Tongue-Tie in Newborns: What Every Parent Should Know

ByTarin Hussain
Updated: 2 Jul 2025, 11:33 am

Tongue-tie, also known as ankyloglossia, is a condition seen in some newborns where the strip of tissue under the tongue (lingual frenulum) is shorter or tighter than usual. This can limit tongue movement and may affect breastfeeding or swallowing. In most cases, it’s mild and doesn’t require treatment, but more severe cases may need medical intervention.

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Tongue-tie, or ankyloglossia, is a condition present at birth that can affect your newborn’s ability to move their tongue freely. It might make breastfeeding challenging and cause discomfort for you as a breastfeeding parent. But knowing what signs to look for and when to seek medical guidance can help your baby feed more comfortably.

In this article:



What is Tongue-Tie in Newborns?

Tongue-tie occurs when the lingual frenulum, the thin band of tissue connecting the underside of your baby’s tongue to the floor of their mouth, is unusually short, thick, or tight. This restricts the tongue’s range of motion. Normally, this tissue separates before birth to allow free movement. But in cases of tongue-tie, it remains attached in a way that limits function. This can make it hard for your baby to breastfeed effectively, as they need to place their tongue over the lower gum to suck properly.

While all babies are born with a lingual frenulum, it's only considered a problem when it restricts tongue movement or interferes with feeding. This condition is usually more common in boys than girls.

Types of Tongue-Tie

There are two main types of ankyloglossia in newborns:

  1. Anterior Tongue-Tie

  • The frenulum attaches near the front of the tongue, close to the tip.
  • Often more visible, making the tongue appear heart-shaped when extended.
  • Easier to notice during a physical exam due to its visible placement.

  1. Posterior Tongue-Tie

  • The frenulum is attached further back, closer to the base of the tongue.
  • Less obvious visually, as it’s shorter and deeper under the tongue.
  • Harder to detect and often requires a skilled practitioner for diagnosis.

Signs and Symptoms of Tongue-Tie

Recognising tongue-tie early is important to avoid potential issues. Symptoms can show up in your baby, and you might notice some signs during breastfeeding, too.


Symptoms in Newborns

  • Tongue-tied newborns may face difficulty latching onto the breast or staying latched.
  • Makes clicking sounds or pops off the breast during feeding.
  • Poor weight gain due to inadequate milk intake.
  • Lack of swallowing sounds during breastfeeding.
  • Heart-shaped or notched tongue when extended.
  • Trouble lifting the tongue to the upper gums or moving it side to side.
  • Inability to stick the tongue past the lower gums.
  • Fussiness or colic-like symptoms (clenched fists, arched back, knees pulled up).
  • Gasiness from swallowing air due to a poor latch.
  • Chewing on the nipple instead of sucking.
  • A preference for mouth breathing over nasal breathing.

Symptoms in the Parent

  • Painful breastfeeding with sore, cracked, or blistered nipples.
  • Prolonged feeding sessions as your baby struggles to suck milk.
  • Frequent nursing because your baby isn’t satisfied.
  • Low milk supply due to inadequate milk removal during breastfeeding.
  • Increased risk of breast infections like mastitis or thrush.

Symptoms in Toddlers and Children

  • Trouble pronouncing sounds like “t,” “d,” “z,” “s,” “th,” “n,” and “l.”
  • Difficulty chewing or swallowing solid foods, leading to picky eating or a preference for soft foods.
  • Gagging or choking on food due to restricted tongue movement.
  • Mouth breathing, especially during sleep.
  • Some experts believe that tongue-tie may be linked to spacing between the lower front teeth, but this is not always the case.
  • Slow eating and longer mealtimes.
  • Frequent colds, coughs, and allergies.
  • Digestive issues like reflux or colic.
  • Nighttime teeth grinding (bruxism).
  • Restlessness, difficulty focusing, or daytime drowsiness.
  • Misaligned teeth or orthodontic concerns.
  • Loud snoring or laboured breathing during sleep.

It's important to note that these signs aren’t unique to tongue-tie only and could arise from other issues. That’s why seeing a healthcare professional or lactation consultant is important for a proper diagnosis.


Causes of Tongue-Tie

Tongue-tie is a congenital condition, meaning your baby is born with it. Its exact cause isn’t fully understood by researchers yet. However, a few factors may play a role:

  • Family history: Tongue-tie might be passed down within families, suggesting a genetic link.
  • Development before birth: Typically, the lingual frenulum loosens before birth to allow free tongue movement. This process doesn’t completely happen in tongue-tied newborns, leaving the tissue tight or short.


Complications of Untreated Tongue-Tie

If tongue-tie isn’t addressed, it can lead to challenges for your baby. Early intervention can prevent these issues:

  • Feeding problems: Your baby may chew instead of suck, leading to poor milk intake, inadequate nutrition, and slow growth.
  • Maternal discomfort: Ineffective latching can cause nipple pain, trauma, and reduced milk supply.
  • Speech difficulties: Restricted tongue movement can make it hard to form certain sounds and potentially delay speech development.


Diagnosing Tongue-Tie

Diagnosing ankyloglossia involves a careful look at your baby’s tongue and feeding patterns. Your paediatrician or lactation consultant will take these steps:

  • Review breastfeeding history: They will ask about your feeding experiences, including latch issues, session length, frequency, and whether you pump or use formula.
  • Ask about your comfort: Inform your healthcare professional if breastfeeding is painful or uncomfortable for you. This doesn’t necessarily mean your pain is caused by tongue-tie, but it’s important to let them know if you’re experiencing it so they can better understand your problem.
  • Check baby’s medical history: Other factors like neurological disorders or airway blockages might affect feeding and need to be ruled out.
  • Physical exam: The doctor will examine your baby’s mouth, looking at the tongue and frenulum for signs of restriction.
  • Observe breastfeeding: A lactation consultant will watch how you hold your baby and how they latch, checking if positioning adjustments help.
  • Assess tongue function: No tests are needed, just observation and touch to see how the tongue moves and if the frenulum limits it.


Frenotomy As A Treatment Option for Tongue-Tie Newborns

Not every case of tongue-tie requires treatment or surgery. The approach depends on the severity and impact on breastfeeding. A lactation consultant can help you adjust your position and your baby’s latch. If positioning doesn’t help, a quick in-office procedure called a frenotomy may be recommended. The doctor clips the lingual frenulum to free the tongue, usually within the first month of life, for best results.

It is a safe and simple treatment option with minimal discomfort. A topical anaesthetic gel is applied for about 30 minutes to numb the area. The frenulum is then released with scissors or a laser, forming a diamond-shaped wound. Lasers can offer precision and less bleeding during this tongue-tie procedure.

Many babies don’t need a frenotomy. Your doctor will rule out other causes of breastfeeding difficulty before suggesting this step.

Risks of Frenotomy

A frenotomy is generally safe, but rare risks may include:

  • Bleeding.
  • Infection.
  • Scarring.
  • Feeding aversion.
  • Injury to salivary ducts in the mouth.

Aftercare and Tongue-Tie Exercises

Healing takes time after a frenotomy, and the full benefits aren’t immediate. Without proper care, the tongue might revert to its old position, or the frenulum could reattach. To prevent this, follow the steps mentioned below:

  • Follow your doctor’s aftercare instructions to support healing after tongue-tie surgery.
  • Perform tongue-tie exercises as advised by the doctor to encourage new movement patterns. These exercises help strengthen and coordinate the tongue and prevent relapse.
  • Work closely with a lactation consultant to monitor breastfeeding progress.


When to Seek Medical Help

Do not wait to seek help if your baby struggles with nursing. Reach out to a paediatrician or lactation consultant if you notice:

  • Trouble latching or frequent fussiness during feeds.
  • Poor weight gain or excessive feeding frequency.
  • Painful breastfeeding, sore nipples, or low milk supply.
  • Signs include a heart-shaped tongue or limited tongue movement.

Tongue-tie isn’t usually a cause for worry. Many babies manage well without a procedure, especially with proper guidance from a healthcare professional. Don’t try to diagnose or treat tongue-tie on your own. Always reach out for expert care to make sure you and your baby feel comfortable and supported.

FAQs on Tongue-Tie in Newborns: What Every Parent Should Know

  1. What happens during a tongue-tie procedure?
    A tongue-tie surgery, also called a frenotomy, involves snipping the tight tissue under the tongue. It’s quick and usually done in a clinic with little discomfort for your baby.
  2. Does every tongue-tie newborn need surgery?
    No, many newborns with tongue-tie don’t need surgery if the condition is mild and doesn’t affect feeding or development.
  3. How can I tell if my baby has tongue-tie?
    You may notice trouble latching, clicking sounds during feeding, poor weight gain, or a heart-shaped tongue when your baby cries. Pain while breastfeeding can also be a sign.
Disclaimer: Medically approved by Dr. Narendra Jha- Senior Consultant, Paediatrics, Max Super Speciality Hospital, Vaishali