What You Need to Know About Tongue-Tie in Babies

Tongue-tie, or ankyloglossia, is a minor condition that's fairly common in newborn babies and affects the tongue’s range of motion. Sometimes it doesn’t need any treatment, but in other cases it may require a small medical procedure called a frenotomy. Learn more about the symptoms and treatment of tongue-tie, including how it can affect breastfeeding and other aspects of your baby’s well-being.

What Is Tongue-Tie?

Tongue-tie (ankyloglossia) is when the little strip of skin that attaches your baby’s tongue to the bottom of the mouth – called the lingual frenulum – is shorter than usual, restricting the tongue’s movement. There are two main types of tongue-tie:

• Posterior tongue-tie. This is where the tight strip of skin making your baby tongue-tied is mostly in the back of your baby’s mouth, near the base of the tongue. This type is harder to see.

• Anterior tongue-tie. This type of tongue-tie runs all the way along the underside of the tongue from the base to its tip. This kind of tongue-tie tends to be more noticeable.

How Serious Is Tongue-Tie?

How Common Is Tongue-Tie in Babies?

Tongue-tie is quite common, affecting around 10 percent of all newborn babies. It is more common in boys than in girls. Tongue-tie can run in families: Around half of all tongue-tied babies have someone else in their family who was also born with tongue-tie.

What Are the Symptoms of Tongue-Tie?

A heart-shaped tongue is one possible tongue-tie symptom, but you may not notice this immediately after birth. Other signs that may not be easy to spot at first are if your baby has difficulty lifting his or her tongue up, sticking it out or moving it from side to side. Because tongue-tie affects your baby’s ability to extend the tongue and open the mouth, the most obvious sign of tongue-tie could be if you experience feeding problems. These could include:

• Difficulty attaching to your breast or staying latched for the full duration of the feed

• Having a long feed, followed by a short break and then another feed

• Being unsettled and constantly seeming hungry

• Making a ‘clicking’ sound during feeding

• Not enough weight gain due to some trouble with feeding.

Keep in mind that some of these problems may just mean you need some help with your baby’s positioning and attachment when breastfeeding. Before jumping to the conclusion that it’s tongue-tie, it may be worth trying out some alternative breastfeeding positions or asking your midwife or health visitor for personalised advice.

How Can Tongue-Tie Be Treated?

This minor operation can be performed on your newborn baby by your midwife, a nurse or doctor, without an anaesthetic. For an older baby or child, the procedure is usually done under a general anaesthetic and you may be referred to a paediatric hospital or clinic for the operation. A frenotomy simply involves cutting the lingual frenulum – the strip of skin restricting the tongue’s movement – using a pair of sterilised scissors (with rounded ends to prevent injuring the inside of your baby’s mouth). When this is done, you’ll be able to start feeding your baby immediately. Research shows that most babies find it easier to breastfeed after the operation. There may be a tiny amount of bleeding, and in some cases your baby may develop a small white patch, or ulcer under the tongue. This does not hurt and usually heals by itself within a day or two.

Is Tongue-Tie Surgery Necessary?

Tongue-tie surgery will usually only be recommended for your newborn baby if the tongue-tie is causing difficulties. If your baby isn’t having any problems with feeding, tongue-tie surgery may not be considered necessary as there’s a chance that the skin causing the tongue-tie will stretch or naturally divide as your child gets older. Later, when you start introducing your baby to solid foods, you may be advised to consider surgery if the tongue-tie makes it difficult for your child to chew and move food to the back of the mouth.

At What Age Can Tongue-Tie Be Treated?

Tongue-tie can be treated at any age. In younger babies a few months old, the procedure is performed without an anaesthetic or just with a local anaesthetic that numbs the tongue. The operation doesn’t seem to hurt babies because there are very few nerve endings in the affected part of the mouth. In fact, some babies even sleep through the procedure. Older babies and children will usually be given a general anaesthetic (which puts them to sleep) for the operation.

What Happens If You Don’t Fix Tongue-Tie?

Tongue-tie doesn’t always need to be treated, but in some cases if the tongue-tie isn’t separated it can lead to:

• Feeding problems in young babies

• Sore or cracked nipples for you if you’re breastfeeding (more on this in the next section)

• Difficulty chewing or swallowing food

• Problems pronouncing certain sounds when learning to talk.

How Can Tongue-Tie Affect You When Breastfeeding?

Tongue-tie can affect you, too, if you’re breastfeeding. If you’re having any breastfeeding difficulties with your tongue-tied baby, speak to your midwife, health visitor or a lactation consultant for advice.

Problems you might encounter with breastfeeding if your baby has tongue-tie include:

• Sore or cracked nipples. If the tongue-tie makes it hard for your baby to open his or her mouth or extend the tongue properly, this may affect how your child latches onto your breast when feeding. Poor attachment is the most common cause of sore nipples among breastfeeding mums.

• Drop in milk supply. If the tongue-tie is preventing your baby from getting all the breast milk he or she needs, your breasts may respond by producing less milk. Find out how to increase your milk supply if this happens.

• Blocked milk duct or mastitis. The tongue tie may stop your baby from taking all the milk your breasts are producing, and the backed-up milk can lead to blocked ducts. Try relieving a swollen, blocked milk duct by applying heat and/or gently massaging the affected breast. If a blocked milk duct isn’t cleared as soon as possible, it can lead to mastitis, a painful inflammation of the breast.

The Bottom Line

When you first set eyes on your newborn baby, you might feel a little tongue-tied yourself, in another sense of course: Nobody could blame you for being speechless with emotion. The wonder and joy can easily turn to panic if your little one shows the symptoms of some kind of a condition, but if it turns out that your newborn baby has tongue-tie, there’s nothing to worry about: It’s a common and minor complaint that’s easy to fix with a simple medical procedure – in fact, it may not need any treatment at all. If you’re breastfeeding and find that your tongue-tied baby has a difficult time latching, ask your midwife, a lactation consultant or your health visitor, what you can do to make breastfeeding easier.