Tongue-Tie in Infants: How it Affects Feeding and When to Get Surgery
Jake Newby
| 4 min read
During the past 20 years, there has been a dramatic increase in the number of infants diagnosed with and treated for tongue-tie in the U.S. Nearly 10% of all babies under the age of 1 are born with at least a mild tongue-tie, also known by its medical term, ankyloglossia.
Tongue-tie occurs when an unusually short, thick, or tight band of connective tissue known as the lingual frenulum tethers the base of the tongue’s tip to the floor of the mouth.
Mild cases may result in just a tiny fold of tissue holding the tip of the tongue in place. More extreme cases may result in the entire bottom of the tongue is attached to the floor of the mouth. Surgery to resolve this condition – known as a frenotomy – is often recommended as treatment.
Signs and symptoms of tongue-tie
The most common symptom associated with tongue-tie in newborns is the difficulty of both breastfeeding and bottle feeding, which requires the baby to get the tongue to the roof of the mouth to squeeze the nipple or the teat of a bottle and express milk. The tongue’s limited range of motion leads to a weak latch and the baby cannot express milk from the nipple or bottle effectively. Some babies with milder cases of tongue-tie may chew on the nipple instead of sucking, which can be painful for the mother and also keep the baby from properly expressing milk.
Latching and feeding challenges are not exclusively caused by tongue-tie, so it’s important to rule out other causes such as poor positioning, jaundice, a recessed jaw or infection before seeking tongue-tie treatment.
Examining the shape of the baby’s tongue while they are crying or lifting their tongue can help a parent identify tongue-tie, which may look like a small heart. Other signs include:
- An inability to curl toward their nose or lick their lips
- An inability to move far from side to side
- Fussiness when trying to feed
- Making a clicking sound while trying to feed
- Trouble sticking the tongue past the gums and lower lip
Potential tongue-tie complications for children and teens
A frenotomy may not be recommended for a baby with tongue-tie that breastfeeds without issue. They may instead be diagnosed later in life and grow into adolescence and adulthood while managing symptoms. Children and adolescents with tongue tie may experience:
- Speech difficulties: Tongue-tie can interfere with pronunciation and the ability to make sounds such as "t," "d," "z," "s," "th" and "l."
- Poor oral hygiene: The condition can make it challenging to clear debris from the teeth and can sometimes cause tooth decay and inflammation of the gums (gingivitis).
- Challenges with other oral activities: Tongue-tie and poor tongue control can interfere with activities like eating food, kissing or playing a wind instrument.
These issues may vary in terms of difficulty depending on the person. Adults have minimal issues eating because they can cut food up into small pieces and place it further back into the mouth. Additionally, speech therapy can help with improved pronunciation.
When to get tongue-tie surgery
The decision to get a frenotomy depends on a doctor’s discretion. In some cases, the frenulum will release on its own and doesn’t cause long-term issues, so not all individuals with the condition require treatment. Most parents who elect for a frenotomy do so right away, typically do so within the baby’s first few weeks of life.
Frenotomies are considered low-risk procedures that resolve the condition in just a few minutes. They involve using a laser or sterile scissors to snip the connective tissue. The procedure doesn’t typically require anesthesia. Side effects are rare, but can include:
- Bleeding
- Damage to the saliva ducts
- Infection
- Nerve damage under the tongue
- Pain
- Reluctance for the baby to feed soon after the procedure
Parents should talk to their child's pediatrician or otorhinolaryngology professional for any concerns, questions or recommendations related to tongue-tie.
Photo credit: Getty Images
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