Tongue-Tie (Ankyloglossia) in Babies and Children

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

What is it?

The thin fold of tissue that connects the underside of the tongue to the floor of the mouth is called the lingual frenulum. Every baby has this fold, and it is a normal structure. In some babies the frenulum is short, tight or thick, or it is attached very close to the tip of the tongue; when this happens, the movement of the tongue may be restricted. This is the condition known medically as ankyloglossia and in everyday language as “tongue-tie”.

Tongue-tie is present from birth and is common; studies have reported it in about 3 to 11 per cent of newborns. In a large proportion of babies and children with tongue-tie, it causes no problems at all. This is why what matters is not how the frenulum looks, but whether it actually affects the movement of the tongue, feeding or daily life.

Symptoms

In some babies and children, tongue-tie is noticed because of the following signs:

• A notch at the tip of the tongue: when the tongue is stuck out, its tip is pulled in at the middle and the tongue looks heart-shaped.
• Being unable to lift the tongue: with the mouth open, the tip of the tongue cannot rise towards the roof of the mouth or the upper gum.
• Being unable to stick the tongue out: the tongue cannot be stuck out far enough to pass the lower gum or the lower lip.
• Difficulty moving the tongue from side to side: the tip of the tongue struggles to reach the corners of the mouth.

Babies may have difficulty latching on well, keep slipping off the breast while feeding, make a clicking sound while sucking, have very long or very frequent feeds, and gain weight poorly. The mother may have nipple pain and cracked nipples during breastfeeding. However, these problems can also arise from many causes other than tongue-tie; not every breastfeeding difficulty is due to tongue-tie.

What problems can it cause?

• Breastfeeding difficulty: tongue-tie can make it harder for the baby to latch on to the breast and to take milk effectively. Breastfeeding difficulty is common in the newborn period, and tongue-tie is only one of its possible causes. Studies looking at the effect of releasing a tongue-tie on breastfeeding have had differing results: the procedure may reduce nipple pain in some mothers, but it does not lead to better feeding in every baby.
• Speech: in most children with tongue-tie, speech develops normally; tongue-tie usually does not affect speech and is not regarded as a cause of late talking. Most children can make even sounds such as r and l, which need the tip of the tongue to lift high; a small number of children may have difficulty saying some sounds.
• Daily life in older children: children may find it hard to lick an ice cream or their lips, may be unable to clear food caught between their teeth with the tongue, which makes it harder to keep the mouth clean, and may have a gap between the lower front teeth or feel self-conscious about how their tongue looks.

Examination and assessment

Assessment looks at how the tongue works rather than how the frenulum looks. You will be asked about the baby’s feeding history, any difficulties during breastfeeding, the mother’s nipple pain and the baby’s weight gain. The examination 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.

In babies with breastfeeding difficulty, assessing the breastfeeding technique and reviewing other causes that may make feeding harder (such as nasal blockage, reflux or a cleft palate) are also part of the assessment. In older children, you will be asked about any problems with eating, keeping the mouth clean, the teeth and speech, and the movements of the tongue are examined.

Treatment

Not every tongue-tie needs to be cut. 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.

• 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 with adjustments to the breastfeeding technique, without a procedure.
• Frenotomy (cutting the tongue-tie): a simple procedure performed in newborns and young babies. The frenulum is cut with sharp, blunt-ended scissors. The procedure takes a very short time, and in the first months of life general anaesthesia is usually not needed. There is very little or no bleeding; the baby can feed straight after the procedure.
• Frenuloplasty: it may be performed in older children, when the frenulum is thick, or when restriction develops again after a previous procedure. The frenulum is released, and the tissue is rearranged and closed with dissolving stitches. The operation is usually performed under general anaesthesia.

Frenotomy is generally a safe and well-tolerated procedure. Rarely, bleeding, infection, damage to the salivary gland ducts under the tongue, scarring, reattachment of the frenulum or reluctance to feed may occur. The procedure may not resolve breastfeeding difficulty in every baby; this is also discussed with the family when the decision is being made.

Posterior tongue-tie and lip-tie

In recent years, the terms “posterior tongue-tie” and “lip-tie” have been widely discussed. 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, and the evidence that procedures for it are beneficial was described as 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. The fold of tissue that connects the upper lip to the gum (the upper lip frenulum), on the other hand, is a normal structure in babies; the definition of the condition called “lip-tie” is not clear, its link with breastfeeding is uncertain, and most of the time it does not require any intervention.

After the procedure

• Feeding: after frenotomy, the baby can be breastfed or fed straight away.
• How the wound looks: a whitish-yellow healing patch may form under the tongue; this is part of normal healing and goes away on its own.
• Tongue exercises: there is not enough evidence that regular stretching or massage exercises are needed in babies after the procedure; unless your doctor specifically advises it, avoid any forceful movements of the tongue. In older children, after frenuloplasty, simple tongue exercises may be recommended to help the child make use of the tongue’s new range of movement.
• Eating and mouth care: in older children, soft foods are preferred in the first days after frenuloplasty and the mouth is kept clean; the stitches dissolve on their own.
• Speech: in children who have the procedure because of a speech concern, speech exercises can support the process when needed.

When to see a specialist

If your baby has difficulty latching on to the breast, you have marked nipple pain during breastfeeding or your baby is not gaining enough weight, and you have also noticed that your baby’s tongue movement seems restricted, it is advisable to see an ENT specialist. In older children, an examination is helpful if the movement of the tongue affects eating, keeping the mouth clean or making certain sounds. There is no need to worry about a tongue-tie that is not causing problems; an assessment makes it easier to decide calmly whether a procedure is needed.

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