Ankyloglossia in Children

What is ankyloglossia in children?

Ankyloglossia, or “tongue-tie,” is a problem with the tongue that is present from birth. It causes speech and eating difficulties in some children.

The frenulum of the tongue is a small fold of tissue that reaches from the floor of the mouth to the underside of the tongue. You can easily see it if you look under your tongue in a mirror.

Some children have a frenulum that is too short and tight at birth. The frenulum may attach to the tip of the tongue instead of attaching farther back. When that happens, the tongue can’t move around normally. Your child might have difficulty sticking his or her tongue out, moving it from side to side, or bending it to touch the upper teeth. The tongue often has a notch at its tip. These problems can cause difficulties with speaking and eating.

Ankyloglossia is different in each child. The condition is divided into categories, based on how well the tongue can move. Class I is mild ankyloglossia, and class II is moderate. Severe ankyloglossia is class III. In class IV, the tongue can hardly move at all.

A small number of babies born each year have ankyloglossia. It happens in boys slightly more than in girls.

What causes ankyloglossia in a child?

Ankyloglossia happens when the tongue and frenulum don’t form quite normally. Healthcare providers aren’t sure exactly what causes this. Tongue-tie runs in some families, so your family health history may play a role.

What are the symptoms of ankyloglossia in a child?

Your child may not have any problems from his or her tongue-tie. Many children do not. Others may have certain problems, like:

• Difficulty breastfeeding
• Problems making certain sounds
• A gap between the bottom 2 front teeth
• Problems keeping the mouth healthy, which can cause tooth decay

Ankyloglossia can make it hard for your child to do other activities, like licking an ice cream cone, playing a wind instrument, or kissing.  And, it may cause embarrassment or social difficulties in some children.

Most infants with tongue-tie do not have trouble with breastfeeding. Babies with ankyloglossia may have trouble latching to the nipple, or the breastfeeding might cause nipple pain. If not corrected, your baby may not gain weight normally. It causes some women to give up breastfeeding earlier than they would like.

Tongue-tie usually doesn’t keep babies from learning to speak. Your child may just have difficulty make certain sounds, like “t,” “d,” “z,” “s,” “th,” “n,” and “l.”

Very rarely, children with ankyloglossia have other problems, like cleft lip or cleft palate. These can cause other symptoms. 

How is ankyloglossia diagnosed in a child?

Your healthcare provider can diagnose the condition with a medical history and physical exam. Your provider will carefully check your child’s tongue and its movements.

Your child’s healthcare provider might find ankyloglossia when looking for possible causes of your infant’s breastfeeding difficulties. He or she might recommend that your child see an ear, nose, and throat healthcare provider after diagnosis.

How is ankyloglossia treated?

Your healthcare provider might not recommend any treatment if your child doesn’t have any symptoms, or if your child’s symptoms are mild. In some children, many or all symptoms go away with time. Between ages 6 months and 6 years, the frenulum naturally moves backward. This may solve the problem if the ankyloglossia was only mild. With time, your child may find ways to work around the problem. Symptoms may be less likely to go away if your child has class III or IV ankyloglossia.

If your child is having trouble breastfeeding, your healthcare provider may recommend working with a breastfeeding specialist. If that doesn’t work, your child may need to have a surgical procedure.

Your child may need to see a speech specialist as well. This specialist will test your child’s speech. The specialist may recommend speech therapy. Or, he or she may recommend surgery.

A simple surgical procedure called a frenotomy is an effective treatment for many children. A healthcare provider can usually do this procedure in the office. The provider makes a cut in the frenulum. This allows the tongue to move normally. Your child might need to see a speech therapist after a frenotomy. This can help him or her learn how to retrain the muscles of the tongue.

Some children need a slightly more complicated procedure called a frenectomy. This completely removes the frenulum. Another choice is frenuloplasty. This uses several other methods to release the tongue-tie. Your child might need this if a frenotomy was unsuccessful, or if your child’s frenulum is very thick.

Talk with your child’s provider about the risks and benefits of a procedure.

When should I call my child's healthcare provider?

Call your child’s healthcare provider or breastfeeding specialist if your child is having trouble breastfeeding. If you believe your child is having problems making sounds, see your child’s healthcare provider or a speech pathologist.

Key points about ankyloglossia in children

Ankyloglossia, or tongue-tie, is a problem with the tongue that is present from birth. It keeps the tongue from moving as freely as it normally would:

• Ankyloglossia is caused when the frenulum on the bottom of the tongue is too short and tight.
• Symptoms are different in each child. Some children may not have any symptoms.
• Ankyloglossia causes breastfeeding difficulties in some infants.
• Your child might have trouble making certain sounds.
• Not all children with ankyloglossia need a surgical procedure. Your child might need one if his or her tongue-tie is more severe and causes significant symptoms.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.