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Tongue-Tie

(Ankyloglossia)

Definition

Tongue-tie is difficulty moving the tongue because of attachment of tissue too close to the tip of the tongue or tight tissue under the tongue. The limited movement can make it difficult to breast feed. The degree of limitation can vary from infant to infanton.

Tongue-tie is present at birth.

Causes    TOP

A tissue called the frenulum helps the development of the mouth before and shortly after birth. This frenulum is attached to the underside of the tongue. After birth the frenulum should start to shrink and loosen its hold on the tongue.

In some, the frenulum does not shrink as expected. The exact reason is not clear but it may be associated with genetics.

Risk Factors    TOP

Tongue-tie is more common in boys. It may also be more likely if other family members have had it.

Symptoms    TOP

Symptoms will depend on the degree of limitation. Most children with tongue-tie won’t have symptoms.

In those that have symptoms, tongue-tie may cause problems with latching on to the nipple during breast feeding.

Muscles and Nerves of the Tongue

Nucleus factsheet image
Copyright © Nucleus Medical Media, Inc.

Diagnosis    TOP

Tongue-tie can be diagnosed with a routine physical exam. There are also ways to estimate how severe it is.

Treatment    TOP

Discuss your treatment preferences and options with your child’s doctor.

If there are no severe functional issues, your child’s doctor may recommend watchful waiting. Over time, the frenulum will loosen on its own.

The frenulum may be surgically corrected if there is very limited movement in the tongue associated difficulty breast feeding and gaining weight. Options include:

  • Frenulotomy—The frenulum is snipped to release the tongue for normal movement.
  • Frenuloplasty—Repair of a frenulum that is too thick and short.

These surgeries can often be done in the doctor’s office.

Prevention    TOP

There are no current guidelines to prevent tongue-tie because the cause is unknown.

RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org/content/patient-health
Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES:

Canadian Society of Otolaryngology—Head and Neck Surgery
http://www.entcanada.org
Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca

References:

Ballard JL, Auer CE, et al. Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110(5):e63.
Hathaway A, McCauley R. Assessment and management of tongue-tie in children: A survey of related professionals. American Speech Language Hearing Association website. Available at:
...(Click grey area to select URL)
Accessed November 10, 2015.
Kummer A. Ankyloglossia: To clip or not to clip? That’s the question. American Speech Language Hearing Association website. Available at:
...(Click grey area to select URL)
Published December 27, 2005. Accessed November 10, 2015.
Lalakea ML, Messner AH. Ankyloglossia: Does it matter? Pediatr Clin North Amer. 2003;50(2):391-397.
Neonatal ankyloglossia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated April 17, 2017. Accessed April 24, 2017.
Tongue-tie. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
...(Click grey area to select URL)
Accessed November 10, 2015.
4/24/2017 DynaMed Plus Systematic Literature Review http://www.dynamed...: O'Shea JE, Foster JP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017 Mar 11;3:CD011065.
Last reviewed April 2017 by Michael Woods, MD, FAAP
Last Updated: 4/24/2017

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