Ankyloglossia, commonly known as a tongue tie, is a congenital condition where the lingual frenulum—the thin band of tissue connecting the underside of the tongue to the floor of the mouth—is unusually short or tight. This restriction limits the tongue’s range of motion, interfering with an infant’s feeding mechanics at the breast or bottle. Parents frequently report that a restricted tongue tie is associated with increased fussiness and gastrointestinal discomfort in their baby. The perceived link between tongue tie and gas is primarily due to the physiological consequences of an ineffective feeding process.
The Mechanism Linking Tongue Tie to Air Swallowing
The restrictive nature of a tongue tie prevents the baby’s tongue from achieving the proper seal and movement required for effective feeding. When nursing, a baby needs to cup the nipple and areola and perform a wave-like motion with the tongue to efficiently extract milk. A restricted frenulum makes this deep, wavelike action difficult or impossible, resulting in a shallow latch on the breast or a poor seal around a bottle teat. This compromised seal creates an open pathway for air to be inadvertently swallowed during the feeding process.
The medical term for this excessive swallowing of air is aerophagia, and it represents the direct link between a tongue tie and gas in infants. Instead of creating a vacuum seal that allows the baby to draw milk without ingesting air, the shallow latch causes the baby to gulp air along with the milk. This ingested air travels down the esophagus into the stomach, where it becomes trapped.
As the air moves through the infant’s immature digestive tract, it causes abdominal distension, bloating, and discomfort. The baby will often exhibit signs of fussiness, require frequent burping, and experience increased flatulence. This cycle of inefficient feeding leading to aerophagia and subsequent gastrointestinal distress can also contribute to symptoms often mistaken for colic or reflux.
Recognizing Other Feeding Difficulties and Symptoms
While increased gas and fussiness are common concerns, parents should be aware of a broader spectrum of signs indicating a tongue tie that is interfering with feeding. Many of these symptoms stem directly from the infant’s inability to maintain a deep, stable latch. Infants may frequently lose suction and fall off the breast or bottle teat during a feeding session. This disruption is often accompanied by an audible clicking sound, which is the sound of the tongue releasing the vacuum seal.
The baby may also tire quickly during feeds and require long, frequent feeding sessions because of poor milk transfer. Due to the strain of an ineffective latch, the baby may exhibit poor weight gain or excessive early weight loss. The tongue may also appear notched or heart-shaped when the baby attempts to lift or extend it, which is a physical manifestation of the restrictive tissue.
These feeding difficulties can also produce symptoms for the nursing parent, often serving as a secondary indicator of the baby’s oral restriction. Parents may experience significant nipple pain during feeds, and nipples may appear blanched, compressed, or misshapen after nursing. The inability of the baby to effectively empty the breast can also lead to maternal complications, such as recurrent blocked ducts, mastitis, or a prematurely diminished milk supply.
Diagnostic Process and Intervention Options
The assessment for ankyloglossia is typically performed by healthcare professionals specializing in infant feeding, such as lactation consultants, pediatricians, pediatric dentists, or ear, nose, and throat (ENT) specialists. Diagnosis relies on both a visual examination of the frenulum’s anatomy and a functional assessment of the tongue’s mobility. Assessment tools, such as the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), are often used to objectively score the restriction based on appearance and movement.
If the restriction is confirmed to be impairing feeding, the primary intervention is a frenotomy, which is a simple surgical procedure to release the tight frenulum. In infants, this procedure is often performed quickly in the office setting without the need for general anesthesia. The practitioner lifts the tongue and uses sterile scissors, a scalpel, or a laser to clip the restrictive tissue.
The frenotomy procedure usually takes less than a minute, and the discomfort is minimal because the frenulum has few nerve endings and blood vessels in newborns. The goal is to immediately restore full tongue mobility, which allows the baby to achieve a deeper, more effective latch. This improved function can help reduce aerophagia, thereby alleviating the associated gas and digestive discomfort. More complex cases or revisions of previous procedures may require a frenuloplasty, which involves a more involved surgical revision of the tissue.