Tongue tie in infants causes and effects on breastfeeding and health

Some newborns suffer from a condition called tongue-tie (ankyloglossia), which can affect their ability to breastfeed, speak, and even impact proper oral development. Early detection of this issue helps prevent various health complications such as feeding difficulties, pain during breastfeeding for the mother, and delayed speech development. In this article on Dalili Medical, we will explore the causes, symptoms, degrees, and treatment options for tongue-tie in newborns in a simple and clear way for parents. We’ll also share important post-treatment tips to ensure your baby’s health and well-being.

What Does Tongue-Tie Look Like in Newborns?

Your baby’s tongue may appear heart-shaped or have a small notch because the lingual frenulum (the thin tissue under the tongue) is attached too close to the tip, restricting its movement. In some cases, tongue-tie is barely noticeable. Doctors often detect it during a routine physical examination right after birth.

What Causes Tongue-Tie?

Tongue-tie is a congenital condition (present at birth). The exact cause is unknown, but there may be a genetic component, as it can run in families and might be linked to an X-chromosome inheritance pattern.

Does Tongue-Tie Affect Bottle-Feeding?

It usually does not cause significant problems with bottle-feeding, as tongue movement differs from breastfeeding. If difficulties occur, a lactation consultant can help by adjusting the bottle nipple or milk flow rate.

How Long Does Tongue-Tie Treatment Take?

The procedure usually takes less than 10 minutes and is done in a pediatrician’s or surgeon’s office. It’s a simple and quick procedure, especially when performed in the first few months of life.

Breastfeeding With Tongue-Tie

If your baby has tongue-tie or has recently had it treated, breastfeeding may be painful or difficult due to poor latch.

Try different breastfeeding positions to improve latch.
Follow up with a lactation consultant to ensure effective feeding before and after treatment.

Does Tongue-Tie Cause Sleep Apnea?

There is no current scientific evidence that tongue-tie causes sleep apnea in infants.

Effect of Tongue-Tie on Speech

Tongue-tie rarely affects speech development, so surgery is not recommended solely to prevent potential speech problems.

What Is a Posterior Tongue-Tie?

A posterior tongue-tie refers to the frenulum extending deeper under the tongue rather than near the tip. This term is debated, and many doctors prefer to use “ankyloglossia” regardless of the frenulum’s location.

Is Tongue-Tie Surgery Painful?

The procedure is very minor. Most babies do not experience significant pain, though they might feel mild, temporary discomfort.

Recovery and Aftercare

Recovery is usually quick because the frenulum tissue is thin and typically doesn’t require stitches.
If frenuloplasty (a more complex procedure) is performed, dissolvable sutures may be used.
The doctor might recommend tongue exercises to help the baby adapt to improved tongue mobility.

Can Tongue-Tie Grow Back?

After surgery, the frenulum does not grow back, but it’s important to monitor your baby to ensure the tissue doesn’t reattach during healing.

Stages of Tongue-Tie in Newborns

Stage	Description	Effect on the Baby
Mild (Grade 1)	Slightly short frenulum near the tongue tip with minimal restriction.	Minor latch difficulties, often no immediate surgery needed.
Moderate (Grade 2–3)	Moderate restriction of tongue tip movement.	Noticeable feeding problems, fatigue or discomfort during feeding; may need frenotomy.
Severe (Grade 4)	Very short frenulum restricting full tongue movement or reaching the base.	Severe feeding difficulties, maternal pain, swallowing problems, frequent crying; often needs urgent surgery.

How to Know If Your Baby Has Tongue-Tie

Heart-Shaped Tongue
When your baby tries to stick out their tongue or open their mouth, it looks heart-shaped — a classic sign of tongue-tie.
Limited Tongue Movement
Your baby struggles to lift the tongue up or move it side to side, and it may not go past the lower front teeth.
Sores Under the Tongue
Older infants may develop sores under the tongue from the frenulum rubbing against the teeth during feeding or talking.
Clicking Sounds During Feeding
You may hear a “clicking” sound while your baby feeds from the breast or bottle, indicating poor latch and weak suction.
Breastfeeding Problems
One of the main signs is difficulty latching, frequent coughing, excessive drooling, or an inability to feed properly.

Does Tongue-Tie Affect Breastfeeding?

Yes — tongue-tie can lead to several breastfeeding challenges:

Excessive Drooling
Poor tongue control leads to excess saliva, which can be uncomfortable for both mother and baby.
Longer Feeding Sessions
The baby struggles to extract milk efficiently, taking longer to feed and detaching frequently.
Incomplete Feeding
Feeding problems prevent the baby from getting enough milk, leading to frequent feeding demands.
Fatigue
Because the baby exerts extra effort to feed, they often become tired after just a minute or two, pulling off and crying.
Gas and Colic
Air swallowed during feeding can cause bloating, gas, and colic, making the baby irritable.
Coughing During Feeding
Limited tongue movement can make it hard to coordinate breathing and swallowing, causing coughing or brief choking.
Reduced Milk Supply in Mothers
Poor suction reduces breast stimulation, leading to lower milk supply, cracked nipples, or even mastitis in severe cases.

Causes of Tongue-Tie in Newborns (Ankyloglossia)

Genetic Factors

A family history of tongue-tie increases the likelihood of occurrence.
Certain genes control the growth and length of the frenulum during fetal development.

Abnormal Fetal Development

The frenulum forms in the early weeks of pregnancy.
Any disruption in tissue separation can cause a short or tightly attached frenulum.

Syndromic or Congenital Conditions

Some genetic syndromes are associated with short or malformed frenula, affecting the mouth and jaw overall.

Unknown Causes

In many cases, the exact cause is unclear beyond heredity.
It is not caused by parental actions, birth type, or feeding methods.

Symptoms of Tongue-Tie in Newborns

Breastfeeding Difficulties

Poor latch and painful feeding.
Inefficient suction causing low milk intake or frothy milk.

Slow Weight Gain

Weight loss or poor weight gain due to feeding difficulties.

Limited Tongue Mobility

Trouble sticking the tongue out or moving it freely.
Tongue may appear tethered to the floor of the mouth.

Swallowing or Speech Issues (Later)

Some children may experience swallowing difficulties or trouble pronouncing certain sounds later in life.

Visible Oral Signs

A short or thick frenulum connecting the tongue to the mouth floor.
The tongue may look heart-shaped when lifted.

Maternal Symptoms

Cracked or sore nipples from improper latch.
Exhaustion due to prolonged feeding sessions.

Types of Tongue-Tie in Newborns (Ankyloglossia / Tongue-tie)

Tongue-tie is classified based on the length, thickness, and attachment point of the frenulum, as well as how much it restricts tongue movement:

Type	Description	Effect on the Baby
Anterior Tongue-tie	The frenulum is short and attached near the tip of the tongue.	Difficulty latching during breastfeeding, limited forward movement, easily visible when the tongue is lifted.
Posterior Tongue-tie	The frenulum is thick, tight, and located under the surface of the tongue rather than the tip.	Less obvious breastfeeding difficulties, possible swallowing or speech issues later, requires careful examination.
Partial Tongue-tie	The frenulum restricts only part of the tongue tip.	Mild feeding or tongue movement issues, less severe than anterior type.
Complete Tongue-tie	The frenulum restricts the entire tongue from tip to base.	Severe breastfeeding, swallowing, and speech problems, often requires urgent surgical intervention.

Surgical Treatment Options for Tongue-Tie

Before treatment, the doctor will perform a thorough examination to determine the type and severity of the frenulum and choose the most appropriate procedure. The goal is to release tongue movement and restore normal function.

Frenotomy
- Used for thin frenulum cases.
- Performed with sterile scissors, usually without anesthesia.
- Nearly painless, with minimal bleeding.
- Babies can usually breastfeed immediately after the procedure.
Frenuloplasty
- Recommended for thick or posterior tongue-ties.
- Performed under local anesthesia, involves reshaping the frenulum.
- The wound is closed with absorbable sutures.
- Tongue exercises are advised afterward to improve mobility.

Diagnosis of Tongue-Tie in Newborns

Diagnosis relies on a detailed clinical examination of tongue movement and feeding ability. Main steps include:

Diagnostic Step	Description	Purpose
Clinical examination of mouth and tongue	Observing tongue movement during crying, feeding, or when the mouth is open	Determine the degree of restriction
Feeding evaluation	Observing latch quality and any signs of pain	Check if tongue-tie affects feeding
Severity classification	Using systems like Coryllos or Kotlow to classify as mild, moderate, or severe	Guide treatment decisions
Family history review	Ask parents about similar cases	Assess possible genetic factors
Rule out other issues	Examine mouth, jaw, and palate for other anomalies	Ensure accurate diagnosis

Risks of Tongue-Tie Surgery in Newborns

While generally safe and simple, some potential risks include:

Mild bleeding: Usually resolves quickly.
Temporary pain or discomfort: May occur during feeding or sleeping.
Swelling: Typically minor and disappears within 2–3 days.
Infection: Rare if proper sterilization and hygiene are maintained.
Temporary feeding difficulties: Baby may need time to adapt to new tongue movement.
Scar tissue or reattachment: Rare but may require reassessment.
Very rare complications: Injury to surrounding tissues or reaction to anesthesia.

Frenectomy vs. Frenuloplasty in Newborns

Criteria	Frenectomy	Frenuloplasty
Definition	Full or partial removal of the frenulum	Reshaping or lengthening without complete removal
Purpose	Improve breastfeeding and prevent future dental/speech problems	Improve tongue/lip movement with minimal complications
Technique	Direct cut using scissors or laser	Partial cut + direction/length adjustment + fine suturing
Duration	Very quick, only a few minutes	Slightly longer (10–20 mins)
Recovery	Fast, usually a few days	Requires careful follow-up
Common use	Very short frenulum that restricts feeding	Short frenulum where removal isn’t necessary
Possible risks	Minor bleeding, temporary pain, reattachment risk	Mild bleeding, slight pain, imperfect healing risk
Parent notes	Immediate improvement in breastfeeding is common	Requires close monitoring to ensure proper healing

Summary of Tongue-Tie Surgery Types in Newborns

Type of Surgery	Description	Suitable Age/Case	Procedure	Benefits	Risks
Simple Frenotomy	Cutting the short frenulum with a scalpel or laser	Newborns up to 3–4 months, mild cases	Quick cut, often no anesthesia	Immediate breastfeeding improvement, minimal pain	Minor bleeding, incomplete healing if no exercises
Frenuloplasty	Reshaping the frenulum to increase mobility	Older infants or severe cases	Under anesthesia, cut and reattach	Natural tongue movement, reduces reattachment risk	Requires anesthesia, mild pain/swelling
Laser Frenotomy/Frenectomy	Using a low-energy laser to cut the frenulum	Newborns and older infants	Laser cutting under mild anesthesia	Precise, less bleeding, faster healing	Possible bleeding/inflammation, higher cost
Complex Frenuloplasty (Z-plasty)	Advanced reshaping for severe cases	Older infants or those with anomalies	Under general anesthesia, Z-shaped reconstruction	Best for severe cases, long-term mobility	Requires anesthesia, longer healing

Post-Surgery Care for Newborns

Do tongue exercises to strengthen movement and prevent reattachment.
Monitor feeding patterns and weight gain.
Gently clean the surgical area to prevent infection.
Follow up with the doctor 1–2 weeks after surgery.

Unsafe Tongue-Tie Treatments to Avoid

Unsafe Practice	Risks
Home cutting with non-medical tools	Severe bleeding, infection, tongue or throat injury
Delaying treatment for too long	Feeding, jaw development, and speech problems
Forcefully pulling the tongue	Pain, tissue tearing, bleeding
Using unsuitable creams or medications	Infections or allergic reactions
Relying only on exercises when surgery is needed	Ongoing feeding and speech issues
Going to non-specialists	Higher risk of complications, lower success rates

Tips After Tongue-Tie Treatment in Newborns

Tip	Details
Breastfeed immediately after treatment	Helps reduce bleeding and encourages tongue movement.
Gently clean the mouth	Use a clean, damp gauze or saline solution — avoid harsh chemicals.
Monitor for bleeding	A small amount is normal, but heavy bleeding needs medical attention.
Use safe pain relief if needed	Only as prescribed by a doctor (e.g., infant paracetamol drops).
Do simple tongue exercises	Encourage forward and side-to-side movement to improve mobility.
Watch feeding and nutrition	Make sure the baby latches properly — consult a lactation specialist if needed.
Schedule follow-up visits	To check healing progress and tongue movement.
Avoid harmful practices	Don’t press the wound, use sharp tools, or introduce solid foods without advice.
Ensure comfort and rest	Keep a calm environment and minimize crying to avoid pressure on the wound.