Health Library

Tongue tie

Ankyloglossia

Tongue tie is when the bottom of the tongue is attached to the floor of the mouth.

This may make it hard for the tip of the tongue to move freely.

I Would Like to Learn About:

Causes

The tongue is connected to the bottom of the mouth by a band of tissue called the lingual frenulum. In people with tongue tie, this band is overly short and thick. The exact cause of tongue tie is not known. Your genes may play a role. The problem tends to run in some families.

Symptoms

In a newborn or infant, the symptoms of tongue tie are similar to the symptoms in a child who is having problems with breastfeeding. Symptoms may include:

• Acting irritable or fussy, even after feeding.
• Difficulty creating or keeping suction on the nipple. The infant may become tired in 1 or 2 minutes, or fall asleep before eating enough.
• Poor weight gain or weight loss.
• Problems latching onto the nipple. The infant may just chew on the nipple instead.
• There may be speech and pronunciation difficulties in older children.

The breastfeeding mother may have problems with breast pain, plugged milk ducts, or painful breasts, and may feel frustrated.

Exams and Tests

Most experts do not recommend that health care providers examine newborns for tongue tie unless there are breastfeeding problems.

Most providers only consider tongue tie when:

• The mother and baby have had problems starting breastfeeding.
• The mother has received at least 2 to 3 days of support from a breastfeeding (lactation) specialist.

Treatment

Most breastfeeding problems can be managed easily. A person who specializes in breastfeeding (lactation consultant) can help with breastfeeding issues.

Tongue tie surgery, called a frenulotomy, is rarely needed. The surgery involves cutting and releasing the tethered frenulum under the tongue. It is most often done in the surgeon's office. Infection or bleeding afterward is possible, but rare.

Surgery for more severe cases or for older children is done in a hospital operating room. A surgical procedure called a z-plasty closure may be needed to prevent scar tissue from forming.

Possible Complications

On rare occasions, tongue tie has been linked to problems with tooth development, swallowing, or speech.

References

Dhar VK. Common lesions of the oral soft tissues. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 361.

Lawrence RA, Lawrence RM. ABM clinical protocol #11: guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad: The Academy of Breastfeeding Medicine: ABM Protocols. In: Lawrence RA, Lawrence RM, eds. Breastfeeding: A Guide for the Medical Profession. 9th ed. Philadelphia, PA: Elsevier; 2022:870-873.

Newkirk GR, Newkirk MJ. Tongue-tie snipping (frenotomy) for ankyloglossia. In: Fowler GC, eds. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 169.

Review Date: 7/28/2025  

Reviewed By: Ashutosh Kacker, MD, FACS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics. This site complies with the HONcode standard for trustworthy health information: verify here.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language.

© 1997- 2026 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

All content on this site including text, images, graphics, audio, video, data, metadata, and compilations is protected by copyright and other intellectual property laws. You may view the content for personal, noncommercial use. Any other use requires prior written consent from Ebix. You may not copy, reproduce, distribute, transmit, display, publish, reverse-engineer, adapt, modify, store beyond ordinary browser caching, index, mine, scrape, or create derivative works from this content. You may not use automated tools to access or extract content, including to create embeddings, vectors, datasets, or indexes for retrieval systems. Use of any content for training, fine-tuning, calibrating, testing, evaluating, or improving AI systems of any kind is prohibited without express written consent. This includes large language models, machine learning models, neural networks, generative systems, retrieval-augmented systems, and any software that ingests content to produce outputs. Any unauthorized use of the content including AI-related use is a violation of our rights and may result in legal action, damages, and statutory penalties to the fullest extent permitted by law. Ebix reserves the right to enforce its rights through legal, technological, and contractual measures.