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What is a tongue tie? 

Tongue tie (ankyloglossia) is the persistence of a portion of midline tissue under the tongue, that usually undergoes apoptosis during embryonic development. This tissue causes restriction of normal tongue movement. 

In other words, tongue tie occurs when the string of tissue under the tongue is especially short, thick or tight and as a result causes restricted movement of the tongue. MOST babies have a lingual frenulum (a string of tissue that attaches the tongue to the floor of the mouth) but not all of these babies have a tongue tie! There MUST be restriction that causes a problem with tongue function. Incidence figures vary, but is likely that 3-5 babies in every 100 are affected, and males are more affected. What causes is is still unknown, but genes may be a factor, and there can often be other members of the family with tongue tie. Tongue mobility is the critical factor that affects breastfeeding, and so it may lead to difficulties for the breastfeeding baby. Bottle fed infants are less likely to have any problems with a tongue tie but certainly can have symptoms.

Tongue tie can be described as being anterior or posterior. With anterior tongue ties, the tongue is held down close to or at the tongue tip. These are usually very noticeable, as in the picture above. Whereas an anterior frenulum is normally quite visible and frenotomy (the procedure to divide the frenulum) has been done for a long time, the concept of the posterior tie is more recent. Posterior tongue-ties are situated nearer to the base of the tongue, and are not as visible. A health professional MUST examine a child's mouth with a gloved finger to exclude posterior ties. 

Sometimes tension on the floor of the mouth can masquerade as a tie and having body work, by a craniosacral therapist or  a cranial osteopath trained to work with babies can have great results. For this reason, i often recommend that babies who show signs of fascial strain or tension have sessions of bodywork to see do things improve first, before considering surgical intervention. It can also help optimise timing and outcome of tongue tie release. This can be discussed at the assessment.

Frenotomy may help if your baby (and yourself) are experiencing some of the symptoms below. 

Potential challenges for the breastfed baby with a tongue tie include 

  • Difficulties in achieving and maintaining deep attachment to the breast

  • Weight loss or challenges to gain weight

  • Restless and unsettled feeds

  • Noisy or clicking sounds during the feed

  • Tiring easily and falling asleep on the breast

  • Colic or reflux symptoms as a result of swallowing air during feeds

Challenges for the mother breastfeeding a baby with a tongue tie include

  • Distorted nipple shape after a breastfeed

  • Bleeding, damaged or ulcerated nipples resulting in nipple pain  

  • Incomplete milk transfer by the baby resulting in engorgement and /or mastitis

Potential challenges for the bottle-fed baby with a tongue tie include

  • Frequent small volume feeds

  • Slipping off the teat

  • Dribbling of milk during feeds

  • No improvement when the teat is changed for a different type

  • Difficulty keeping soother in mouth

  • Colic or reflux symptoms as a result of swallowing air during feeds


Potential challenges for a weaning baby with a tongue tie include

  • food refusal

  • spitting food back out

  • difficulty moving on from very thin consistency foods

  • choking or gagging

There is growing evidence that tongue tie can causes issues with speech, especially articulation of some consonants like 'R' and 'L. Tongue tie can limit the tongue's ability to remove food from the teeth, resulting in poorer dental hygiene and cavities, and can result in malocclusion (misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close).  There is also evidence that tongue ties can be related to poor sleep,  mouth breathing, poor maxillofacial development, poor posture and head and neck pain and strain in adulthood. 

image from HSE

Tongue Tie: About
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