Ankyloglossia in Children

What is tongue-tie in children?

Tongue-tie (ankyloglossia) is a problem with the tongue that is present from birth. It causes speech and eating problems in some children.

The lingual frenulum of the tongue is a small fold of tissue that reaches from the floor of the mouth to the underside of the tongue. You can easily see it if you look under your tongue in a mirror.

Some children have a lingual frenulum that is too short and tight at birth and may attach to the tip of the tongue instead of attaching farther back. When that happens, the tongue can’t move around normally. Your child might have trouble sticking their tongue out, moving it from side to side, or bending it to touch the upper teeth. The tongue often has a notch at its tip. These problems can cause trouble with speaking and eating.

Tongue-tie is different in each child. The condition is divided into categories, based on how well the tongue can move. Class 1 is mild tongue-tie, and class 2 is moderate. Severe tongue-tie is class 3. In class 4, the tongue can hardly move at all.

A small number of babies born each year have tongue-tie. It happens in boys slightly more than in girls.

What causes tongue-tie in a child?

Tongue-tie happens when the tongue and lingual frenulum don’t form quite normally. Healthcare providers aren’t sure exactly what causes this. Tongue-tie runs in some families, so your family health history may play a role.

What are the symptoms of tongue-tie in a child?

Your child may not have any problems from their tongue-tie. Many children do not. Others may have certain problems such as:

• Trouble breastfeeding

• Problems making certain sounds

• A gap between the bottom 2 front teeth

• Problems keeping the mouth healthy, which can cause tooth decay

Tongue-tie can make it hard for your child to do other activities. These include licking an ice cream cone, playing a wind instrument, or kissing. And it may cause embarrassment or social problems in some children.

Most babies with tongue-tie don't have trouble with breastfeeding. But some babies with this condition may have trouble latching to the nipple. Or the breastfeeding might cause nipple pain. If not corrected, your baby may not gain weight normally. It causes some women to give up breastfeeding earlier than they would like.

Tongue-tie often doesn’t keep babies from learning to speak. Your child may just have trouble making certain sounds such as t, d, z, s, th, n, and l.

In rare cases, children with tongue-tie have other problems, such as cleft lip or cleft palate. These can cause other symptoms. 

How is tongue-tie diagnosed in a child?

Your child's healthcare provider can diagnose the condition with a health history and physical exam. The provider will carefully check your child’s tongue and its movements.

Your child’s provider might find tongue-tie when looking for possible causes of your infant’s breastfeeding problems. They might advise that your child see an ear, nose, and throat doctor (ENT or otolaryngologist) after diagnosis.

How is tongue-tie treated?

Your child's healthcare provider might not advise any treatment if your child doesn’t have any symptoms, or if their symptoms are mild. In some children, many or all symptoms go away with time. Between ages 6 months and 6 years, the lingual frenulum naturally moves backward. This may solve the problem if the tongue-tie was only mild. With time, your child may find ways to work around the problem. Symptoms may be less likely to go away if your child has class 3 or class 4 tongue-tie.

If your child is having trouble breastfeeding, the healthcare provider may advise working with a breastfeeding specialist. If that doesn’t work, your child may need to have a surgical procedure.

Your child may need to see a speech specialist as well. This specialist will test your child’s speech. The specialist may recommend speech therapy. Or they may advise surgery.

A simple surgery called a frenotomy is an effective treatment for many children. A healthcare provider may often do this procedure for infants in the office. Older children may need anesthesia. The provider makes a cut in the frenulum. This lets the tongue move normally. Your child might need to see a speech therapist after a frenotomy. This can help them learn how to retrain the tongue muscles.

Some children need a slightly more complex procedure called a frenectomy. This completely removes the lingual frenulum. Another choice is frenuloplasty. This uses several other methods to release the tongue-tie. Your child might need this if a frenotomy was unsuccessful. Or if your child’s lingual frenulum is very thick.

Talk with your child’s provider about the risks and benefits of a procedure.

When should I call my child's healthcare provider?

Call your child’s healthcare provider or breastfeeding specialist if your child is having trouble breastfeeding. If you believe your child is having problems making sounds, see your child’s provider or a speech pathologist.

Key points about tongue-tie in children

• Tongue-tie (ankyloglossia) is a problem with the tongue that is present from birth. It keeps the tongue from moving as freely as it normally would.

• It occurs when the lingual frenulum on the bottom of the tongue is too short and tight.

• Symptoms are different in each child. Some children may not have any symptoms.

• It causes breastfeeding problems in some infants.

• Your child might have trouble making certain sounds.

• Not all children with tongue-tie need surgery. Your child may need surgery if their tongue-tie is more severe and causes major symptoms.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.