Definition

Tongue-tie is difficulty moving the tongue because of tight tissue under the tongue. The limited movement can make it difficult to eat or speak. The degree of limitation can vary from person to person.

Tongue-tie is present at birth.

Causes

A tissue called the frenulum helps the development of the mouth before and shortly after birth. This frenulum is attached to the underside of the tongue. After birth the frenulum should start to shrink and loosen its hold on the tongue.

In some, the frenulum does not shrink as expected. The exact reason is not clear but it may be associated with genetics.

Risk Factors

Tongue-tie is more common in boys. It may also be more likely if other family members have had it.

Symptoms

Symptoms will depend on the degree of limitation. Most children with tongue-tie won’t have symptoms.

In those that have symptoms, tongue-tie may cause some functional problems such as:

• Problems with feeding, such as latching on to the nipple during breast or bottle feeding
• Difficulty clearing food from teeth or the mouth (more common in older children)
• Difficulty using the tongue to lick their lips or an ice cream cone, or kiss
• Speech problems

Diagnosis

Tongue-tie can be diagnosed with a routine physical exam.

Treatment

Discuss your treatment preferences and options with your child’s doctor.

If there are no severe functional issues, your child’s doctor may recommend watchful waiting. Over time, the frenulum may loosen on its own.

The frenulum may be surgically corrected if there is very limited movement in the tongue, difficulty gaining weight, or psychosocial concerns due to speech patterns. Options include:

• Frenulotomy—The frenulum is snipped to release the tongue for normal movement.
• Frenulectomy—The frenulum is removed.
• Frenuloplasty—Repair of the frenulum without complete removal. This may also be necessary to correct other defects found during a frenulectomy.

These surgeries can often be done in the doctor’s office with local anesthesia.

Following surgery, your child may need to do tongue exercises and/or speech therapy.

Prevention

There are no current guidelines to prevent tongue-tie because the cause is unknown.

Healthy Children—American Academy of Pediatrics http://www.healthychildren.org

Hathaway A, McCauley R. Assessment and management of tongue-tie in children: A survey of related professionals. American Speech Language Hearing Association website. Available at:
http://search.asha.org/default.aspx?q=tongue-tie
Accessed December 8, 2014.

Kummer A. Ankyloglossia: To clip or not to clip? That’s the question. American Speech Language Hearing Association website. Available at:
http://www.asha.org/Publications/leader/2005/051227/f051227a.htm
Published December 27, 2005. Accessed December 8, 2014.

Lalakea ML, Messner AH. Ankyloglossia: Does it matter? Pediatr Clin North Amer. 2003;50(2):391-397.

Oral lesions. PEMSoft at EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Accessed December 8, 2014.

Tongue-tie. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
http://www.entnet.org/?q=node/1413
Accessed December 8, 2014.