What is tongue-tie?

The tongue is connected to the bottom of the mouth by a small piece of skin called the frenulum. If this connection is tighter or shorter than usual, the tongue is unable to move freely — a condition known as tongue-tie. The medical term for tongue-tie is ankyloglossia.

Tongue-tie is a congenital condition, which means the baby is born with it. The cause isn’t known, but the condition can run in families.

Signs and symptoms of tongue-tie

If your baby has tongue-tie, you might notice:

• a piece of skin holding their tongue close to the floor of their mouth
• their tongue can’t move freely — for example, it can’t move from side to side, or reach up to the roof of the mouth, or extend past their lips
• the tip of the tongue is an unusual shape — instead of having a round tip, it might look square or heart-shaped, or have a V-shaped notch in it

If you are breastfeeding your baby, you might also notice:

• your baby is having trouble staying attached, gets tired quickly or makes clicking sounds during breastfeeding
• your baby is not gaining weight
• you have sore nipples, or nipples that change shape or develop a mark after breastfeeding
• you develop blocked ducts or mastitis
• you produce less breast milk as time goes by

If you are feeding from a bottle, signs of tongue-tie can include:

• your baby dribbling or swallowing a lot of air during feeding
• milk leaking from their mouth during feeding
• feeding taking a long time

Diagnosis of tongue-tie

If you notice some of the signs above, it doesn’t necessarily mean your baby has tongue-tie. If you have any concerns, however, you should see your doctor.

If you are having problems breastfeeding, it’s best to seek advice straight away — see your child and family health nurse or a lactation consultant. If they think tongue-tie is an issue, they can refer you to a doctor or lactation consultant who can make the diagnosis and talk to you about treatment options.

To diagnose tongue-tie, your doctor or a lactation consultant may:

• ask you about breastfeeding, if you breastfeed your baby
• talk about any signs and symptoms you have noticed
• examine your baby’s tongue and mouth

Treatment of tongue-tie

If your baby has tongue-tie, this doesn’t necessarily mean they will need treatment. In many babies, the piece of skin loosens as they get older.

However, if your doctor or lactation consultant believes that tongue-tie is making it hard for your baby to feed properly, they might recommend that your baby has a simple procedure called a frenectomy (also known as ‘frenuloplasty', 'frenulotomy' or ‘frenotomy’). This involves cutting the piece of skin under the tongue so the tongue is released and can move normally.

If your baby is younger than 4 months, this may be done without anaesthetic and with little discomfort. You can feed your baby straight afterwards. Older babies, on the other hand, might need an anaesthetic.

After the procedure, you may see a small white area under your baby’s tongue. This is normal, and should heal within a couple of weeks.

In some cases, you may be referred to a specialist (such as a paediatrician or an oral surgeon) for surgery.

Where to get help

• Call the Australian Breastfeeding Association’s National Breastfeeding Helpline on 1800 686 268
• Find a lactation consultant at Lactation Consultants of Australia and New Zealand