Tongue Tie or Ankyloglossia

Tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia.

The frenulum is the main structure causing tongue tie. It is a strong cord of tissue that prenatally guides development of mouth structures and is positioned in the center of the mouth. After birth, the lingual frenulum continues to guide the position of incoming teeth. As we grow, it usually recedes and thins. This frenulum is visible and easily felt if you look in the mirror under your tongue. In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems.

The tongue is one of the most important muscles for speech and swallowing. For this reason having tongue-tie can lead to eating or speech problems, which may be serious in some individuals.


In Infants

A new baby with too tight a frenulum can have trouble  breastfeeding, taking a bottle or even a pacifier. Infants can struggle with sucking, latching on, and may have poor weight gain. Mothers who experience significant pain while nursing should have their infant evaluated for ankyloglossia, especially if they are considering abandoning breast feeding altogether. 

In Toddlers and Older Children

Many children have no speech impediments due to tongue-tie. For some kids the problem shows up around the age of three with speech problems - especially articulation of the sounds - l, r, t, d, n, th, sh, and z. More than half  three year old's speech should be understandable to those outside the family. Although, there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common:

  • V-shaped notch at the tip of the tongue
  • Inability to stick out the tongue past the upper gums
  • Inability to touch the roof of the mouth
  • Difficulty moving the tongue from side to side

As a simple test, parents might ask themselves if the child can lick an ice cream cone or lollipop without much difficulty. –For older children with tongue-tie, appearance can be affected by persistent dental problems such as a gap between the bottom two front teeth. 


Tongue-tie surgery is a safe, simple procedure and there are normally no complications. For very young infants (less than six-weeks-old) with a thin frenulum, it may be done in the office with little to no pain. If the frenulum is very thick or child is older with strong jaw muscles then general anesthesia may be recommended. While frenulectomy is relatively simple, it can yield big results. Parents should consider that this surgery often yields more benefit than is obvious by restoring ease of speech and self-esteem.

Posterior Tongue Tie

Posterior tongue tie may be more difficult to see than the more typical anterior ties. The typical heart shaped deformity in the anterior ties is absent. Sometimes, a posterior tongue tie can be felt better than it can be seen. A tongue that doesn't hit the roof of the mouth or won't protrude very far are typically seen. 

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