Ankyloglossia in Children
Tongue-tie (ankyloglossia) is a
problem with the tongue that is present from birth. It causes speech and eating problems
in some children.
The frenulum of the tongue is a
small fold of tissue that reaches from the floor of the mouth to the underside of the
tongue. You can easily see it if you look under your tongue in a mirror.
Some children have a frenulum that
is too short and tight at birth. The frenulum may attach to the tip of the tongue
instead of attaching farther back. When that happens, the tongue can’t move around
normally. Your child might have trouble sticking his or her tongue out, moving it from
side to side, or bending it to touch the upper teeth. The tongue often has a notch at
its tip. These problems can cause trouble with speaking and eating.
Tongue-tie is different in each
child. The condition is divided into categories, based on how well the tongue can move.
Class 1 is mild tongue-tie, and class 2 is moderate. Severe tongue-tie is class 3. In
class 4, the tongue can hardly move at all.
A small number of babies born each
year have tongue-tie. It happens in boys slightly more than in girls.
Tongue-tie happens when the tongue and frenulum don’t form quite
normally. Healthcare providers aren’t sure exactly what causes this. Tongue-tie runs in
some families, so your family health history may play a role.
Your child may not have any
problems from his or her tongue-tie. Many children do not. Others may have certain
problems such as:
- Trouble breastfeeding
- Problems making certain sounds
- A gap between the bottom 2 front
- Problems keeping the mouth healthy,
which can cause tooth decay
Tongue-tie can make it hard for
your child to do other activities. These include licking an ice cream cone, playing a
wind instrument, or kissing. And it may cause embarrassment or social problems in some
Most babies with tongue-tie don't
have trouble with breastfeeding. Babies with this condition may have trouble latching to
the nipple. Or the breastfeeding might cause nipple pain. If not corrected, your baby
may not gain weight normally. It causes some women to give up breastfeeding earlier than
they would like.
Tongue-tie often doesn’t keep
babies from learning to speak. Your child may just have trouble making certain sounds
such as t, d, z, s, th, n, and l.
In rare cases, children with
tongue-tie have other problems such as cleft lip or cleft palate. These can cause other
Your healthcare provider can
diagnose the condition with a health history and physical exam. Your provider will
carefully check your child’s tongue and its movements.
Your child’s healthcare provider
might find tongue-tie when looking for possible causes of your infant’s breastfeeding
problems. He or she might recommend that your child see an ear, nose, and throat doctor
(ENT or otolaryngologist) after diagnosis.
Your healthcare provider might not
recommend any treatment if your child doesn’t have any symptoms, or if your child’s
symptoms are mild. In some children, many or all symptoms go away with time. Between
ages 6 months and 6 years, the frenulum naturally moves backward. This may solve the
problem if the tongue-tie was only mild. With time, your child may find ways to work
around the problem. Symptoms may be less likely to go away if your child has class 3 or
class 4 tongue-tie.
If your child is having trouble
breastfeeding, your healthcare provider may recommend working with a breastfeeding
specialist. If that doesn’t work, your child may need to have a surgical procedure.
Your child may need to see a speech
specialist as well. This specialist will test your child’s speech. The specialist may
recommend speech therapy. Or he or she may recommend surgery.
A simple surgery called a frenotomy
is an effective treatment for many children. A healthcare provider can often do this
procedure in the office. The provider makes a cut in the frenulum. This lets the tongue
move normally. Your child might need to see a speech therapist after a frenotomy. This
can help him or her learn how to retrain the tongue muscles.
Some children need a slightly more
complex procedure called a frenectomy. This completely removes the frenulum. Another
choice is frenuloplasty. This uses several other methods to release the tongue-tie. Your
child might need this if a frenotomy was unsuccessful, or if your child’s frenulum is
Talk with your child’s provider
about the risks and benefits of a procedure.
When to Call a Healthcare Provider
Call your child’s healthcare provider or breastfeeding specialist if
your child is having trouble breastfeeding. If you believe your child is having problems
making sounds, see your child’s healthcare provider or a speech pathologist.
- Tongue-tie (ankyloglossia) is a problem with the tongue that
is present from birth. It keeps the tongue from moving as freely as it normally
- It occurs when the frenulum on the
bottom of the tongue is too short and tight.
- Symptoms are different in each
child. Some children may not have any symptoms.
- It causes breastfeeding problems in
- Your child might have trouble
making certain sounds.
- Not all children with tongue-tie
need surgery. Your child may need surgery if their tongue-tie is more severe and
causes major symptoms
Tips to help you get the most from
a visit to your child’s healthcare provider:
- Know the reason for the visit and what
you want to happen.
- Before your visit, write down
questions you want answered.
- At the visit, write down the name of a
new diagnosis, and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
- Ask if your child’s condition can be
treated in other ways.
- Know why a test or procedure is
recommended and what the results could mean.
- Know what to expect if your child does
not take the medicine or have the test or procedure.
- If your child has a follow-up
appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s
provider after office hours. This is important if your child becomes ill and you have
questions or need advice.