie Treated?

Treatment depends on symptoms, tongue function, feeding concerns, and the provider’s assessment.

There’s a lack of concrete evidence to guide the management and treatment of this condition. Treatment decisions are based on provider experience and symptoms. A frenotomy is the cutting of the frenulum with scissors or a laser, which is the most common procedure for tongue-tie treatment in children.³ More significant tongue-ties may require a frenectomy, an oral surgery involving the removal of frenum tissue, or a frenuloplasty, the release and repositioning of frenulum tissue.²

A frenotomy is usually performed in the provider’s office. The procedure can be achieved with or without a topical anesthetic using scissors, laser, or electrocautery to snip the frenulum tissue.³ This procedure may restore tongue mobility, improve latch, and decrease parental nipple pain.⁶ Discomfort or pain is minimal with this quick procedure.⁴

Because feeding challenges can have multiple contributing factors, providers should discuss the concerns prompting treatment and continue to offer breastfeeding support after the procedure. The inside of a baby’s mouth typically heals very quickly. You will be encouraged to breastfeed immediately to help with comfort.

The Bottom Line

Tongue-tie is fairly common, but not every baby with tongue-tie needs treatment. If your baby is struggling to latch, feed effectively, gain weight, or breastfeeding is painful for you, it’s worth asking for a full feeding evaluation. An IBCLC, pediatrician, pediatric dentist, or ENT can help you understand whether tongue-tie is part of the problem and what treatment, if any, makes sense for your baby.