Ankyloglossia, commonly known as tongue tie, is a congenital condition where a restrictive band of tissue, called the lingual frenulum, connects the underside of the tongue to the floor of the mouth. When the frenulum is unusually short, thick, or tight, it limits the tongue’s range of motion and function. This restriction can interfere with the oral movements necessary for effective feeding. Identifying the signs of restricted tongue movement is the first step in determining if professional evaluation and intervention may be necessary for your baby.
Observable Physical and Feeding Signs in the Baby
The restricted movement of the frenulum may cause the tip of the tongue to look notched or take on a distinctive heart shape when the baby cries or tries to lift it. A baby with a tongue tie may also be unable to protrude their tongue beyond their lower lip or gum line, and they may have difficulty lifting the tongue to the roof of the mouth.
An inability to lift and extend the tongue prevents the baby from achieving a deep, comfortable latch on the breast. Instead of drawing the breast tissue deep into the mouth, the baby may resort to shallow sucking or gumming the nipple to extract milk.
This ineffective sucking often results in audible cues during a feeding session. Parents may hear a distinct clicking or smacking sound as the baby loses suction on the breast or bottle. The poor seal also leads to the baby swallowing excessive air, which can manifest as gassiness, colic-like symptoms, or excessive spitting up after a feed.
A consequence of inefficient milk transfer is that the baby may require very long or unusually frequent feeding sessions because they struggle to get enough milk in a typical amount of time. This can ultimately lead to insufficient weight gain or failure to thrive. The baby may also become fussy or frustrated at the breast or bottle due to the difficulty of feeding.
Maternal Symptoms Related to Tongue Tie
The baby’s restricted tongue mobility and subsequent poor latch often result in physical discomfort for the breastfeeding parent. While some initial nipple tenderness is common, intense or persistent pain throughout the feeding session is not typical. The shallow latch forces the baby to compress or chew the nipple, leading to sharp pain, pinching, or a scraping sensation.
This repeated trauma to the nipple can quickly cause visible damage, such as cracking, blistering, or bleeding. The nipple may also appear misshapen, flattened, or have a distinct compression stripe after the baby has unlatched, indicating it was pinched against the roof of the baby’s mouth.
Incomplete drainage of the breast is another common issue stemming from the baby’s ineffective suckling. When the breast is not emptied fully, the parent is at a higher risk of developing blocked milk ducts, which feel like tender, hard lumps in the breast tissue. These blocked ducts can escalate into mastitis, a painful infection characterized by redness, swelling, and flu-like symptoms.
Over a longer period, the chronic inability to drain the breasts adequately can lead to a reduction in the parent’s milk supply. The body interprets the poor milk removal as a reduced demand, signaling the breasts to decrease production.
Professional Assessment and Treatment Options
If a parent observes these physical or functional signs, the next step is to seek a professional assessment. This evaluation is typically conducted by professionals experienced in infant oral function and feeding, such as:
- A pediatrician
- A specially trained lactation consultant
- A pediatric dentist
- An Ear, Nose, and Throat (ENT) physician
The assessment involves more than just a visual check of the frenulum’s appearance; it focuses on the tongue’s functional mobility and the baby’s feeding effectiveness.
The clinician will physically examine the length and elasticity of the frenulum and use specialized screening tools to score the tongue’s ability to move and lift. Observing a feeding session is often a crucial part of the process, as it allows the professional to correlate the anatomical restriction with the observed feeding difficulties. A diagnosis is made only when the physical presence of the tie causes demonstrable functional problems, such as feeding challenges or pain.
If the tongue tie is determined to be the cause of significant feeding issues, the primary treatment option is a procedure called a frenotomy. This is a simple, quick procedure often performed in a clinic or office setting, sometimes with the baby swaddled. The procedure involves the provider using sterile scissors or a laser to snip the restrictive frenulum, which immediately releases the tongue’s tethering.
Because the frenulum in newborns has few nerve endings and minimal blood vessels, the procedure is typically quick and involves little discomfort. The baby is often encouraged to feed immediately afterward, which can help calm them and stop any minor bleeding. While some babies show immediate improvement, others may take a few days or weeks to learn how to use their newly freed tongue for more effective sucking.