Ankyloglossia, commonly known as tongue-tie, is a congenital condition where the lingual frenulum, the thin band of tissue beneath the tongue, is unusually short, tight, or thick. This restriction tethers the tongue to the floor of the mouth, limiting its range of motion. Not all cases interfere with feeding or development, but recognizing the common indicators suggests the need for professional evaluation to determine if the limited mobility is causing functional difficulties.
Physical and Visual Indicators
A visual inspection of the baby’s mouth can reveal distinct physical signs of a tongue-tie, especially when the baby is crying or attempting to lift the tongue. The lingual frenulum may appear short, thick, or tight, attaching unusually close to the tip of the tongue or the lower gum ridge. This tethering prevents the tongue from achieving a normal, rounded shape when extended.
When the infant cries or tries to lift their tongue, the restricted tissue pulls on the tip, often creating a characteristic heart-shaped or notched appearance. The baby may struggle to lift the tongue up to the upper gums or the roof of the mouth, which is necessary for creating a proper suction seal during feeding. They may also be unable to extend the tongue past the lower lip or move it easily from side to side beyond the gums.
Behavioral Signs During Feeding
The physical limitations caused by ankyloglossia often translate into specific difficulties while the infant attempts to feed, whether by breast or bottle. A baby with a tongue-tie may have trouble achieving or maintaining a deep, effective latch, resulting in a shallow latch where they chew or clamp down instead of using a wave-like sucking motion. This poor seal can cause a distinct clicking or smacking sound during feeding as the suction breaks.
Inefficient milk transfer can lead to the baby appearing constantly hungry, as they expend energy without getting a full feed. This struggle may cause the infant to fall asleep quickly out of exhaustion, only to wake shortly after demanding to feed again. Signs of inadequate intake, such as poor weight gain, may become apparent over time. The baby may also gulp or choke frequently due to an inability to control a strong milk flow, or they may dribble milk from the corners of their mouth.
Secondary Maternal Symptoms
The infant’s feeding difficulties often have a direct and painful impact on the breastfeeding caregiver. The shallow or compressive latching pattern, where the baby chews rather than sucks, can cause nipple pain and trauma. Caregivers may notice that their nipples appear cracked, blanched, or flattened, sometimes resembling the shape of a lipstick tube after a feeding session.
When the infant is unable to effectively drain the breast, it can lead to secondary health issues for the caregiver. Inefficient milk removal can result in incomplete breast drainage, increasing the risk of recurrent blocked milk ducts or mastitis. Over time, the lack of adequate stimulation and milk transfer can also negatively affect the caregiver’s milk supply.
Seeking Professional Confirmation
If a caregiver observes a combination of these physical and behavioral signs, the next step is to seek a formal evaluation from qualified professionals. The initial assessment is often performed by a pediatrician, an International Board Certified Lactation Consultant (IBCLC), a pediatric dentist, or an ear, nose, and throat (ENT) specialist. These practitioners will examine the appearance and, more importantly, the function of the infant’s tongue.
The diagnostic process focuses on how the restriction affects the baby’s ability to perform necessary oral motor functions, rather than just a visual inspection of the frenulum’s length. Specialized screening tools, such as the Hazelbaker Assessment Tool for Lingual Frenulum Function, may be used to assign a score based on the tongue’s appearance and mobility. This functional assessment helps determine if the tongue-tie is the cause of feeding issues, guiding the decision for intervention.