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Tongue tie

Definition

Tongue tie is when the bottom of the tongue is attached to the floor of the mouth.

This makes it hard for the tip of the tongue to move freely.

Alternative Names

Ankyloglossia

Causes

The tongue is connected to the bottom of the mouth by a band of tissue called the lingual frenulum. In people with tongue tie, this band is overly short and thick. The exact cause of tongue tie is not known. Your genes may play a role. The problem tends to run in some families.

Symptoms

In a newborn or infant, the symptoms of tongue tie are similar to the symptoms in a child who is having problems with breast feeding. Symptoms may include:

  • Acting irritable or fussy, even after feeding
  • Difficulty creating or keeping suction on the nipple. The infant may become tired in 1 or 2 minutes, or fall asleep before eating enough.
  • Poor weight gain or weight loss
  • Problems latching onto the nipple. The infant may just chew on the nipple instead.

The breastfeeding mother may have problems with breast pain, plugged milk ducts, or painful breasts, and may feel frustrated.

Most experts do not recommend that health care providers examine newborns for tongue tie unless there are breastfeeding problems.

Most health care providers only consider tongue tie when:

  • The mother and baby have had problems starting breastfeeding.
  • The mother has received at least 2 to 3 days of support from a breastfeeding (lactation) specialist.

Treatment

Most breastfeeding problems can be managed easily. A person who specializes in breastfeeding (lactation consultant) can help with breastfeeding issues.

Tongue tie surgery, called a frenulotomy, is rarely needed. The surgery involves cutting the tissue under the tongue. It is most often done in the doctor's office. Infection or bleeding afterwards are possible, but rare.

Surgery for more severe cases is done in a hospital operating room. A surgical procedure called a z-plasty closure may be needed to prevent scar tissue from forming.

On rare occasions, tongue tie has been linked to problems with tooth development, swallowing, or speech.

References

Hall DM, Renfrew MJ. Tongue tie. Arch Dis Child. 2005;90:1211-1215. Review. Erratum in: Arch Dis Child. 2006;91:797.

Tinanoff N. Common lesions of the oral soft tissues. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 307.

Review Date: 10/18/2013
Reviewed By: Ashutosh Kacker, MD, BS, Associate Professor of Otolaryngology, Weill Cornell Medical College, and Associate Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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