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

Recognizing a tongue-tie isn’t as difficult as you might think. In fact, it is much more common than most parents realize.

We’re here to break down the current medical advice, research, and real-world solutions for ankyloglossia. Set your worries aside; we will guide you through recognizing the signs and finding the right help for your little one.

What Is a Tongue-Tied Baby?

Tongue-tie, medically known as ankyloglossia, is a condition present at birth. It happens when the small band of tissue under the tongue (the lingual frenulum) is too short, thick, or tight. This restricts the tongue from moving freely within the mouth.

Depending on the severity, a tongue-tie can interfere with nursing, eating solids, speech, and even oral hygiene.

In a tongue-tied baby, that tight membrane connects the bottom of the tongue to the mouth’s floor too aggressively ⁽¹⁾. This restriction might stop your baby from lifting their tongue to the roof of the mouth or sticking it past their lips.

However, not every tie is a disaster. Some babies with mild restrictions don’t show symptoms or experience problems later in life.

Many cases are spotted right in the newborn nursery. If the restriction is affecting feeding, your pediatrician might recommend a simple procedure to release the tie immediately. Addressing it in the first few weeks often prevents long-term feeding struggles and nipple trauma for you.

The Different Types of Tongue-Tie

1. Anterior Tongue-Ties

An anterior tie is the most visible type. Doctors typically classify these into three classes based on how close the tie is to the tongue tip.

• Class One: The membrane attaches the very tip of the tongue to the floor of the mouth. This usually looks heart-shaped when the baby cries and is what most people picture when they hear “tongue-tie.”
• Class Two: The band of tissue sits just a bit further back from the tip but is still clearly visible.
• Class Three: The tie is located further back near the base of the tongue. It is harder for parents to spot but still restricts elevation.

2. Posterior Tongue-Tie (Class Four)

A posterior tongue-tie is the master of disguise. It sits deep under the mucous membrane at the base of the tongue. It is often misdiagnosed as a “short tongue” because you cannot easily see a distinct string or band.

Despite being hidden, posterior ties cause the same functional issues as anterior ties. They can be incredibly painful for breastfeeding mothers because the baby cannot lift the mid-tongue to cup the breast properly ⁽²⁾.

Why Does Tongue-Tie Seem So Common Now?

You might feel like every other baby has a tongue-tie diagnosis these days. While it seems like a trend, the condition has always existed.

Historically, midwives in the Middle Ages would often release a tight frenulum immediately after birth using a sharp fingernail ⁽³⁾. They understood that a free tongue was necessary for nursing.

As bottle-feeding became the norm in the 20th century, the focus on oral function decreased. Bottle nipples are easier for babies to compress, so a restricted tongue didn’t cause as many obvious feeding failures. Doctors often advised mothers to wean to bottles rather than fixing the anatomical issue.

Now that breastfeeding science and support have improved, we are paying attention again. We understand that effective nursing requires a complex wave-like motion of the tongue. Consequently, we are spotting, and treating, ties that would have been ignored just a few decades ago.

What Causes Tongue-Tie?

The exact cause isn’t fully understood, but genetics play a significant role. If you or your partner had a tie, there is a higher chance your baby will too.

During pregnancy, the tongue separates from the floor of the mouth. The lingual frenulum is supposed to recede or thin out before birth to allow free range of motion. In tongue-tied babies, this tissue fails to recede, leaving a tight anchor behind.

This restriction can also happen on the upper lip (lip-tie) or cheeks (buccal ties).

Signs Your Baby Might Be Tongue-Tied

Not all babies show obvious symptoms. Sometimes, the mother is the one suffering while the baby seems fine. However, if your baby cannot move their tongue properly, you will usually see signs during feeding or, later, speech development.

Common physical signs include:

• Difficulty lifting the tongue to the upper gums.
• Inability to move the tongue side to side.
• A heart-shaped notch at the tip of the tongue when crying or sticking it out.
• The tongue appearing white or coated (milk residue) because it cannot rub against the roof of the mouth to self-clean.

Symptoms for the Baby:

• Constant hunger (inefficient milk transfer).
• Colic or excessive gas from swallowing air.
• Clicking or smacking noises while nursing.
• Slow weight gain.
• Fussiness at the breast.
• Milk leaking out of the side of the mouth.

Symptoms for the Mother:

• Cracked, bleeding, or blistered nipples.
• Severe pain during latch.
• Decreased milk supply (due to poor breast drainage).
• Nipples looking creased or lipstick-shaped after nursing.
• Mastitis or plugged ducts.

Possible Complications

1. Breastfeeding Struggles

To breastfeed successfully, a baby must latch deeply. The tongue needs to extend over the lower gum line to cup the breast and create a vacuum ⁽⁴⁾.

A restricted tongue prevents this vacuum. Your baby might compensate by clamping down with their gums or chewing on the nipple to extract milk. This causes you severe pain and limits how much milk your baby gets.

Left untreated, this often leads to early weaning. Before you give up, see a lactation specialist. While a release (surgery) can help, it works best when combined with professional breastfeeding support ⁽⁵⁾.

Breastfeeding is important for health and bonding, but your mental health matters too. If the pain is unbearable, seek help immediately.

2. Speech and Articulation

Speech issues often appear in toddlerhood. While a tongue-tie rarely prevents a child from speaking, it can affect clarity.

Problems arise with sounds that require the tongue tip to articulate against the roof of the mouth.

• Alveolar sounds: T, D, N, L, S, and Z.
• Rolling sounds: The R sound can be particularly difficult.

3. Oral Hygiene and Eating

A free tongue acts as a natural toothbrush. It sweeps food particles off the teeth. A tied tongue cannot reach the back molars or the spaces between gums and cheeks, leading to trapped food, tooth decay, and gingivitis.

It also impacts solid foods. Children may struggle to move food around their mouth (bolus manipulation), leading to gagging or “chipmunking” food in their cheeks.

4. Airway and Sleep Issues

This is a critical area of new research. A low-resting tongue (common in ties) can restrict jaw development. This often leads to a high, narrow palate and smaller nasal passages.

This structural change forces the child to mouth-breath. Mouth breathing during sleep can cause snoring, restless sleep, and even sleep apnea. Poor sleep quality in children is often misdiagnosed as ADHD or behavioral issues later in life.

In my practice, parents often mention that their child has “noisy breathing” at night or that their child snores with pauses in breathing. These are signs of sleep apnea. It is very important for these concerns to be evaluated as sleep apnea can impair focusing and brain function during daytime activities ⁽⁷⁾.

Editor's Note:

Dr. Leah Alexander, MD, FAAP

5. TMJ and Tension

The tongue is connected to the hyoid bone and the fascia of the neck. A tight tongue can create tension throughout the jaw, neck, and shoulders. This often manifests as TMJ pain, clenching, grinding, or headaches as the child grows into adulthood ⁽⁸⁾.

How Doctors Diagnose Tongue-Tie

Diagnosing an anterior tie is usually straightforward; a doctor can see the tight string when your baby cries.

Posterior ties are trickier. Because the restriction is hidden under the mucosal lining, a doctor cannot diagnose it just by looking. They must perform a manual examination.

Your provider should place their fingers under the baby’s tongue to assess:

• Elevation: Can the tongue lift to the palate?
• Lateralization: Can it move side to side?
• Extension: Can it come out over the gum line?

We highly recommend seeing a pediatric dentist or an otolaryngologist (ENT) who specializes in ties, alongside a skilled lactation consultant.

Treatment Options

Approaches vary wildly. Some doctors prefer a “wait and see” method, hoping the frenulum stretches. Others advocate for early release to prevent feeding trauma.

Many of the infants I see with this problem have moms who have tried a variety of techniques in order to breastfeed. In addition to seeking help from lactation consultants, they often try a nipple shield to help with latching ⁽⁹⁾. I’ve even seen a mom who resorted to feeding her baby pumped breast milk with a syringe. For tongue-tie cases such as these, surgical treatment is the best remedy.

Editor's Note:

Dr. Leah Alexander, MD, FAAP

While the frenulum doesn’t technically “stretch” or disappear, the mouth grows, which can sometimes alleviate mild symptoms ⁽¹⁰⁾.

If intervention is needed, the two main surgical options are frenotomy and frenuloplasty.

1. Frenotomy (The Clip)

This is the most common procedure for infants. It is quick, often done in a doctor’s office, and requires no general anesthesia.

• Scissors: The doctor snips the frenulum with sterile surgical scissors. It’s fast and simple.
• Laser: Many pediatric dentists now use a soft tissue laser (CO2 or diode). The laser cauterizes as it cuts, resulting in very little bleeding and essentially no risk of infection.

Babies can usually breastfeed immediately after the procedure. In fact, the breast milk acts as a natural pain reliever and antiseptic.

2. Frenuloplasty

This is a more involved surgery, typically reserved for older children or adults, or for very thick, complex ties. It is usually performed under general anesthesia. The surgeon excises the frenulum and closes the wound with sutures (stitches).

3. The Importance of Aftercare

This is the step most parents miss. Because the mouth heals incredibly fast, the wound will try to reattach. To prevent the tie from growing back, you must perform “active wound management.”

This involves gently stretching and massaging the wound site several times a day for a few weeks. Your provider should teach you these stretches. Additionally, bodywork (like CranioSacral Therapy or pediatric chiropractic care) can help release the muscle tension your baby built up while trying to nurse with a restricted tongue.

Tongue-Tied Baby FAQs

Is Tongue-Tie a Disability?

Technically, severe tongue-tie can be classified as a minor congenital anomaly. While not usually labeled a “disability” in the general sense, it can significantly impair major life functions like eating, breathing, and speaking if left untreated.

Can Babies Grow Out of Tongue-Tie?

No, the tissue does not go away. However, as the mouth grows larger, some children learn to compensate for the restriction. This “adaptation” works for some, but others may develop issues like speech impediments or sleep apnea later in life.

Does Tongue-Tie Surgery Hurt the Baby?

The procedure is very quick. While there is brief discomfort during the clip or laser release, babies usually settle down almost immediately when put to the breast. The area has few nerve endings, making it less painful than a vaccination shot.

Will Insurance Cover Tongue-Tie Release?

Coverage varies significantly. Many medical insurance plans cover the “frenotomy” procedure code. However, some specialized pediatric dentists operate as out-of-network providers. Always call your provider and ask about coverage for “frenectomy” or “frenotomy.”