Tongue tie, or ankyloglossia, is a condition that affects the tongue’s ability to move freely. It’s caused by an unusually short, thick, or tight ligual frenulum. The lingual frenulum is a fold in the floor of the mouth that forms when the tongue lists – connecting the underside of the tongue to the floor of the mouth. While this might sound minor, restricted tongue movement can have a significant impact—particularly when it comes to infant feeding.
Breastfed Babies – Symptoms Associated with Tongue Tie
Baby-related symptoms:
- Shallow latch or inability to latch effectively
- Clicking, popping, or loss of suction while feeding
- Dribbling milk or leaking from the corners of the mouth
- Short or very long feeds (both may signal inefficient milk transfer)
- Falling asleep at the breast before completing a feed
- Frequent feeding or “snacking” without seeming satisfied
- Signs of frustration or fussiness at the breast
- Poor weight gain or faltering growth
- Excessive wind, burping, or hiccups
- Arching back, pulling away, or showing distress during feeds
- Reflux-like symptoms (posseting, unsettledness, back-arching)
- Clicking jaw or chin tremors
- Coughing, gagging, or choking during feeds
- Milk pooling in the throat or signs of aspiration
- Milk remaining visible in the mouth after swallowing
- Difficulty sustaining suction, leading to frequent unlatching
Mother-related symptoms:
- Nipple pain or trauma (cracks, blisters, scabs)
- Nipple compression (lipstick-shaped nipple after feed)
- White spots or vasospasm on the nipple
- Mastitis or blocked ducts due to incomplete drainage
- Low milk supply (from poor milk transfer)
- Oversupply or fast letdown (compensation from the body)
- Anxiety around feeding due to persistent pain or challenges
- Engorgement or uneven breast drainage
Bottle-fed Babies – Symptoms Associated with Tongue Tie
- Difficulty sealing lips around the teat
- Milk leaking from the sides of the mouth
- Gulping or choking on milk
- Clicking sounds during feeds
- Taking in excessive air (leading to wind or colic-like symptoms)
- Inability to pace feeds, leading to overeating or discomfort
- Prolonged feeds due to inefficient sucking
- Need to try multiple teat types or flow rates
- Frequent breaks or refusal of bottle
- Fussiness or arching during feeding
- Reflux-like symptoms (even with paced bottle feeding)
- Poor weight gain despite sufficient milk intake
- Strong preference for a particular feeding position
- Oral aversions or refusal to feed
General Signs of Oral Dysfunction in Either Feeding Method
- High or narrow palate
- Limited tongue elevation or extension
- Tongue that appears heart-shaped or notched when lifted
- Difficulty with tongue lateralisation (side-to-side movement)
- Mouth breathing or open mouth posture when sleeping
- Poor suck-swallow-breathe coordination
- Chronic dribbling outside of feeds
Who is Trained to assess for tongue tie?
Healthcare professionals can be trained to identify and treat tongue ties; however, this is not usually covered in formal education and requires a specialised course that can be undertaken post-registration.
As a result, most midwives, GPs, paediatricians, and health visitors have not received this training and should not be diagnosing or ruling out this condition, unless trained to do so. If there is any doubt, inquire about the training they have completed related to identifying tongue tie or oral dysfunction. If the diagnosis or exclusion was based solely on visual appearance, it is advisable to seek further support.
What is Meant by Anterior or Posterior Tongue Tie
Anterior and posterior tongue ties refer to the location of the tongue tie along the underside of the tongue, they are not different types of tongue tie but a description of appearance. Anterior tongue tie is when the tongue tie is visibly attached near the tip of the tongue. This type is easier to spot.
Posterior tongue tie is more subtle, with the tongue tie situated further back under the tongue. This type can be more challenging to diagnose as it is not always visibly apparent, yet it can still greatly affect tongue movement. Posterior tongue ties are often misdiagnosed and, in many instances, are not tongue ties at all but rather tight muscles with a restricted range of movement.
The appropriate treatment for this would be oral function exercises; an incorrect diagnosis as a tongue tie could lead to a frenulotomy, cutting this muscular tissue may result in significant scarring that continues to affect function. Both types necessitate a professional assessment to determine the most suitable treatment approach. Understanding the distinction is vital for addressing the specific needs of each case.
Is a Slight Tongue Tie a Thing
The concept of a “slight tongue tie” can be misleading. While some frenula may appear less restrictive, the impact on function is what truly matters. A hard to identify tongue tie may still cause feeding issues, such as difficulty latching or inefficient milk transfer. It’s essential to assess the functional impact rather than just the appearance of the frenulum. Parents should seek a thorough evaluation if they suspect a tongue tie, even if it seems minor. Treatment decisions should be based on the severity of symptoms and functional limitations, rather than just the visual assessment. If a professional says it is ‘slight’ but your symptoms are anything but, seek further support.
Will a tongue tie resolve on its own?
Every tongue tie is anatomically different. We use an assessment tool that will give us information on whether to offer a surgical division (if a resolution cannot be reached through conservative methods, such as positioning and attachment support and oral exercises).
This is often seen in tongue ties that are made of the same tissue as the webbing between your fingers and as such, do not ‘stretch’ over time.
As your baby grows (and there is more space within their mouth), you may experience different symptoms of a tongue tie. Likewise, your baby may learn other ways of using their oral muscles to compensate for the restriction.
I Have Been Told No Tongue Tie But We Are Experiencing Associated Symptoms
Even if a tongue tie is not visually apparent, symptoms may persist due to other underlying causes. It’s essential to explore these possibilities with a knowledgeable professional. In such cases, other causes of oral dysfunction might be the root cause. This could involve muscle tension, poor coordination, or other structural issues unrelated to the frenulum. Working with specialists who understand the nuances of infant feeding and oral function is crucial.
