How to tell if your baby is tongue-tied

When you have a newborn in the house, your whole world suddenly revolves around the baby. Naturally, you search for the latest information to make sure your little one is eating right, sleeping right, and is happy and healthy. Keeping them fed is a priority, and sometimes it can be surprisingly challenging.

One issue that new parents might hear about is tongue-tie, especially if their baby is having trouble breastfeeding.

So what is tongue-tie, and do you need to worry? Read on to learn about how to tell if your baby is tongue-tied.

What does it mean when a baby is tongue-tied?

Everyone is born with a bit of tissue under the tongue, called a frenum or frenulum. It connects the bottom of the tongue to the floor of the mouth. Tongue-tie is when the tissue under the tongue is too short or too thick and restricts the tongue's range of motion. The medical term for tongue-tie is ankyloglossia.

"In some cases, the central part of the tongue cannot elevate, which is why people say it is 'tied' to the floor of the mouth," explains Felicity Lenes-Voit, M.D., Pediatric Otolaryngologist with Children's Health℠ and Assistant Professor of UT Southwestern. "When looking for tongue-tie, we also examine several other factors related to the tongue's movement, which include how well it moves side to side, how well the tongue 'cups' while sucking and if there is a wavelike motion from the front to the back of the tongue."

How common is tongue-tie?

Tongue-tie may affect 4-11% of newborns and infants, though an exact number is not known.

"It could be that even up to 25% of babies have some degree of tissue under their tongues, but we see a wide variety and severity, and not every baby needs corrective surgery or treatment," says Dr. Lenes-Voit.

What does tongue-tie look like?

To check for tongue-tie, you can look at the shape of your baby's tongue. If your baby is tongue-tied, the tip of the tongue may look like a little heart. That's because the tissue that attaches the baby's tongue to the bottom of the mouth is too short or too thick. It tethers or pulls down the tongue in one area, causing the tip of the tongue to form a heart shape.

You might see this heart shape when the baby is crying or lifting the tongue. If you don't see it, you might notice other signs or symptoms of tongue-tie.

What are tongue-tie symptoms in babies?

Typically, parents first notice signs of tongue-tie in babies during breastfeeding. Babies with tongue-tie might:

• Cause pain with breastfeeding
• Compress the breast rather than suck
• Have noisy feeding sessions as they swallow lots of air (this can also be related to positioning issues or reflux)
• Have trouble latching when breastfeeding
• Not make enough wet or dirty diapers
• Require long feeding times

Other signs that a baby might have tongue-tie include if the baby cannot:

• Lift the tongue to the roof of the mouth
• Keep a pacifier in the mouth (though many babies without tongue-tie also refuse pacifiers)
• Move the tongue from side to side
• Move the tongue past the gumline where teeth will grow

As children get older, parents often worry about a tongue-tie causing speech problems, but there is no scientific evidence to support this.

Not all symptoms mean your baby is tongue-tied

If your baby has trouble taking a pacifier or nursing, this doesn't necessarily mean your baby has tongue-tie.

"Breastfeeding can take a lot of work. Teaching a baby to develop a good latch takes time and patience," says Kandi Trevino, SLP, a Speech-Language Pathologist at Children's Health who cares for babies with tongue-tie.

To improve breastfeeding, the mother and baby may need to try another position. If feeding issues continue, your baby may need a thorough evaluation to check other physical factors that can affect feeding.

"Sometimes the baby's inability to generate good suction while feeding is an issue with the overall oral motor function or the coordination of the suck, swallow, breathe reflex," says Dr. Lenes-Voit. "Maybe the baby has issues with muscle tone or strength. If a baby is having to take frequent breaks to breathe while eating, or ever stops breathing or turns blue, they need to be evaluated."

What should you do if you think your baby has tongue-tie?

If you're concerned about tongue-tie symptoms in your baby such as feeding issues, start by talking with your pediatrician or a lactation consultant.

"Go to someone who is very knowledgeable and will consider the big picture, and not recommend a tongue-tie procedure unnecessarily," advises Trevino.

Your pediatrician may refer you to a pediatric ear, nose and throat (ENT) specialist for further evaluation.

"It's important that we perform a comprehensive evaluation and make sure nothing more serious than tongue-tie is going on," says Dr. Lenes-Voit. "Certainly, if a mother experiences pain every time a baby feeds, and no matter what she tries, the baby cannot latch properly, that's concerning. If tongue-tie is the reason for the pain and feeding problems, we can intervene. The ability to nurse is incredibly precious for many parents, and we support that."

How is tongue-tie treated?

If treatment is needed, your pediatrician or ENT specialist can perform a frenotomy, removing part of the tissue that restricts the baby's tongue movement. If your baby is less than 3 months old, the procedure can be performed in the physician's office. If the baby is older than 3 months, the doctor will treat the baby in a hospital setting. Typically, babies do very well after treatment.

See more advice for feeding a baby with a tongue-tie, including after a frenotomy.

Learn more

The Pediatric Ear, Nose and Throat program at Children's Health provides convenient, accessible ENT care to families. If you're concerned about tongue-tie in babies, contact us for a comprehensive evaluation or second opinion in our Multidisciplinary Tongue-Tie Clinic.