Tongue tie

How it works

Lift your tongue and look under it in a mirror. The thin fold of tissue running from the floor of the mouth to the underside of the tongue is the lingual frenulum². In the embryo the tongue is fully attached to the floor of the mouth, and it gradually separates. The frenulum is what is left of that attachment².

In tongue tie the frenulum is unusually short, thick, or attached close to the tip of the tongue¹². The tongue cannot lift to the roof of the mouth¹ or poke out past the lower lip⁵. When the person tries, the tip pulls into a heart shape⁵⁶.

It seems more common in boys⁵, and it may run in families⁵.

The main problem is breastfeeding. A baby needs to cup the nipple with the tongue to feed. Some tied babies cannot, so they feed slowly, click, and lose the latch, and the mother gets sore¹⁶. Later in childhood a few children have trouble with sounds like t, d, l, and r, or with licking an ice cream. Many have no problems at all, and the frenulum often stretches and loosens with growth¹.

If feeding is affected, a doctor can snip the frenulum. This is called a frenotomy. In babies it takes seconds and is usually done without anaesthetic⁵⁶. Any bleeding usually stops with local pressure⁵. Whether to cut when the baby is feeding well is debated. Diagnoses have risen in recent years, and some doctors think this leads to unnecessary surgery⁵.

How common it is

A 2022 review of 71 studies finds 5% across all ages and 7% in infants⁴. The rate ranges from 2% to 20%, depending on the tool used to assess the tongue⁴. Studies of newborns find more cases than studies of older children and adults, partly because mild cases can loosen with time⁵. The same review finds it about 1.3 times as common in boys as in girls⁴. The review rates this evidence as very low certainty⁴.

Is it a problem?

Often not. Many children with tongue tie grow up with no feeding, speech, or eating trouble, and in some the frenulum stretches and loosens on its own¹. The clearest problem is breastfeeding difficulty in babies, such as a poor latch or a sore nipple for the mother, which is when doctors most often recommend cutting the frenulum¹.

Mention it to a doctor if:

• a baby is not feeding well,
• an older child struggles with sounds like t, d, l, or r,
• an older child cannot lick an ice cream.

A snip is a simple, low-risk fix when one is needed¹.

History and culture

Some yoga traditions deliberately cut and stretch the frenulum over months so the tongue can curl back behind the soft palate into the nasal cavity³. The frenulum that a surgeon snips in a tied baby is the same band.