Tongue-Tie

Topic Overview

What is tongue-tie?

Tongue-tie (ankyloglossia) is a birth defect in which the tissue that attaches the tongue to the bottom of the mouth (lingual frenulum) is abnormally short. Movements of the tongue may be restricted, depending on the degree of attachment to the mouth.

See a picture comparing a normal lingual frenulum with tongue-tie .

What causes tongue-tie?

Tongue-tie is an inherited birth defect. Usually the mother or father or a close relative also had the condition.

Most often a baby with tongue-tie does not have other birth defects. But tongue-tie occurs more frequently in babies whose mothers abused cocaine during pregnancy and in babies with other congenital conditions that affect the mouth and face, such as X-linked cleft palate.

What are the symptoms?

Many babies with tongue-tie do not have symptoms. The lingual frenulum stretches as the child grows or adapts to the tongue restriction. But some children with tongue-tie have:

• Trouble latching on to the mother's breast and sucking, because the tongue cannot move milk from the milk glands of the breast to the nipple. Bottle-fed babies usually do not have feeding problems, because it is easy to get milk from the nipple of a bottle.
• Speech problems, because the tip of the tongue cannot rise high enough to make (articulate) some sounds clearly, such as t, d, z, s, th, n, and l.
• Personal or social problems related to the restricted tongue movement. The restricted tongue can make it difficult to play a wind instrument or to clean food off of the teeth with the tongue. A child with tongue-tie may be ridiculed by peers.

How is tongue-tie diagnosed?

Tongue-tie usually is diagnosed by a physical exam of the mouth and by the baby's symptoms. The health professional lifts the baby's tongue to see whether the lingual frenulum is short and to see how far it extends to the tip of the tongue. In an older child or adult, the health professional observes the shape and movements of the tongue when it is protruded.

How is it treated?

Many children with tongue-tie adapt to the tongue restriction, or the lingual frenulum stretches as they grow. If your child has tongue-tie, you may choose to wait and see whether his or her lingual frenulum stretches on its own or whether surgery may be needed to release the tongue.

Surgery may be needed if your child has significant breast-feeding, speech, or personal or social problems caused by the tongue restriction. If surgery is done before 1 year of age, a procedure to clip the lingual frenulum (frenotomy) is usually all that is needed to release the tongue. If surgery is done after 1 or 2 years of age, a procedure that clips the lingual frenulum and closes the wound with stitches (frenuloplasty) may be required.

Frequently Asked Questions

Learning about tongue-tie:	What is tongue-tie? What causes it? What are the symptoms? Who is affected?
Being diagnosed:	How is tongue-tie diagnosed?
Getting treatment:	How is tongue-tie treated? What is a frenotomy? What is frenuloplasty? When is surgery needed? At what age should my child have surgery?
Ongoing concerns:	What kind of problems can my child have?
Living with a child with tongue-tie:	What can I do if I choose to watch and wait? What care does my child need after tongue-tie surgery?

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Author:	Debby Golonka, MPH	Last Updated: September 6, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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