Tongue Tie In Babies: Causes And Treatment

Your pediatrician should know about latching and tongue movement issues in your baby.

Medically reviewed by Dr. Neema Shrestha, MD Dr. Neema Shrestha Dr. Neema ShresthaMD facebook_iconlinkedin_iconinsta_icon Specialty: Neonatology and PediatricsExperience: 5 years
Written by Dr. Ritika Shah
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Tongue-tied Baby Symptoms, Causes And Treatment

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Ankyloglossia, commonly known as tongue-tie, is a condition present at birth and leads to restriction of tongue movement. Tongue-tie happens when the frenulum of the tongue is too short or tight that it tethers the tongue to the floor of the mouth. It inhibits the free movement of the tongue and may lead to issues with breastfeeding, speaking, and eating(1). The condition is treatable, with early interventions.

Read on to learn about the symptoms, causes, diagnosis, and treatment of tongue-tie in babies.

Signs And Symptoms Of Tongue-Tie In Babies

Infants with tongue-tie could display any of the following signs and symptoms (2).

  • A thin or thick vertical piece of skin visible under the tongue
  • Inability to raise the tongue towards the roof of the mouth
  • The tongue does not move from side-to-side
  • Unusually shaped tongue tip displaying a V-shape, heart-shape, flat-shape, or square-shape

A tightly attached tongue to the floor of the mouth makes it difficult for the baby to establish a strong latch around the nipple. A mother may notice one or more of the following signs of tongue-tie in a breastfeeding baby.

  • Frequent latching and unlatching
  • Little or no weight gain
  • Weight loss
  • Gets tired quickly or goes to sleep during feeding

The mother of a breastfeeding baby with tongue-tie may experience the following symptoms.

  • Nipple pain while breastfeeding
  • Pinched or creased nipple after feeding the baby
  • Blocked ducts or mastitis

Bottle-fed infants with tongue-tie may display the following signs.

  • Swallowing a lot of air
  • Getting tired very quickly
  • Dribbling or leaking milk around the mouth

Many of these signs and symptoms could indicate other orofacial issues, such as cleft palate, or congenital disorders (birth defects) in babies. It is also essential to get severe tongue-tie treated soon to avoid complications. Therefore, consult a doctor if you notice any of these signs and symptoms in your baby.

Causes And Risk Factors Of Tongue-Tie In Babies

The exact cause of tongue-tie in babies is unknown. Genetic factors may play a role as it is often noted in babies with a family history of the condition. Other problems associated with genes, such as cleft palate and cleft lip, may also coincide with tongue-tie. Nevertheless, tongue-tie could occur randomly in babies with no family history of the condition.

There are no significant predisposing risk factors identified for tongue-tie in babies. However, it is found that males are more likely to have tongue-tie than females for unexplained reasons(3).

Diagnosis Of Tongue-Tie In Babies

Tongue-tie in babies may be diagnosed at birth during the physical examination. However, it may go unnoticed, too. If the mother notices any signs and symptoms of tongue-tie in babies, they can report it to the primary healthcare provider.

A primary healthcare provider may diagnose the condition and refer you to a specialist, such as an otolaryngologist, ENT doctor, or a pediatric dentist, for further evaluation and treatment. You may also be referred to a lactation consultant if there are issues with breastfeeding, to learn ways to feed the baby effectively (4).

Treatment For Tongue-Tie In Babies

The treatment approach for tongue-tie may vary depending on the severity of tongue-tie and the doctor’s preferred treatment modality. Some doctors prefer immediate treatment, while others may take a wait-and-watch approach if tongue-tie causes no trouble. Mild cases of tongue-tie often resolve on their own with age (4).

Severe tongue-tie, including those affecting breastfeeding, could require immediate treatment. The following surgical interventions could be used to free the tongue from the tight frenulum(5).

1. Frenotomy

  • It is a relatively simpler procedure and can be done in the ENT doctor’s office or even in the hospital’s nursery after birth.
  • The physician uses a sterilized, round-ended scissors to snip the frenulum.
  • The procedure is quick and causes only a few drops of blood to ooze out from the tissue.
  • Local anesthesia is often not needed since there are very few nerve endings and blood vessels in the frenulum.
  • After this procedure, the doctor may encourage you to breastfeed the baby. Breast milk acts as a painkiller and an antiseptic.
  • In some babies, the frenulum may regrow again, requiring another procedure.

2. Frenuloplasty

  • It is a more complex procedure than frenotomy and is preferred for babies with thick frenulum or those with a frenulum that tends to regrow.
  • The baby is given general anesthesia, and complex surgical tools are used to incise and separate the thick frenulum.
  • The wound is closed with sutures, and the baby may be kept under observation for a day.
  • Frenuloplasty may also be conducted through laser cauterization. A medical-grade laser is used to chip away the tight frenulum slowly.
  • Laser cauterization usually causes less bleeding, and the wound may not require any closure with sutures.

In rare cases, surgical procedures may cause excess bleeding, infection, or scarring. Your doctor may provide you guidelines on when to resume feeding the baby.

Complications Of Tongue-Tie In Babies

Untreated tongue-tie, especially the one that interferes with eating and breastfeeding, may lead to the following complications in babies and toddlers (6).

  • Difficulty in breastfeeding or bottle-feeding
  • Inadequate weight gain
  • Weight loss
  • Developmental delay
  • Irregular teeth alignment
  • Poor oral hygiene
  • Speech problems, leading to other problems, such as social issues and poor language skills

Frequently Asked Questions

1. At what age can tongue-tie be corrected?

Tongue-tie can be treated soon after birth or anytime during infancy or toddlerhood, depending on when it is diagnosed.

2. How common is tongue-tie in babies?

Tongue-tie affects about 4-10 % of children (3).

3. Do babies grow out of tongue-tie?

The frenulum naturally moves backward between the ages of six months and six years. Thismay solve the problem if the baby has mild tongue-tie (1).

4. Can the baby live with tongue-tie and avoid surgery?

Yes. Some babies have asymptomatic tongue-tie, which causes no problems. In such cases, a baby can live with a tongue-tie and avoid surgery (1).

5. Does tongue-tie affect speech?

The tongue needs to touch the roof of the mouth to pronounce sounds, such as “t,” “d,” “z,” “s”, “th,”“n,”and “l.” Tongue-tie could restrict tongue movement, making it difficult for a child to pronounce these sounds, affecting speech and language skills in the long term.

6. Does tongue-tie affect sleep?

Studies suggest that untreated tongue-tie may cause sleep disturbances in a baby if the condition obstructs respiratory passages. It may eventually contribute to other sleep-related disorders (7).

Tongue-tie is an uncommon condition, and most cases can be treated before you take your baby home after delivery. Undiagnosed cases can be detected by parents, especially by the mother while breastfeeding. If you notice the baby’s tongue attached to the floor of the mouth, consult a doctor soon. Prompt treatment could help prevent long-term issues and complications.

Key Pointers

  • A baby with a tongue-tie has an unusually shaped tongue that cannot thrust forwards.
  • The baby would also have a thick string under the tongue that prevents them from latching well during feeding.
  • Delayed growth, difficulty in breastfeeding, irregular teeth formation, etc., are a few complications of tongue-tie in babies.
  • The treatment usually includes a surgery that may be simple or complex depending on the depth of the tongue-tie.

References

1. Ankyloglossia in Children; Cedars Sinai
2. Tongue-tie in babies; Queensland Government
3. Nurdogan Ata et al., The Relationship of Ankyloglossia With Gender in Children and the Ideal Timing of Surgery in Ankyloglossia; Sage Journals
4. Ankyloglossia (Tongue Tie); Children’s Hospital of Philadelphia
5. Tongue-Tie (Ankyloglossia); Cleveland Clinic
6. Tongue and Lip Ties; La Leche League International
7. Tongue-Ties and Sleep Issues (and More!); Light Scalpel; Dental sleep practice.
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Dr. Neema Shrestha
Dr. Neema ShresthaMD
Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. She has an overall experience of five years working in the field. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.

Read full bio of Dr. Neema Shrestha
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