Tongue Tie
Infants / Children
Tongue Tie in Infants
A tongue-tie, or ankyloglossia, occurs when the lingual frenulum beneath the tongue restricts tongue movement. In some infants, restricted tongue mobility may contribute to difficulties with breastfeeding or bottle-feeding, although not every infant with a tongue-tie will experience feeding problems.
Feeding is a complex coordinated activity involving the tongue, jaw, lips, cheeks and the coordination of sucking, swallowing and breathing. When tongue movement is restricted, some infants may develop compensatory feeding patterns or have difficulty coordinating these movements efficiently.
Feeding difficulties may involve a shallow latch, difficulty maintaining a latch, clicking or loss of suction, milk leakage, prolonged feeds or maternal nipple pain. A comprehensive feeding assessment can help determine whether restricted tongue movement may be contributing to these difficulties.
What Is Tongue-Tie?
Tongue-tie (ankyloglossia) is a congenital variation in the lingual frenulum—the tissue connecting the underside of the tongue to the floor of the mouth. In some individuals, the frenulum restricts tongue movement and function.
The appearance of the frenulum alone does not determine whether a tongue-tie is functionally significant. Assessment should consider tongue mobility, oral function and the individual's symptoms or feeding concerns.
Possible Feeding Signs in Infants
Shallow or difficult latch
Difficulty maintaining a latch
Clicking during feeding
Difficulty creating or maintaining suction
Milk leaking from the sides of the mouth
Prolonged or frequent feeds
Fussiness during feeding
Difficulty coordinating sucking, swallowing and breathing
Poor milk transfer
Maternal nipple pain during breastfeeding
Difficulty gaining weight or inadequate milk intake
If an infant is experiencing feeding difficulties or is not gaining weight appropriately, assessment by an appropriate healthcare or feeding professional is important.
Signs of Restricted Tongue Function in Older Children
As children grow, restricted tongue mobility may become more apparent during oral activities and daily function. Possible signs may include:
Difficulty lifting the tongue toward the palate
Difficulty moving the tongue from side to side
Difficulty extending the tongue
Difficulty maintaining an appropriate oral rest posture
Difficulty managing age-appropriate foods
Persistent drooling
Difficulty with certain oral motor tasks
These signs can have many possible causes, so they should not be used on their own to determine whether a tongue-tie is present or functionally significant.
What Is a Frenectomy?
A frenectomy or frenotomy is a procedure used to release a restrictive lingual frenulum. Depending on the provider and individual circumstances, the procedure may be performed using scissors, a scalpel or laser. The specific technique, use of anesthesia and need for sutures vary depending on the patient's age, anatomy and the clinician performing the procedure.
Not every infant with a tongue-tie requires a frenectomy. The decision should be based on functional assessment, feeding difficulties and the individual circumstances of the infant rather than appearance alone.
When a tongue restriction is suspected, our role is to assess relevant orofacial function and collaborate with the appropriate healthcare and feeding professionals to help determine the most appropriate next step.
What If Feeding Difficulties Continue After a Tongue-Tie Release?
Some infants and toddlers continue to experience feeding or oral functional difficulties after a tongue-tie release. Persistent symptoms do not necessarily mean that the release was unsuccessful. Feeding is a complex skill involving the tongue, jaw, lips, cheeks, positioning and coordination of sucking, swallowing and breathing.
Following a release, some children may benefit from appropriate oral motor or functional support to help develop efficient tongue movement and coordination. The timing and type of therapy will depend on the child's age, functional needs and the recommendations of the healthcare professionals involved in their care.
If concerns persist after a release, a functional assessment can help identify whether altered tongue movement, oral motor patterns or other factors may be contributing to the ongoing difficulty.
For older children, a reassessment may be appropriate if concerns about tongue mobility, oral rest posture, chewing, swallowing or other orofacial functions become apparent as they develop.
Who Should Assess an Infant With a Possible Tongue-Tie?
A suspected tongue-tie should be considered in the context of the infant's overall function rather than appearance alone.
Depending on the concerns, assessment may involve collaboration with a lactation or infant-feeding professional, pediatric healthcare provider, dentist or other appropriately qualified clinician. An Orofacial Myofunctional Therapist may also assess relevant oral motor and orofacial functional patterns when appropriate.
When feeding difficulties are present, our goal is to work collaboratively with the professionals involved in your baby's care to better understand the factors affecting feeding and determine the most appropriate next step.
How Can OMT Support Tongue Function Before or After a Release?
When appropriate, orofacial myofunctional or oral motor therapy may be incorporated before or after a tongue-tie release to support functional tongue movement and coordination.
Depending on the child's age and individual needs, therapy may focus on oral awareness, tongue mobility, resting posture, coordination and functional movements related to feeding.
Following a release, the healthcare professional who performed the procedure will provide specific instructions for wound care and post-procedure management. Additional functional therapy may be recommended when appropriate to support the development of new movement patterns.
Every child is different, and the need for therapy before or after a release should be determined based on the child's individual function and clinical needs.
The goal is not simply to release tissue—it is to support comfortable, functional tongue movement and feeding.
