Tongue-Tie (Ankyloglossia): Detailed Guide

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 22.10.2026

What is tongue-tie?

In the middle of the underside of the tongue there is a thin fold of tissue that connects the tongue to the floor of the mouth; this is called the lingual frenulum. Every baby has this structure, and its thickness, its length and the place where it attaches to the tongue vary from person to person. The presence of a frenulum is not a problem in itself.

Ankyloglossia, known in everyday language as tongue-tie, is when a short, tight or thick frenulum restricts the movement of the tongue. The AAO-HNS clinical consensus statement likewise defines tongue-tie as “a condition of limited tongue mobility caused by a restrictive lingual frenulum”. The key point in this definition is that the movement of the tongue is genuinely restricted and that this restriction is due to the frenulum.

Tongue-tie is present from birth and is common; studies have reported it in about 3 to 11 per cent of newborns. A broader definition of tongue-tie is thought to be one of the reasons it has been diagnosed more often in recent years. In a large proportion of babies and children with tongue-tie, it causes no problems at all with feeding, speech or daily life.

Why do tongue movements matter?

During breastfeeding, the baby’s tongue extends over the lower gum and cups the breast from below; the rhythmic movements of the tongue produce the sucking that lets the baby take milk. When the tongue cannot extend far enough forward or cannot lift, the baby may not achieve a deep latch; this can make it harder for the baby to take milk and can cause nipple pain in the mother.

In a growing child, the tongue plays a part in many functions, such as moving food around the mouth, clearing the teeth and the corners of the mouth, licking the lips and forming speech sounds. The effect of a tongue-tie is assessed according to which of these functions are affected, and to what extent.

Symptoms and appearance

Signs seen in the tongue

• When the tongue is stuck out, its tip is pulled in at the middle and the tongue looks heart-shaped
• With the mouth open, the tip of the tongue cannot rise towards the roof of the mouth or the upper gum
• The tongue cannot be stuck out far enough to pass the lower gum or the lower lip
• The tip of the tongue struggles to reach out to the sides, towards the corners of the mouth
• When the tongue is lifted, the frenulum can be seen or felt as a tight band

In babies

A baby may have difficulty latching on to the breast, keep slipping off the breast while feeding, make a clicking sound while sucking, have very long or very frequent feeds, still seem hungry after feeds and gain weight poorly. The mother may have nipple pain and cracked nipples during breastfeeding, and the nipple may look flattened or misshapen after a feed. None of these problems is specific to tongue-tie; the same picture can also result from breastfeeding technique, how the baby is positioned, nasal blockage and many other causes.

In older children

Older children may find it hard to lick an ice cream or their lips, may be unable to use the tongue to clear food caught between the teeth and inside the cheeks, and may have a gap between the lower front teeth or difficulty with some speech sounds. Some children and teenagers may feel embarrassed about not being able to stick their tongue out or about how their tongue looks.

Breastfeeding and tongue-tie

Breastfeeding difficulty is common in the newborn period, and tongue-tie is only one of its possible causes. A marked tongue-tie can make it harder for the baby to latch on to the breast; the mother may have nipple pain and the baby may not gain enough weight. However, nipple pain and difficulty latching on are also common without tongue-tie.

Studies looking at the effect of releasing a tongue-tie (frenotomy) on breastfeeding have had differing results. A Cochrane review that brought these studies together reported that frenotomy reduced the mother’s nipple pain in the short term but did not show a consistent positive effect on how well the baby breastfeeds. In the studies, mothers often reported that breastfeeding became easier after the procedure; however, these assessments are mostly based on mothers’ own observations, and the studies are few, short and differ in their methods.

This is why, in a baby with breastfeeding difficulty, the whole picture is assessed first. It is important to review the breastfeeding technique, how the baby is positioned at the breast and other causes that may make feeding harder. In babies with tongue-tie too, breastfeeding difficulty and nipple pain can sometimes improve without a procedure. In babies whose tongue movement is clearly restricted and whose breastfeeding difficulty continues despite these adjustments, frenotomy is one of the options considered; once the decision has been made, the procedure can be carried out without undue delay.

Speech and tongue-tie

One of the questions families often ask is whether tongue-tie will affect speech. According to the AAO-HNS clinical consensus statement, tongue-tie usually does not affect speech. Most children whose tongue-tip movement is significantly restricted can still make sounds such as r and l, which need the tip of the tongue to lift high. There are studies reporting a link between tongue-tie and difficulty making certain sounds; however, the quality of evidence from these studies is low, and studies looking at the effect of the procedure on speech have also had differing results.

Tongue-tie is a condition related to the movement of the tongue; matters of language development, such as when a child starts to talk, the size of their vocabulary or how they put sentences together, are not attributed to tongue-tie. In a child who is late to talk, other causes of the speech delay are looked into. In a small number of children, however, there may be difficulty saying some sounds. A tongue-tie that does not clearly restrict tongue movement does not need to be cut in infancy to prevent speech problems later on.

In older children for whom a procedure is being considered because of a speech concern, a detailed assessment of the child’s speech before the procedure is important. This makes it easier to understand whether the concern is related to the tongue-tie or to another cause. Speech exercises are also among the non-surgical options and, when needed, can be used together with the procedure.

Tongue-tie in older children and teenagers

A tongue-tie that was not noticed or caused no problems in infancy may come to light later in childhood through other concerns. These include difficulty licking an ice cream or the lips, difficulty clearing the teeth and the inside of the mouth with the tongue, a gap between the lower front teeth and feeling self-conscious around others about how the tongue looks. In some children and teenagers with these kinds of concerns, an improvement in day-to-day quality of life has been reported after release of the tongue-tie; however, studies on this subject are few.

There is no upper age limit for releasing a tongue-tie. In older children, the procedure is usually performed under general anaesthesia; frenotomy or frenuloplasty may be used, and no single method has been shown to be better than the others. The decision takes into account both whether the concern is genuinely related to the tongue-tie and how much it affects the child’s daily life.

Examination and assessment

Assessment starts with a detailed history. In babies, you will be asked about the birth and feeding history, any difficulties during breastfeeding, the length and frequency of feeds, the mother’s nipple pain and the baby’s weight gain. You will also be asked whether anyone in the family has a bleeding disorder. In older children, any problems with eating, keeping the mouth clean, the teeth and speech, and how much they affect daily life, are discussed.

The examination focuses on how the tongue works rather than how the frenulum looks. It checks how far the tongue can lift, stick out and move to the sides; the frenulum is felt to assess its thickness, its elasticity and where it attaches to the tongue. Some scoring tools are used to assess tongue-tie; however, there is no consensus on which one should be preferred, and the result is always interpreted together with the examination findings. If tongue movement is not restricted, or if the restriction is not due to the frenulum, the diagnosis of tongue-tie is reconsidered.

In babies with breastfeeding difficulty, assessing the breastfeeding technique and reviewing other causes that may make feeding harder (such as nasal blockage, airway problems, reflux or a cleft palate) are part of the assessment. In some situations, such as a lower jaw that is set back or unusually small, neuromuscular conditions, low muscle tone or a bleeding disorder, the decision on a procedure is made with greater care.

Treatment options

The decision on treatment is made together with the family, based on whether the tongue-tie is causing a real problem with feeding, speech or daily life, after discussing the possible benefits and risks.

Watchful waiting

If the tongue-tie is not causing a problem, no procedure is needed. A tongue-tie that does not clearly restrict tongue movement does not need to be cut to prevent feeding or speech problems later on. In some babies, breastfeeding difficulties can also improve over time and with adjustments to the breastfeeding technique. If a new concern arises during monitoring, the situation is reassessed.

Frenotomy

Frenotomy releases a tongue-tie with a simple cut, and it is the procedure usually performed in newborns and young babies. The baby’s head is gently held still, the tongue is lifted and the frenulum is cut with sharp, blunt-ended scissors. The procedure takes a very short time. In the first months of life, frenotomy can usually be done without general anaesthesia; as the baby grows, the procedure may need to be done under general anaesthesia. There is very little or no bleeding, and the baby can feed straight after the procedure. A follow-up check may be carried out after the procedure to assess healing and any changes in breastfeeding.

Frenuloplasty

Frenuloplasty is an operation in which, after the frenulum has been released, the tissue is rearranged and closed with dissolving stitches. It may be preferred in older children, when the frenulum is thick, or when restriction develops again after a previous procedure. The operation is usually performed under general anaesthesia. For older children, no single surgical technique has been shown to be better than the others.

Frenotomy and frenuloplasty can be performed with different instruments, such as scissors, a scalpel or a laser. There is not enough evidence that any method, including laser, is better than the others.

Possible risks and recovery after the procedure

Frenotomy is generally a safe and well-tolerated procedure. No serious problems have been reported in controlled studies of frenotomy; however, the number of babies studied in these trials is small. Rare problems include:

• Bleeding: it is usually very slight and stops within a short time.
• Infection: it is rare.
• Damage to the salivary gland ducts: the salivary gland ducts that open under the tongue lie close to the area of the procedure; rarely, they may be affected.
• Scarring and reattachment: scar tissue that forms during healing, or reattachment of the frenulum, can restrict tongue movement again.
• Reluctance to feed: some babies may be unsettled while feeding for a short time after the procedure; rarely, the reluctance to feed may be more marked.
• Effects on breathing: this is very rare; it may be linked to the tongue falling backwards in babies whose lower jaw is set back or unusually small, or who have low muscle tone. This is one of the reasons why the decision on a procedure is made with greater care in these babies.

The possibility that the procedure may not resolve breastfeeding difficulty and nipple pain in every baby is also discussed with the family when the decision is being made.

After frenotomy, the baby can feed straight away. A whitish-yellow healing patch may form under the tongue; this is part of normal healing and goes away on its own. There is not enough evidence that babies need regular stretching, massage or exercises in which the tongue is lifted by hand after the procedure; unless your doctor specifically advises it, avoid any forceful movements of the tongue. If bleeding continues or your baby clearly refuses to feed, contact your doctor.

In older children, there may be mild pain under the tongue and discomfort when eating or talking after frenuloplasty; in the first days, soft, lukewarm foods are preferred and the mouth is kept clean. The stitches dissolve on their own. Simple tongue exercises may be recommended to help the child make use of the tongue’s new range of movement; in children who have had the procedure because of a speech concern, speech exercises can support the process when needed. A follow-up examination is carried out after the procedure to assess healing and tongue movements.

Posterior tongue-tie, lip-tie and buccal tie

In recent years, the terms “posterior tongue-tie”, “lip-tie” and “buccal tie” (cheek tie) have been widely discussed on social media and in some sources. Scientific opinion on these subjects is not yet settled; calm and balanced information is important for families.

Posterior tongue-tie: Unlike the classic tongue-tie, which extends to the tip of the tongue, this term is used for a frenulum that attaches further back on the tongue or lies beneath the lining of the mouth (the mucosa). In the 2020 clinical consensus statement of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), no consensus was reached on the definition of posterior tongue-tie; some experts believe it does not exist as a separate structure. Evidence that a procedure for posterior tongue-tie is beneficial is limited. The same statement also noted that in some places tongue-tie is diagnosed more often than it should be and that unnecessary procedures are carried out. This is why, in a baby thought to have a posterior tongue-tie, the decision is based on a careful assessment of tongue movements and feeding.

Lip-tie: The fold of tissue connecting the inside of the upper lip to the gum (the upper lip frenulum) is a normal structure in babies. The definition of the condition called “lip-tie” is not clear and its link with breastfeeding difficulties is uncertain; the consensus statement noted that in some places lip-tie, too, is diagnosed more often than it should be. Cutting a lip-tie while the child still has milk teeth does not prevent a gap from forming between the upper front teeth later on. Most of the time, a lip-tie does not require any intervention.

Buccal tie: The folds of tissue on the inside of the cheeks are also normal structures; according to the expert consensus, these structures should not be operated on under the label of “buccal tie”.

Frequently asked questions

Does tongue-tie go away on its own? It is not fully known how much a tongue-tie loosens as a child grows. However, what matters is not the frenulum itself but whether it causes a problem; a tongue-tie that is not causing problems does not need a procedure. In some babies, breastfeeding difficulties can also improve over time and with adjustments to the breastfeeding technique, without a procedure.

If the tongue-tie is not cut, will my child be late to talk? Usually not. Tongue-tie is a condition related to the movement of the tongue; when a child starts to talk, the size of their vocabulary and how they put sentences together are not attributed to tongue-tie. In most children with tongue-tie, speech develops normally; a small number of children may have difficulty saying some sounds. This is why a tongue-tie that is not causing problems does not need to be cut to prevent speech problems later on.

Does frenotomy hurt the baby? The procedure takes a very short time; the baby may be unsettled or cry briefly during it. There is very little or no bleeding, and the baby can be breastfed or fed straight after the procedure. Most babies are back to their usual selves within a short time.

Is a laser procedure better? There is not enough evidence that any method, including laser, is better than a procedure done with scissors. What matters is a sound assessment of whether the procedure is really needed.

Does tongue-tie cause snoring or sleep apnea? According to the AAO-HNS clinical consensus statement, tongue-tie does not cause sleep apnea. In children who snore, sleep with their mouth open or have pauses in their breathing during sleep, enlarged adenoids and tonsils are assessed (adenoids and tonsils in children).

Can tongue-tie come back after it has been cut? Data on this are limited. In some children, scar tissue that forms during healing or reattachment of the frenulum can restrict tongue movement again. If the problems come back, the tongue movements are reassessed; if needed, a repeat procedure may be considered.

This article is for general information; please consult your physician for diagnosis and treatment.