What to Know About Infant Tongue Tie

Is your infant struggling to feed? You might have a tongue tied baby on your hands. Here’s how to tell.
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By Anna Davies, Contributing Writer
Published October 11, 2019
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Image: Mayte Torres

You may have pictured nursing your newborn as a blissful experience—only to find yourself faced with a reality of cracked and bleeding nipples, a newborn who cries around the clock and a concerned doctor telling you baby has fallen below their birth weight. Breastfeeding can be challenging to be sure, but sometimes nursing difficulties are in fact due to tongue tie, a physical condition that can interfere with baby’s feeding. Luckily, it’s easily treated. Read on to learn what infant tongue tie is, how it’s treated and what you should do if you think you have a tongue tied baby on your hands.

What Is Tongue Tie?

Tongue tie—officially known as ankyloglossia (pronounced ang-kuh-loh-glaw-see-uh)—occurs when the tissue, called the frenulum, that connects baby’s tongue to their mouth floor is so tight and thick that it restricts the tongue’s range of motion. Because the tongue can’t move freely, it may be hard for baby to properly latch onto a nipple or bottle, making it difficult to get enough milk or formula.

Tongue tie is relatively rare, affecting somewhere between 4 and 10 percent of infants, research suggests. But even if you peer into baby’s mouth and it looks like they have a thick or tight frenulum, that doesn’t necessarily mean your child will have difficulty feeding. For that reason, experts often rely on symptoms—including nipple pain, weight loss or a painful or shallow latch—to assess whether a potentially tongue tied baby needs treatment.

“Babies will present with difficulty feeding and moms complain about babies with unsatisfying feeding, poor weight gain and feedings that are long with no or little break between feeds,” notes Lauren Macaluso, MD, FAAP, whose practice focuses on breastfeeding mothers. “A baby in this case will have a hard time latching on and getting enough milk. This could cause limited breast draining and could lead to mastitis or breast infection for the nursing mom.”

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There are two types of tongue ties: Anterior tongue ties (also known as Type 1 and Type II) and posterior tongue ties (also known as Type III and Type IV). Anterior tongue ties are near baby’s gum line when they open their mouth. A posterior tongue tie may be farther back on the tongue. Both types of tongue tie may restrict movement. Tongue tie may have a genetic component, so if you or your partner had it, your child might too. Similarly, if your first was a tongue tied baby, your second might be as well.

Tongue Tie Symptoms

So how can you tell if baby has a tongue tie? While the thick frenulum can be plainly visible, you may need to rely on secondary factors for the real clues, says Leigh Anne O’Connor, IBCLC, a lactation consultant in New York City. Here, some possible signs of tongue tie to look for:

  • A heart shaped tongue
  • A tongue that can’t fully protrude
  • Painful nursing
  • Cracked, bleeding nipples
  • An infant who isn’t gaining weight or producing dirty diapers

While feeding problems can be indicative of infant tongue tie, it’s not necessarily the reason baby is feeding poorly, O’Connor stresses. Many new mothers initially struggle with breastfeeding, and for a variety of reasons, which is why it’s important to speak with your child’s pediatrician or a lactation consultant. “Pain with latching could be caused by poor positioning or other impacts,” Macaluso explains. “A mother may have physiological issues that cause latching problems and in some instances the baby may be too relaxed to feed properly.”

Tongue Tie Surgery

Tongue tie treatment generally involves a simple surgical procedure called a frenotomy or a tongue tie revision. Some doctors and lactation consultants recommend correcting infant tongue tie right away, sometimes even before a newborn is discharged from the hospital. Others advocate for a wait-and-see approach. That’s because the frenulum may loosen over time, according to the Mayo Clinic. Even if it persists, it doesn’t always interfere with feeding. “If baby is gaining weight and nursing is comfortable for both of you, then revision may not be necessary,” O’Connell says.

Still, even if a newborn tongue tie isn’t causing feeding problems right off the bat, it could create issues down the line. O’Connell sometimes sees infants who are 3 to 6 months old begin to have feeding issues due to tongue tie. “If a mom has a strong supply, the infant may not need to suck to get milk—the milk just lands in their mouth,” she explains. “But as the mom’s supply regulates, baby may not have an effective latch, and a revision may need to be done.”

If baby’s tongue tie is interfering with feeding, surgery may be suggested. Don’t worry—the procedure itself is minor, and can be done with topical anesthesia in the hospital or a doctor’s office. A doctor will either use scissors or a laser to “cut” the tie, O’Connell says. The tongue tie clip is quick, and since there are few blood vessels in the frenulum, you’re likely to see only a drop or two of blood.

After surgery, you’ll be taught a series of exercises that will help prevent the tongue tie from growing back. Baby will be able to nurse right away after surgery, and some moms report immediate improvement. You may also be advised to see a lactation consultant post-surgery to assess your breastfeeding and provide any feedback on positions and technique.

Published October 2019

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

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