What is tongue-tie?
Tongue-tie, also known as ankyloglossia, is a congenital condition (the child is born with it) in which a child’s tongue remains attached to the bottom (floor) of his or her mouth. This happens when the thin strip of tissue (lingual frenulum) connecting the tongue and the floor of the mouth is shorter than normal. The short frenulum can restrict tongue mobility. Ankyloglossia has been associated with difficulties with breastfeeding and problems with speech.
Who is affected by tongue-tie?
Anyone can develop tongue-tie. In some cases, tongue-tie is hereditary (runs in the family). The condition occurs up to 10 percent of children (depending on the study and definition of tongue-tie). Tongue-tie mostly affects infants and younger children, but older children and adults may also live with the condition.
Symptoms and Causes
What causes tongue-tie?
The tongue and the floor of the mouth fuse together when an embryo is growing in the womb. Over time, the tongue separates from the floor of the mouth. Eventually, only a thin cord of tissue (the frenulum, or lingual frenulum) connects the bottom of the tongue to the mouth floor.
As an infant grows, the lingual frenulum usually thins and shrinks. In children who are affected by tongue-tie, the frenulum remains thick and does not recede, which makes it difficult to move the tongue.
What are the symptoms of tongue-tie?
Symptoms of tongue-tie range from mild to severe. The tongue may appear to be heart-shaped or may have a notch in it. In some cases, tongue-tie is mild enough that symptoms do not interfere with daily life.
Tongue-tie may cause the following symptoms in infants:
- Difficulty latching when breastfeeding
- Breastfeeding for extended periods of time
- Constant hunger
- Trouble gaining weight
- A clicking sound while the child is feeding
In young children, tongue-tie symptoms may include:
- Speech impairments
- Swallowing difficulties
- Difficulty moving the tongue toward the roof of the mouth or from side to side
- Difficulty licking ice cream
- Difficulty playing a wind instrument
- Problems sticking the tongue out
- Difficulty kissing
Breastfeeding mothers may also have symptoms related to an infant’s tongue-tie, including:
- Cracked, sore nipples
- Pain during nursing
- Insufficient milk supply
Diagnosis and Tests
How is tongue-tie diagnosed?
Ankyloglossia is often diagnosed by the patient’s pediatrician or a lactation consultant. Examining the undersurface of the tongue will reveal that the tongue is connected to the floor of the mouth, tying the tongue down.
Management and Treatment
How does tongue-tie affect breastfeeding?
In order to create an adequate seal when breastfeeding, an infant must extend his or her tongue over the jaw line. In children who have tongue-tie this is not possible, and they often attempt to use their gums to keep the nipple in the mouth during breastfeeding. This can be painful.
How does tongue-tie affect speech?
The true impact of tongue-tie on speech is not clearly understood. The tongue needs contact with the roof of the mouth when pronouncing the lingual sounds “t”, “d”, “z”, “s,” “th,” “n,” and “l.” When the tongue is severely restricted and cannot reach the roof of mouth, the child can have problems with articulation (pronunciation).
How is tongue-tie treated?
In some cases, tongue-tie is not severe enough to cause noticeable symptoms. Infants and young children who have tongue-tie but do not have problems with feeding, swallowing or speaking may not need treatment.
If your child has tongue-tie and has trouble feeding, the doctor can perform a simple surgical procedure in which the lingual frenulum is cut. This is called a frenectomy (also known as frenulectomy, frenotomy, or tongue-tie division), and is often performed in the clinic without sedation.
The procedure is usually painless for infants. Young children and adults may receive pain medications or general anesthesia before the procedure.
As with any surgical procedure, frenectomy carries risks of complications, including:
- Injury to the saliva ducts in the mouth
What complications are associated with tongue-tie?
If it is not treated, moderate to severe cases of tongue-tie can cause the following problems for a child:
- Long-term feeding problems, which can cause poor weight gain or malnourishment
- Speech impediments, which can cause problems in school
- Difficulty eating certain foods
Can tongue-tie be prevented?
There is no way to prevent tongue-tie. For more severe cases of tongue-tie, early diagnosis and treatment are key to the child’s successful recovery.
Outlook / Prognosis
What is the prognosis (outlook) for people with tongue-tie?
Most infants and children with tongue-tie recover completely without treatment or with minor surgery.
What questions should I ask my doctor about tongue-tie?
- How can I make sure my child receives adequate nutrition?
- Could tongue-tie be the cause of my child’s breastfeeding or nutrition difficulties?
- Is a frenectomy the right treatment for my child?
- Is it necessary to have a frenectomy right away, or can it wait?
- If my child has a frenectomy, what post-surgical complications should I watch out for?