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.
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 cleft palate.
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:
Tongue-tie usually is diagnosed by a physical examination 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.
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:
Living with a child with tongue-tie:
Some experts believe that tongue-tie does not cause symptoms. Others believe that it can lead to feeding difficulties, changes in speech, and personal or social problems related to restricted tongue movements.
A breast-fed baby with tongue-tie may have:
A breast-fed baby must use his or her tongue to move the milk from the milk glands of the breast into the nipple. A bottle-fed baby with tongue-tie usually does not have any feeding problems, because it generally is easy to get milk from the nipple of a bottle.
When on solid food, a baby with tongue-tie usually does not have any feeding problems.
Children with only partial attachment of the tongue to the bottom of the mouth may have no problems related to tongue-tie. The lingual frenulum may stretch as the child grows, or the child may adapt well to the restricted tongue movements.
Some children with tongue-tie develop speech problems. They may have difficulty making (articulating) the sounds that require the tip of the tongue to rise, such as t, d, z, s, th, n, and l. To articulate these sounds, your child may keep his or her mouth opening small and alter the tongue placement.
You also may notice that your child with tongue-tie:
Your child may feel embarrassed or be ridiculed by other children because of this condition.
Tongue-tie is rarely seen in adults, and it generally does not cause problems. An adult with tongue-tie may:
Diagnosis of tongue-tie is usually based on a physical examination and any symptoms your baby may have. To check for tongue-tie, the health professional may:
To diagnose tongue-tie in an older child or an adult, the health professional examines the mouth for:
Many children with tongue-tie do not need treatment, because the tissue underneath the tongue (lingual frenulum) stretches as the child grows and adapts to the tongue restriction. But some children with tongue-tie may need surgery to release the tissue.
If your child has been diagnosed with tongue-tie, you can choose to wait and see if the lingual frenulum stretches or if your child adapts to the tongue restriction. You can:
Surgery is recommended if tongue-tie causes:1
Two types of surgery can be done for tongue-tie. The surgeries are:
The appropriate age for a child to have surgery for tongue-tie is controversial.1
Home treatment may be all that is needed for your child with tongue-tie. The tissue underneath the tongue (lingual frenulum) may stretch on its own, or your child may adapt to the restricted tongue movement.
If you are breast-feeding your baby, talk with a lactation consultant to learn how to help your baby latch on and suck effectively. You also will want to be sure that your baby is getting enough milk and growing well.
If your breast nipples are sore or tender:
If your child develops speech problems, ask your health professional about having him or her evaluated by a speech therapist. If the speech difficulty is believed to be caused by tongue-tie, you may want to consider surgery to release the tongue. Some experts believe that tongue-tie surgery should not be done until the child is 4 years old. Others believe that surgery should be done earlier to prevent speech problems and the possible need for speech therapy after surgery.
If your baby has a release of the lingual frenulum (frenotomy), you may notice some slight bleeding after the procedure. You can give your baby acetaminophen (Tylenol) for any discomfort. If you give medicine to your baby, follow your doctor's advice about what amount to give.
If your child has frenuloplasty, he or she will have stitches on the underside of the tongue. After surgery, your child may be instructed to do some tongue exercises several times a day for 4 to 6 weeks. These will help improve tongue mobility and prevent scar tissue formation.
Even children who have not had surgery may be taught tongue exercises if they have mild problems from tongue-tie.
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- Lalakea ML, Messner AH (2003). Ankyloglossia: Does it matter? Pediatric Clinics of North America, 50(2): 381–397.
Other Works Consulted
- Breward S (2006). Tongue tie and breastfeeding: Assessing and overcoming the difficulties. Community Practice, 79(9): 298–299.
- Hall DMB, Renfrew MJ (2005). Tongue tie. Archives of Disease in Childhood, 90(12): 1211–1215. [Erratum in Archives of Disease in Childhood, 91(9): 797.]
|Primary Medical Reviewer||Michael J. Sexton, MD - Pediatrics|
|Specialist Medical Reviewer||Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics|
|Last Revised||June 3, 2010|
Last Revised: April 3, 2012
Author: Healthwise Staff
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