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"Understanding Ankyloglossia (Tongue-Tie) in Children: Causes, Symptoms, and Treatment Options"

Updated: Mar 23



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 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 frenulum that is too short and tight at birth. The frenulum may attach to the tip of the tongue instead of attaching farther back. When that happens, the tongue can’t move around normally. The child might have trouble sticking his or her 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 : mild tongue-tie

Class 2 : moderate tongue-tie

Class 3 : Severe tongue-tie

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 frenulum don’t form quite normally. Researchers 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?

The child may not have any problems from his or her 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. 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?

The doctor can diagnose the condition with a health history and physical exam. The paediatric surgeon will carefully check your child’s tongue and its movements. The doctor might find tongue-tie incidentally when looking for possible causes of an infant’s breastfeeding problems.


How is tongue-tie treated?

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

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

The child may need to see a speech therapist as well. This specialist will test your child’s speech. The specialist may recommend speech therapy. Or he or she may recommend surgery.

A simple surgery called a frenotomy is an effective treatment for many children. A healthcare provider can often do this procedure in the office. 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 him or her learn how to retrain the tongue muscles.


Some children need a slightly more complex procedure called a frenectomy. This completely removes the 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 frenulum is very thick.


Difference between Frenotomy, Frenuloplasty and Frenectomy


Frenotomy is a simple procedure in which the tight frenulum is snipped off on an outpatient basis. Limited nerve endings make this almost painless therefore there is no need for stitches or anesthesia. Bleeding is minimal as this area has few blood vessels only. However in older children or adults when the frenulum is too thick a simple frenotomy may not be successful. In such situations the frenulum is incised and relocated at the attachment point. This procedure is known as frenuloplasty wherein an abnormally attached frenulum is corrected by surgically repositioning it. In frenectomy mere relocation does not solve the dental issues involved and the frenum is removed completely, right up to its attachment to the underlying bone.


When should I call my child's paediatric surgeon?

Call your child’s paediatric surgeon or breastfeeding specialist if your child is having trouble breastfeeding. If you believe your child is having problems making sounds, see your child’s healthcare 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 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.

  • The child might have trouble making certain sounds.

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



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