Good news: Most tongue ties don’t require surgical treatment. Here’s what to know.
If you’ve been told your baby has a tongue tie, you may be wondering what that means — and what to do about it. The good news is that, often, tongue ties don’t require surgery. Here’s what you need to know.
Tongue ties explained
The lingual frenulum is a small piece of tissue that connects the underside of the tongue to the floor of the mouth. When the tissue is too tight or too short, it can restrict the tongue’s movement and function, a condition known as ankyloglossia, or more commonly, tongue tie.
“Tongue ties are a natural variation that occurs during the development of the tongue in the womb,” said Dr. Filipina Cevallos Schnabel, a pediatric ear, nose and throat nurse practitioner at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “Most often, the lingual frenulum detaches as the baby grows inside the womb, but in some cases, it remains tight. It’s not entirely understood why this happens.”
Ankyloglossia is present in about 5% of all babies, and it’s slightly more common in males (7%) than in females (4%).
What a tongue tie looks like
Tongue ties can vary significantly in appearance and severity. Some tongue ties are obvious while others are not. Some may cause a more pronounced restriction that makes it difficult to move the tongue properly.
“Not all tongue ties appear the same,” Schnabel said. “There are different classifications, ranging from anterior, which is easy to spot, to posterior, which can be harder to see but may still cause symptoms. It’s important to assess based on the baby’s symptoms rather than just appearance.”
Symptoms of a tongue tie in babies include:
- Breastfeeding/feeding difficulty
- Poor latch when breastfeeding and/or bottle-feeding
- Clicking when swallowing
- Gassiness
- Frequent hiccups
- Signs of reflux, such as frequent spitting up and arching back when feeding
- Cluster feeding
- Messy feeds
- Poor weight gain
- In the mother, persistent nipple pain; cracked, sore nipples; not producing enough milk
When tongue ties affect breastfeeding
Tongue ties can make breastfeeding more difficult for some babies, because they are unable to move their tongue in such a way to create an efficient seal to transfer milk. This can lead poor weight gain and frequent feedings in babies and nipple pain for breastfeeding mothers.
Although nipple pain is common in the early days of breastfeeding, it usually resolves as baby gets better at latching effectively. For mothers breastfeeding babies with ankyloglossia, the pain can be more persistent and severe. Up to 80% of these mothers report ongoing nipple pain, and about 25% of them struggle with their babies’ latches six weeks postpartum, compared with just 3% of mothers breastfeeding babies without tongue ties.
“It’s not uncommon for mothers to experience significant pain or even conditions like mastitis because the baby is chomping rather than sucking,” Schnabel said.
Treatment for tongue ties
Most tongue ties do not require surgical treatment unless they are causing feeding difficulties. If a baby is breastfeeding well and there are no other concerns, treatment is not necessary.
“Tongue ties are one cause of breastfeeding difficulty, but they’re not the only cause.”
“Tongue ties are one cause of breastfeeding difficulty, but they’re not the only cause,” Schnabel said. “It’s always a good idea to work with a lactation consultant first and see if they can help baby latch properly. If that fails or there are other symptoms, then we can thoroughly evaluate baby for other causes of feeding difficulties or a possible release of a tongue tie.”
When surgical treatment is warranted, the most common option is a procedure called a frenotomy. This involves cutting the frenulum to release the tongue.
“If breastfeeding is the goal and the tongue tie is the cause of feeding issues, we’ll perform a simple procedure to release the frenulum,” Schnabel said. “For younger babies, this can be performed in clinic without general anesthesia and heals very quickly. It’s safe and effective.”
While tongue ties can be a source of concern for new parents, they are often harmless. If you suspect your baby has a tongue tie and it’s affecting their feeding, ask your pediatrician for a referral to a pediatric otolaryngologist.
Personalized care for your child
The Ear, Nose and Throat team at Monroe Carell Jr. Children’s Hospital at Vanderbilt evaluates and treats infants and babies with tongue ties. The team will help you learn whether or not your child’s tongue tie will resolve on its own or require surgery.
