A tongue tie is a condition where a short, tight band of tissue under a baby’s tongue restricts how far the tongue can move. Up to 10% of newborns are born with some degree of tongue tie, making it one of the more common findings in infant checkups. The medical term is ankyloglossia, and it ranges from mild (barely noticeable) to severe enough to interfere with breastfeeding and, later, eating solid foods.
What’s Happening Under the Tongue
Every baby has a thin strip of tissue connecting the underside of the tongue to the floor of the mouth. This is called the lingual frenulum. In most babies, this tissue is flexible enough that the tongue can move freely in all directions: up to the roof of the mouth, side to side, and out past the lips.
In a baby with tongue tie, that strip of tissue is too short, too thick, or too tight. It essentially tethers the tongue, preventing it from reaching the range of motion it needs. In some cases, the frenulum attaches right at the tip of the tongue. In others, it attaches farther back but is so rigid that it still limits movement. A classic sign during an exam is that the baby cannot stick the tongue out past the lower lip.
Types of Tongue Tie
Tongue ties are often grouped into four types based on where the frenulum attaches:
- Type 1: The frenulum connects right at the tip of the tongue. This is the most visible type.
- Type 2: The attachment sits just a few millimeters behind the tip, still clearly visible.
- Type 3: A thicker, less elastic frenulum attached to the middle of the tongue and the middle of the mouth floor. Harder to spot at a glance.
- Type 4: A thick, shiny band of tissue buried under the mucous membrane at the base of the tongue. This is sometimes called a posterior tongue tie and can be the most difficult to identify because it’s not easily seen, only felt.
Types 1 and 2 are considered anterior tongue ties, where the restriction is toward the front. Types 3 and 4 are posterior, meaning the restriction is farther back. Both anterior and posterior ties can cause functional problems, but posterior ties are more likely to be missed during routine exams.
Signs in the Baby
The most recognizable visual sign is a tongue that looks heart-shaped or notched at the tip when the baby cries or tries to stick it out. You may also notice that your baby can’t lift the tongue to the upper gums or sweep it from side to side. But tongue tie often shows up through feeding difficulties before anyone looks under the tongue.
During breastfeeding, a baby with a tongue tie may not be able to latch deeply enough and ends up chewing on the nipple rather than forming the wave-like sucking motion that draws out milk. This can lead to poor milk transfer, which means the baby isn’t getting enough at each feeding. Frequent feeding sessions that leave the baby still hungry, slow weight gain, and a clicking sound during nursing are all common patterns. Some babies with tongue ties compensate well and feed without obvious problems, which is why the condition isn’t always caught early.
Signs for the Nursing Parent
Breastfeeding pain is often what first raises the question of a tongue tie. When a baby can’t position the tongue properly, the latch becomes shallow, and the nipple takes the brunt of it. Cracked, blistered, or misshapen nipples after feeds are typical. The pain tends to persist through the entire feeding rather than easing once the baby latches. It’s worth knowing, though, that the American Academy of Pediatrics noted in a 2024 report that most breastfeeding difficulties, including pain, are not caused by tongue tie. Latch issues, positioning, and milk supply problems are more common culprits.
How Tongue Tie Is Diagnosed
Diagnosis is based on a physical exam that looks at both the appearance of the frenulum and how well the tongue actually moves. A provider will typically lift the baby’s tongue to check where the frenulum attaches, how long and elastic it is, and whether the tip of the tongue looks notched or rounded. Then they assess function: Can the baby extend the tongue past the lower lip? Can the tongue reach the roof of the mouth? Does it move freely to both sides?
Some clinicians use a structured scoring tool called the Hazelbaker Assessment Tool, which rates five appearance features and seven functional ones. A perfect function score is 14. Scores below 11 suggest the tongue’s movement is meaningfully impaired. But there is no single universally agreed-upon definition or diagnostic cutoff for tongue tie, which is part of why opinions on when to treat it vary so much between providers.
The key considerations that point toward a real problem are an ineffective latch and poor weight gain. A tongue that looks tied but isn’t causing any feeding or functional issues may not need intervention at all.
Treatment Options
The AAP recommends starting with nonsurgical approaches. Working with a lactation consultant to improve positioning and latch techniques resolves many breastfeeding difficulties, even when a tongue tie is present. Speech-language pathologists can also help with oral motor exercises for older infants.
When breastfeeding problems persist despite this support, a minor surgical procedure called a frenotomy may be considered. During a frenotomy, a provider snips the frenulum with sterile scissors. The procedure takes about one minute, is done in an office setting, and most babies can breastfeed immediately afterward. Some providers offer laser frenotomy, which may take slightly longer. The AAP has found no evidence that laser is superior to scissors.
For thicker frenulums that can’t be simply snipped, a more involved procedure called a frenuloplasty may be needed. This is done under general anesthesia and involves stitches, so it’s typically reserved for more significant cases or older children.
Risks and Recovery
Complications from a frenotomy are rare. The main risks are minor bleeding, infection, and damage to the salivary glands, though these are uncommon. The frenulum can also scar or reattach to the base of the tongue, which sometimes means a repeat procedure.
Recovery is generally quick. Some parents notice an immediate improvement in latch quality, while others see gradual progress over days to weeks as the baby learns to use the tongue’s new range of motion. The AAP specifically recommends against post-procedure wound stretching exercises, where parents repeatedly open the healing site to prevent reattachment. While some providers still suggest these stretches, the current evidence doesn’t support the practice, and it can be painful for the baby.
Beyond Breastfeeding
Tongue tie doesn’t only affect nursing. A restricted tongue can make the transition to solid foods harder for older babies and toddlers. Chewing and managing food in the mouth requires the tongue to sweep side to side, lift food to the palate, and push it to the back of the throat for swallowing. Babies with limited tongue mobility may gag, choke, or cough more frequently when starting solids. Some develop a preference for soft or pureed foods well past the age when most children handle varied textures.
Speech can also be affected, particularly sounds that require the tongue to reach the roof of the mouth or the upper teeth, like “l,” “r,” “t,” and “d.” Not every child with an untreated tongue tie will have speech difficulties, but the risk increases with more severe restrictions. If a tongue tie wasn’t addressed in infancy and speech problems emerge in toddlerhood, a frenotomy or frenuloplasty can still be performed at that stage.