Overview

Tongue-tie is a condition that limits tongue movement. A band of tissue, known as the lingual frenulum, ties the bottom of the tongue’s tip to the floor of the mouth. If this lingual frenulum is too short, thick, or tight, it can prevent the tongue from moving upwards.

Tongue-tie can cause different feeding problems for both infants and their breastfeeding mothers.

Delayed diagnosis may raise the risk of stress for birth parents and disrupt parent-infant bonding. As a result, early diagnosis and subsequent management are essential.^1,2

For infants with tongue-tie, breastfeeding can present many challenges, such as proper latch difficulties, irritability while feeding, and weight gain concerns. If tongue-tie is not addressed early, it could potentially lead to speech difficulties, reduced tongue mobility and other developmental issues.³

Anatomy of the tongue and frenulum

A frenum is a rope-like tissue that connects two bodily structures. One of the frena in the oral cavity is the lingual frenulum, which is located under the tongue. Mouth frenula play a pivotal role in supporting your lips and tongue and help you perform everyday tasks, like chewing and speaking.

In Tongue-tie, a short and/or thick lingual frenulum restricts tongue movement. This results in limitations that can cause a range of noticeable signs and symptoms.⁴

What is tongue-tie?

Recently, research has been focusing more on how the tongue works and what symptoms are caused by the small fold of tissue underneath it, rather than just focusing on the shape of that particular tissue. This fold, called the lingual frenulum, can be attached at different places under the tongue, from the tip to the back. But if this frenulum is too short or thick, it can make it hard to stick out the tongue or move it normally.

In milder cases, tongue-tie can sometimes improve on its own as the child grows. This is why tongue-tie is much more common in newborns, with rates between about 1.7% and 10.7%. In older children, teenagers, and adults, the number of people with tongue-tie is much lower, ranging from roughly 0.1% to 2%.⁶

Signs and symptoms of tongue-tie in infants

The symptoms observed in tongue-tie were primarily related to difficulties with sucking (13%), challenges in speech (32%), and mechanical issues originating from restricted tongue movement (14%).  However, in 38% of cases, tongue-tie was identified incidentally and was asymptomatic.⁵

Signs and symptoms of tongue-tie usually manifest as:

Breastfeeding difficulties

Infants may experience various complications while breastfeeding, which can manifest as:

• Poor latching
• Frequent loss of latch
• Irritability during breastfeeding
• Poor weight gain

Mothers also often report other complications, including:

• Pain while breastfeeding — which may be caused by cracked or sore nipples.
• Incomplete breast emptying, which could be due to insufficient sucking by the infant.

Tongue mobility restriction

Tongue-tied infants may suffer from restricted movement of the tongue, which prevents it from extending beyond the vermilion border. This limitation can manifest in significant difficulties, including: 

• Inability to protrude the tongue past the lower gums
• Struggles to lift the tongue high enough to make contact with the upper teeth
• Difficulty swallowing saliva

Speech articulation difficulties

Limited tongue mobility may impact future pronunciation of consonants and the sounds "s, z, t, d, j, l, ch, zh, th, dg," and "r."⁶

On symptoms

It is important to note that these symptoms could be the result of multiple causes. Consulting a healthcare specialist in breastfeeding support is essential. They will accurately identify the root cause of your symptoms, whether it’s tongue-tie or something else, and confidently guide you towards an effective solution.⁷

Tongue-tie diagnosis

Shortly after a baby is born, Tongue-tie is diagnosed by paediatricians who often collaborate with lactation experts to assess whether the baby's tongue may cause breastfeeding difficulties. Healthcare providers diagnose this condition in babies who exhibit both an altered tongue function and a restrictive lingual frenulum, as not all babies with a thick or short frenulum have tongue-tie.

To determine if your baby has tongue-tie, your healthcare providers will

•  Physically examine your baby to check for signs of tongue-tie
•  Ask about your comfort during breastfeeding, and if you complain of any pain
• Closely observe your breastfeeding positioning. Often, even if the baby has tongue-tie
• Adjust the baby’s position and latching methods to significantly improve the condition.

To evaluate your baby's tongue movement and their frenulum function, healthcare providers use different assessment methods by looking at the function and appearance of your baby’s tongue.⁷

Treatment options

Non-surgical interventions

ENT (ear, nose, and throat) professionals take a patient, careful approach and work together with breastfeeding specialists and speech therapists to suggest the best treatment options for each person.

Surgical interventions

Frenotomy, also known as frenulotomy (simple incision of the frenulum) in infants, is a popular method of surgical intervention for Tongue-Tie.

However, it is important to know that whilst frenotomy can improve breastfeeding difficulties in infants, there have been instances where some infants do not benefit from this procedure.⁸

Summary

Tongue-tie is characterised by a short, thick, or tight band of tissue, known as the lingual frenulum, which ties the bottom of the tongue’s tip to the floor of the mouth, leading to limited tongue movement. 

In infants, tongue movement restriction can result in a range of noticeable signs and symptoms, which include breastfeeding difficulties, impact on future pronunciation of consonants and sounds, and difficulties swallowing saliva. Birth parents also often report pain while breastfeeding, which may be caused by cracked or sore nipples. Also, incomplete breast emptying—due to insufficient sucking by the infant. Tongue-tie is usually diagnosed by paediatricians shortly after birth, and they collaborate with lactation experts who evaluate its impact on breastfeeding. Treatment options for Infants with tongue-tie include non-surgical interventions, where specialists work with lactation consultants and speech therapists, and surgical options, like frenotomy, a simple incision of the frenulum.