Tongue Tie: What Is It and How Is It Treated?
Nov 09, 2022 Jaimie Seaton
Many nursing mothers will tell you their babies sometimes fall off the breast or have trouble latching. It could be that Mom and baby both need more practice with breastfeeding, or it could be that the infant has tongue tie.
Tongue tie (ankyloglossia) is when the tissue connecting the tongue to the floor of the mouth is too short or thick and keeps the tongue from lifting up from the bottom of the mouth. This can make it hard for a baby to breastfeed and can later interfere with the child’s speech.
Tongue tie happens when babies are in the womb, so infants are born with it. The medical community doesn’t know exactly what causes it. The condition is rare—only occurring in about 4% to 8% of infants—and is more common in boys. It also tends to run in families.
"Sometimes people say they hear a lot of clicking during breastfeeding, and that’s a sign that a baby doesn’t have good suction on the breast."
How can I tell if my child has tongue tie?
Parents usually notice tongue tie when their baby has trouble breastfeeding. The baby may not latch well or may dribble or fall off the breast often. Babies with tongue tie also may not grow at the usual rate.
“Sometimes people say they hear a lot of clicking during breastfeeding, and that’s a sign that a baby doesn’t have good suction on the breast,” says Dr. Alexis Rieber, an otolaryngologist (ear, nose and throat—ENT—specialist) at Cedars-Sinai.
A nursing mother whose baby has tongue tie may have red, cracked nipples and experience pain while breastfeeding. And if the baby isn’t completely emptying the breast, the mother may develop inflammation of the breast (mastitis), which can lead to an infection.
If your baby isn’t breastfed, it can take longer to figure out that the child has tongue tie. In that case, it may show up as a speech impediment, where the child has trouble pronouncing words or sounds.
Keep in mind that there are many reasons for problems with breastfeeding, and children who do not have tongue tie also may have difficulty pronouncing certain sounds or words.
If your infant is having difficulty breastfeeding or your child is having speech problems, start with your pediatrician, who may refer you to a pediatric ENT specialist.
Tongue tie can only be diagnosed through a physical examination.
"An experienced doctor who looks at hundreds of tongues a year has to look at it and say there is or is not a tongue tie," says Dr. Rieber.
Treatment options for tongue tie
In infants, tongue tie is treated by making a small cut to the tissue connecting the tongue to the floor of the mouth (lingual frenulum). The procedure, called a frenotomy, allows the tongue to move more freely. This can be done in a healthcare provider’s office without anesthesia.
Dr. Rieber says that the younger children are when they have the procedure, the quicker they recover. She’s observed that newborns recover within about a minute of the procedure. She adds that parents may give the child acetaminophen, but it’s not usually necessary.
Dr. Rieber notes that there has been a dramatic increase in frenotomy procedures in recent years, and many of the procedures are unnecessary. She emphasizes that parents who are considering a frenotomy for their child need to go to a pediatric ENT specialist who’s trained in how to cut the frenulum the right way.
"If you’re going to get it done, make sure it’s done by someone who knows how to do it, because we don’t want to put babies through procedures multiple times," Dr. Rieber says.
Some tongue-tied children may need a more complex procedure called a frenuloplasty, which uses sutures to help prevent the tie from reforming. Young patients also may need to see a speech therapist after having any procedure to correct a tongue tie.