What is tongue-tie in babies?

What is tongue-tie in babies?

Tongue-tie known as ankyloglossia - is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual. This shortened piece of skin, called a frenulum, can interfere with a baby’s ability to move their tongue.

Michelle Lyne, education advisor at the Royal College of Midwives, says tongue-tie doesn't normally cause pain, but it can impact how easily a baby can move their tongue. "Signs include the tip of the tongue not protruding beyond the lower gum ridge which may mean that your baby may have difficulty attaching to the breast when feeding," she says.

A baby with tongue-tie may also struggle to feed with a bottle too. Some babies who have tongue-tie do not seem to be bothered by it and can feed successfully. In others, however, it can restrict the tongue's movement significantly, making it harder or even impossible to feed.

What does tongue-tie look like?

If you look in your baby's mouth, you might be able to see signs of tongue tie. For example, they may not be able to extend their tongue fully, or their tongue may have a heart-shaped appearance at the tip. Your baby may find it hard to lift up their tongue or move it around.

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What are the symptoms of tongue-tie in babies?

It can be hard to tell if a baby has tongue-tie, but you may be able to detect the symptoms if your baby is having trouble feeding. If you think your baby has tongue-tie, it's important to get a proper tongue-tie diagnosis and feeding support from a midwife, health visitor or your GP.

Trouble latching when breastfeeding

A breastfed baby may have trouble latching onto the breast or maintaining their latch. They may be clamping down on the breast or making a clicking noise while feeding.

Unsettled behaviour when feeding

You may also be able to tell from their behaviour too, for example, if they seem unsettled while feeding. A baby with tongue-tie may need to be fed very often to get enough milk. If bottle-fed, they may struggle to drink without gagging, even with a slow-flow bottle teat.

Signs of tongue-tie can include your baby being slow to take to a bottle, dribbling a lot during feeds and frequently pushing the bottle teat out of their mouth.

Failure to gain weight

There may be other reasons why your baby is struggling to put on weight, but tongue-tie may be an issue. Speak to your midwife, health visitor or doctor to make sure no other problems, such as a milk allergy, are the cause. Any baby who is struggling to gain weight needs to be assessed by a doctor.

Problems with wind or colic

Some babies with tongue-tie may also be susceptible to colic, a term used to describe when a baby cries for long periods without any obvious cause. They may also struggle with wind, hiccups or reflux, as a result of having to work harder to feed and sucking in excess air.

Engorgement or blocked milk ducts

Babies with tongue-tie may not be able to drain the breast milk properly, which can lead to breast engorgement - when they feel hard or painful - or blocked milk ducts, which can be uncomfortable and cause a lump. You may also get mastitis, a painful inflammation of the breast tissue that sometimes involves an infection.

Is tongue-tie genetic?

It isn't known why tongue-tie occurs, but research suggests it may be genetic. This means a baby may be more likely to be born with tongue-tie if the mother or father had the condition as a baby (2).

How is tongue-tie treated?

Treatment is not always needed, if your baby can feed without any problems. However, if their feeding is affected, tongue-tie treatment involves a simple procedure called a tongue-tie division or a frenulotomy. "This is where the strip of skin between the tongue and the floor of the mouth is cut," says Lyne.

As there are few nerve endings in this strip of skin, anaesthetic isn't normally needed in very young babies. Older babies who have teeth may need general anaesthetic while they have the procedure. It is a quick procedure that takes a few seconds and heals within a couple of days. Babies should be able to feed straight away afterwards.

"Often, babies with the condition will have no symptoms and can breastfeed effectively and it often resolves by itself without the need for treatment," says Lyne. "Treatment can also be achieved conservatively with breastfeeding support and or tongue exercises."

It's also important to note that problems linked to tongue-tie may not appear until the midwife visits have stopped 10 to 14 days after birth, making it more difficult to receive a diagnosis.

If you are worried your baby has tongue-tie and is struggling to feed, don't hesitate to contact your midwife, your health visitor, your GP, or a specialist tongue-tie practitioner.

Further reading

1. The GP infant feeding network UK: Tongue-tie.

2. Soo-Hyung Han et al, A study on the genetic inheritance of ankyloglossia based on pedigree analysis.