Tongue Tie: Ankyloglossia Symptoms, Problems, and Treatments

Have you just been told your baby has tongue tie, or are you worried they might have it?

This medical condition affects four to 11% of all newborns, and the good news is that a tongue tie is treatable and shouldn't cause lasting effects. But we understand it's worrying to be told there is a problem with your baby's mouth or teeth, and no doubt you have a lot of questions.

To help you understand more about how this might affect you and your infant, in this article we'll go through:

• How tongue tie is diagnosed
• Tongue tie symptoms
• The difficulties your child might face
• Different treatments that are available
• The effects of tongue tie in adults

There are differing opinions in the medical profession about tongue tie treatments, but the information here will help you to have a full conversation with your doctor about the right course of action for your baby.

If you want to know more about caring for your child's teeth, we have an entire collection of articles dedicated to dental care for babies and children.

What is tongue tie in babies?

A tongue tie happens when the frenulum linguae – that's the little bit of flesh between your tongue and the floor of the mouth – is shorter, tighter or further forward than normal. You might also hear your doctor refer to the condition by its medical name, ankyloglossia. There are two types of tongue tie, posterior and anterior, which we'll talk about in a moment.

Present from being newborn, ankyloglossia is a congenital issue. The exact cause is not understood, but studies have shown it happens two and a half times more often in boys than girls.

Some of the most common problems that arise due to ankyloglossia include:

• Problems breastfeeding
• Possible speech problems
• Higher risk of tooth decay and gum disease
• Difficulty swallowing food
• A gap between the bottom front teeth, when they erupt

Not every baby with tongue tie will develop these problems. A doctor may or may not recommend surgical treatment, depending on the severity of the issue.

Posterior tongue tie

With a tongue tie posterior in the mouth, the tongue is attached further back, behind the normal flesh. It's not so easy to see this type of tie because it's further back in the mouth and obscured.

Anterior tongue tie

This type of tongue tie is usually easy to see when looking at your baby's mouth. It'll look like a thick string of flesh that is holding the tongue to the floor of the mouth.

How can I tell if my baby is tongue tied?

If there's an anterior tongue tie, you can get a diagnosis very early on, sometimes even during initial health checks. A baby may have trouble moving their tongue, or it may appear heart-shaped.

A posterior tongue tie can be harder to spot straight away. Things to look out for include:

• Difficulties latching on during breastfeeding
• Not wanting to take a bottle
• Slow or no weight gain
• Constant hunger
• Clicking from the mouth while feeding

A breastfeeding mother might also experience soreness or even sharp pain in the breast at feeding times. This is because the baby's tongue is too short to cover the lower gums when feeding.

If you spot these issues, you can talk to your health visitor, midwife, or doctor and they can do a full assessment. They will be able to go through some simple tests that won't hurt your baby, like placing a finger in the mouth and touching their lower lip to see how much tongue movement there is. The person doing the assessment will also want to watch your baby breastfeeding or taking a bottle.

Tongue tie and breastfeeding

One of the main concerns that parents have is how this condition can affect your child's ability to breastfeed. It's certainly true that it can cause problems, but it also may be that there is overdiagnosis of tongue tie because of this fear.

Tongue tie and breastfeeding problems

A lot of the focus of tongue tie is on breastfeeding difficulty, however it can still affect bottle-feeding babies too. When breastfeeding, babies use the tip of the tongue more than with a bottle, so the problem can be more pronounced. However, with a tongue tie, baby can have restricted movement in the middle of their tongue which still presents a problem with bottles.

If you have any concerns at all about feeding your baby, be sure to discuss it with your healthcare professional. They can assess baby's tongue movement and help you decide if treatment is needed.

Tongue tie and breastfeeding overdiagnosis

In the last decade or two, breastfeeding has made a huge comeback—maybe too huge, because although breastfeeding is awesome and healthy and natural, some women and babies have trouble breastfeeding, and when that happens, women can feel like there's something wrong that needs to be fixed. And often, tongue tie is the easy problem to point to, even if it's not actually the reason for trouble breastfeeding. As an interview in the Atlantic points out, “As a new mother, you can't go to any parenting- or breastfeeding-support website that isn't describing [tongue tie] as the predominant reason your child is having difficulty or why breastfeeding is painful.”

Studies have been conducted on whether a frenotomy improves breastfeeding, but some rely on mothers to report about the results after the operation. These results are often subjective, especially since all moms want to believe that if they had their child undergo an operation, it was for a good reason. Other studies, like this one report that no consistent positive effect was found on infant breastfeeding problems following a frenotomy.

Tongue tie treatment options

If your baby isn't having any difficulty feeding, tongue tie medical procedures may not be necessary. Healthy weight gain and successful feeding at the breast or bottle means that, at least for now, they are doing fine. However, when feeding causes breast pain, or problems with bottle feeding, and your baby isn't getting enough milk, intervention may be necessary.

Tongue tie surgery

A frenotomy is a relatively simple procedure that can be done in a doctor's office, and some practitioners even offer it as a home treatment. Your doctor will use a pair of sterile scissors or a laser to cut the lingual frenulum so that the tongue becomes more mobile.

There aren't many nerves or much blood supply in this part of the mouth, so anaesthetic often isn't needed. A little bleeding is normal, but there shouldn't be a need for stitches and your baby should be able to feed normally straight away.

The video below shows a new mother's experience with her tongue tied baby.

You should see their feeding and weight improve pretty quickly. In one study, 92% of babies were able to successfully breastfeed following a simple frenotomy in a doctor's office.

Another type of procedure is a frenuplasty. This type of procedure is usually done under general anesthetic and the outcome is pretty much the same, although a frenuplasty may give your child better outcomes for overall tongue movement. Here's a table comparing the two types of surgery:

Tongue tie surgery cost

When there is a medical need, tongue tie treatment should be covered by your insurance or Medicaid. For babies, a midwife, doctor, or lactation consultant will be able to help you organize a tongue tie division if it's needed.

If you have to pay for a tongue tie surgery without insurance, it could cost between $800 to $8,000. Before you spend your savings on this procedure for your baby, you might want to get a second opinion, because in a study by JAMA Otolaryngology — Head & Neck Surgery found that nearly 63% of infants who were referred for a tongue tie or lip tie procedure turned out to not need the surgery and that their feeding problems were for other reasons, like low milk supply, shallow latching or reflux.

Speech therapy

There isn't much agreement about whether being tongue tied will affect speech. Some doctors say that if the frenulum is restricting the movement of the tongue, then some sounds are harder to make. However there are other doctors that disagree with this.

If the child is feeding normally, it may be best to wait and see if speech issues develop before seeking treatment. Around the age of three or four, you can ask for an assessment by a speech-language pathologist to see if any problems might arise in the long term.

There haven't been any big studies done about the effectiveness of speech therapy techniques. If tongue tie is identified as the cause of problems pronouncing certain sounds, your child will be referred for a tongue tie division rather than a course of therapy.

Being tongue tied as a teen or adult

Even if you've made it through your childhood without many problems, you may still want to seek tongue tie treatment as an adult. Some issues that may come from ankyloglossia as an adult include:

• Speech issues
• Jaw pain
• Headaches and migraines
• Mental health issues
• Increased tooth decay
• Crooked lower teeth
• Gum disease

You might be a little embarrassed by some of these things. If your life is being negatively affected by your tongue tie then visit your doctor to explore treatment options.

A dentist may also be able to refer you for treatment if they think your tongue tie is affecting your teeth. Your tongue plays a vital part in your oral health by sweeping away food debris as you're eating. When your tongue can't reach your upper or side teeth, this could leave food sitting on your teeth for longer, increasing the chances of tooth decay and gum disease.

Because your tongue sits behind your lower teeth most of the time, it can mean you develop a gap between them. Fixing a gap between teeth is normally done with braces, but the problem could return if you don't get your tongue tie released too.

Here, this patient talks about getting his tongue tie released as an adult:

Conclusion

The problems caused by a tongue tie can range from extremely painful breastfeeding and a baby failing to thrive, to absolutely no issues at all except an attached frenulum. Between these two extremes, dental problems and speech issues may occur. Treatment can be a bit of a contentious issue between doctors, but if it's affecting the health of you or your baby, you should have no trouble receiving appropriate treatment.

Frequently Asked Questions

Will a tongue tie improve without treatment?

Sometimes; studies show that ankyloglossia was less common in children than in babies. The extra skin tying down the tongue may wear away when feeding or when your child puts toys in their mouth.

My doctor won't release my child's tongue tie. What can I do?

There is a debate about whether a tongue tie is a big problem, so some doctors will be reluctant to intervene. When breastfeeding is difficult or painful, you may be able to get your baby treated swiftly. You can always seek a second opinion from a different doctor or practice, and there are private clinics that will do a frenotomy, too.

Breastfeeding is painful but I don't want my baby to have surgery. Can I switch to bottle feeding?

Changing from breast to bottle feeding is a big decision which a lactation consultant or midwife can advise you on. It's possible your baby will still experience problems with taking a bottle. In that case, the procedure will still be necessary.