Is breastfeeding causing you a lot of pain, even though you’ve taken classes, consulted friends and family, or visited a professional? Then your baby could be tongue-tied.
What is a tongue-tied baby?
Recognizing tongue-tie isn’t as difficult as you may think, and it’s more common than most parents are aware.
We’ll share current medical practice for this condition along with up-to-date research, statistics, and advice for tongue-tied babies. Set your worries aside and learn the next steps for recognizing and helping a baby with tongue-tie.
- Tongue-tie, or ankyloglossia, is a condition present at birth where a short, tight membrane connects the bottom of the tongue to the mouth’s floor, limiting tongue movement.
- Tongue-tie can cause issues with breastfeeding, speech, oral hygiene, and other oral activities.
- Anterior and posterior tongue-ties are the two types of tongue-tie, with anterior being more visible and easier to diagnose.
- Treatment options include monitoring for improvement, lactation consultants for breastfeeding assistance, speech therapy, or surgical procedures such as frenotomy or frenuloplasty.
What Is a Tongue-Tied Baby?
Tongue-tie or ankyloglossia is categorized as a midline defect, which is present at birth. The condition restricts the tongue from moving freely within the mouth and can cause a variety of issues. Depending on how severe it is, it can interfere with nursing, speech, and oral hygiene.
Tongue-tied babies have a short, tight membrane or band of tissue connecting the bottom of the tongue to the mouth’s floor (1). Depending on what type your baby has, it can interfere with how they breastfeed or restrict them from sticking their tongue out. Sometimes, a baby with a tongue-tie won’t show any symptoms or experience problems down the road.
Many cases of tongue-tie are noted soon after birth, during the first exam in the newborn nursery. If it is significant enough to affect feeding, your pediatrician may recommend a simple office procedure to release the tie at the first or second office visit. It is a much simpler procedure when done within the first few weeks of life, and this avoids further feeding difficulties.
Types of Tongue-Tie
1. Anterior Tongue-Ties
The first and most recognizable tongue-tie type is an anterior tie. Doctors divide it into three classes, depending on how far back the tie is located.
- Class one: If your baby has a class one tongue-tie, the membrane ties the tip of the tongue to the floor of the mouth. It is a common occurrence and typically what parents imagine when discussing this condition.
- Class two: With class two, the band of tissue sits a bit further back. It’s still straightforward to recognize.
- Class three: Ties categorized as class three will be further back, around the base of the tongue. This class is a little trickier to recognize for parents.
2. Posterior Tongue-Tie
A posterior tongue-tie is challenging to spot and is often misdiagnosed as a short tongue. The band sits deep in the mouth, much further underneath the tongue than with anterior ties.
The two types cause the same issues, although a posterior tie isn’t as visible and might be easier to live with (2).
Is Tongue-Tie Common?
Tongue-tie has always been a common occurrence. However, for a long time, it wasn’t talked about as an issue.
During the Middle Ages, it was customary for midwives to keep one fingernail long and sharp. When a baby was born with either class one or two tongue-ties, they’d use it to cut the membrane at birth (3).
Centuries later, when bottle feeding was considered a superior alternative to breastfeeding, mothers were often encouraged to stop nursing.
Doctors and bottle manufacturers even used tongue-tie as a reason mothers should wean their babies to bottles. By then, it was no longer viewed as a defect, and sensible reasons why it should be removed were overlooked.
Once breastfeeding became a preferred method again, tongue-tie re-emerged as a problem requiring a solution. However, for a while, only anterior ties were recognized since they were easier to spot. During this time, finding a doctor willing to remove the tie was also a challenge.
Only recently has tongue-tie received attention again. More awareness has been brought to the condition, particularly for posterior ties. So, tongue-tie has always been around, even though it was ignored for a while.
Causes of Tongue-Tie
The exact reason as to why tongue-tie occurs is unknown. However, some cases are linked to specific genetic factors.
During gestation, the lingual frenulum (membrane between tongue and mouth) doesn’t separate as it should. Typically, it should dissipate before birth, allowing the tongue free range of motion.
Instead, it stays put, causing what we know as tongue-tie. It can also occur on the lips, known as a lip-tie.
Does My Baby Have Tongue-Tie?
Not all babies will have noticeable symptoms from their tongue-tie. Many don’t, and it’s perhaps only the breastfeeding mother who suffers.
For others, the symptoms may not show until later when your child’s teeth come in or they begin to speak. These are some common signs:
- Problems with latching during breastfeeding.
- Trouble lifting the tongue to the upper teeth and moving it from side to side.
- A notched or heart-shaped tongue when sticking it out.
- Difficulty reaching the tongue beyond the lower front teeth.
You should be able to spot it by gently lifting your baby’s tongue and investigating it with a flashlight. If your little one has an anterior tie, you’ll be able to locate it right away.
When tongue-tie causes issues with latching, you are likely to see other indicators like the following:
- Constant hunger.
- Slow or no weight gain.
- Cracked or bleeding nipples.
- Sore nipples.
- A decreased milk supply.
- Pushing away from the breast during feeding.
1. Trouble with Breastfeeding
However, because of the restricted mobility, your baby cannot place their tongue in the right position. To compensate, your little one may use more force when sucking, or they may chew on the nipple. This can cause significant pain to you and restrict your baby’s ability to extract any milk.
Over time, poor breastfeeding will result in inadequate nutrition, which can cause failure to thrive. It’s not uncommon for mothers to choose to stop breastfeeding due to the issues and pain.
Before you give up on breastfeeding entirely, we recommend consulting a nurse or lactation specialist. They can give you tips to help ease the pain and get a better latch. However, they won’t always deem intervention necessary if your little one is gaining weight and is otherwise happy and healthy.
One study revealed that, although releasing the tongue-tie improves pain, it didn’t have a significant effect on breastfeeding success (5).
The cases where it was shown to amplify latching were ones where the tie was released before one month of age (6).
Breastfeeding is important not just for nutrition but also for oral structure and bonding. If you have worries, contact your pediatrician.
2. Speech Difficulties
Speech difficulties are not noticeable until your little one enters toddlerhood. From here, they can have a hard time creating specific sounds.
Problems arise with those sounds requiring the tongue and the tip to touch either the roof or the floor of the mouth.
These sounds include:
- The roof of the mouth: T, D, N, S, L, and Z.
- The floor of the mouth: Mostly the R sound.
A Clinical Note About Speech Clarity
3. Difficulty with Oral Activities
Tongue-tie can interfere with ordinary activities like licking the lips or ice cream. It can significantly impact swallowing foods that require your baby to lick or slurp.
Later on, your child may find it challenging to play wind instruments and even kiss.
4. Poor Oral Hygiene
As your child grows, their oral hygiene can decrease due to the condition. Since the tongue can’t reach around the mouth, sweeping food debris off the teeth can be tricky. This can lead to tooth decay and gingivitis, an inflammation of the gums.
Another issue tongue-tie can cause is a gap between the two front bottom teeth. This is due to the tongue always being in a low-lying position. Your child can correct this later on in life if desired.
5. Sleep Issues
It’s been shown that tongue-tie can lead to sleep disorders, although it may not become a problem until decades into your child’s life.
If your little one has a short lingual frenulum, it can cause impairments of their orofacial growth during early childhood. It occurs if your child primarily breathes through their mouth as opposed to the nose, particularly during sleep.
This can impact the pliable upper airway, reducing its width and increasing the risk of it collapsing. Developmental problems like this one can trigger disordered sleep breathing, such as sleep apnea.
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 (8).
Editor's Note:Dr. Leah Alexander, MD, FAAP
6. Increased Chances of TMJ Pain
The position of the tied tongue inside the mouth can cause excess pressure on the temporomandibular joint (TMJ) muscles (9). It can lead to jaw pain and migraines.
When to See a Doctor
As soon as you have any concerns, contact your doctor. If you experience any of the following, either during infancy or when your child is older, see your pediatrician:
- The tongue-tie is causing problems: You notice the condition is starting to cause trouble, such as with breastfeeding.
- Child complains of tongue problems: Your older child starts to complain about issues interfering with eating, reaching the teeth, or speaking.
- Your child’s speech is affected: The condition causes issues with your child’s speech.
How Doctors Diagnose Tongue-Tie
Anterior tongue-tie is relatively easy for a doctor to diagnose during a physical examination of the tongue and mouth. They are likely to use a device to measure the length of the lingual frenulum.
A posterior tie, however, can be more challenging, especially since its most common symptom is often related to other issues as well.
Since a posterior tie’s most common symptom is trouble feeding, doctors must rule out other causes. So unless the tie is evident, further investigation is necessary.
Besides seeing your pediatrician, it’s a good idea to talk with a lactation consultant. They can do a full evaluation of how your baby latches and feeds.
Treatment of Tongue-Tie
Doctors have different approaches when it comes to tongue-ties. Some recommend you correct it as soon as possible — perhaps even before discharging your newborn from the hospital. Others take a more laid-back approach and will tell you to wait and see.
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 (10). 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
It’s not uncommon for the lingual frenulum to loosen over time, improving, if not resolving, the condition (11).
In cases where it persists, specialists can help reduce the symptoms. Lactation consultants can advise with breastfeeding, and speech therapy can improve your child’s speech sounds.
If the condition causes issues, doctors could consider surgical treatment. Procedures include frenuloplasty or frenotomy (12).
A frenotomy is a straightforward surgical procedure that’s usually done in the doctor’s office or hospital nursery. Doctors can do it with or without anesthesia, and it only takes a few minutes.
After examination, the doctor uses sterile scissors to snip the tissue free. There’s minimal discomfort, even without anesthesia, since the area only contains a few nerve endings and blood vessels. If it begins to bleed, it’s typically only a few drops, and your baby can breastfeed immediately after.
Complications are rare, but with bleeding, there’s always a risk of infection. Scarring is also possible, or the tissue could reattach over time.
Frenuloplasty is a more invasive procedure, which might be necessary if the lingual frenulum is too thick or requires additional repair. This procedure is done while the patient is under general anesthesia. Doctors use surgical tools to cut the frenulum and then close it with sutures.
Possible complications are similar to frenotomy, such as bleeding and infection, and are also rare.
Following the procedure, it’s common that tongue exercises are recommended to improve movement and reduce the chances of scarring.