A tied tongue, medically known as ankyloglossia, is a congenital condition where the lingual frenulum—the small band of tissue connecting the underside of the tongue to the floor of the mouth—is unusually short, thick, or tight. This variation in the frenulum’s structure restricts the tongue’s normal range of motion. The primary concern with a tied tongue is the potential for functional limitations.
The Visual Characteristics of a Tied Tongue
The most direct physical sign of a tied tongue is the appearance of the lingual frenulum itself, which may look noticeably thick, short, or taut, sometimes resembling a piece of string pulled tightly toward the tip of the tongue. When the tongue is at rest, the frenulum might be barely visible, but its restricting presence becomes obvious when the child attempts to move the tongue. Depending on the severity, the frenulum can anchor the tongue either very close to the tip or further back toward the base of the tongue.
When an infant attempts to stick their tongue out or lift it upward, the restrictive frenulum pulls the center of the tongue downward. This tension often results in the tip of the tongue appearing notched or heart-shaped, as the sides protrude while the center remains tethered.
The condition is also identified by observing the restricted range of motion. A tied tongue typically cannot be lifted to touch the roof of the mouth or sweep the upper lip. Furthermore, the tongue may have difficulty moving side-to-side, and it often cannot protrude past the lower front gum line or teeth. This limited mobility correlates with the functional issues that can arise from the condition.
Common Functional Symptoms
The physical restriction of a tied tongue most frequently manifests as difficulties with feeding, particularly in infants. A baby needs to be able to lift and extend the tongue to create a proper seal and remove milk efficiently. One of the most common signs is a poor or shallow latch during breastfeeding, as the tongue cannot cup the nipple and areola correctly.
This ineffective latch often leads to a clicking sound while the baby is feeding, which occurs when the suction seal is repeatedly broken due to the tongue’s inability to maintain its position. The baby may also exhibit prolonged feeding times because they are unable to empty the breast or bottle efficiently. This struggle for effective milk transfer can result in poor weight gain for the infant and a sense of constant hunger.
For the breastfeeding parent, functional symptoms include significant discomfort or pain, as the baby may chew or gum the nipple instead of using the tongue’s wave-like motion. Beyond infancy, the limited tongue movement can later affect articulation, making it difficult to produce specific sounds. Older children may also struggle with oral motor tasks.
Functional Issues in Older Children
- Difficulty producing sounds that require the tongue to touch the upper palate or front teeth (e.g., “T,” “D,” “L,” “R,” and “S”).
- Struggling to move food around the mouth.
- Inability to lick an ice cream cone.
Next Steps: Diagnosis and Correction
If the visual characteristics or functional symptoms suggest a tied tongue, a professional assessment is the appropriate next step. Diagnosis is typically made by a healthcare provider such as a pediatrician, a lactation consultant, an otolaryngologist (ENT), or a specialized dentist. They examine the frenulum’s appearance and the tongue’s range of motion to determine the degree of restriction and whether intervention is warranted based on the symptoms.
The most common corrective procedure for a tied tongue is a frenotomy, often called a frenulum release or clip. This is a simple, quick procedure, especially in newborns, where the tight frenulum is snipped with sterile scissors or a laser. It is typically performed in an office setting without the need for general anesthesia.
For cases involving a thicker or more complex frenulum, a frenuloplasty may be recommended. This is a more extensive repair that sometimes requires sutures and may be performed under local or general anesthesia, depending on the child’s age and the complexity of the tissue. Both procedures aim to restore the tongue’s full range of motion.