Tongue Tie Affecting Feeding (Ankyloglossia)
Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist
Content reviewed against published AAP, NIH guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect tongue tie affecting feeding (ankyloglossia), here is what the evidence says.
The short answer
Tongue tie (ankyloglossia) occurs when the tissue connecting the tongue to the floor of the mouth (frenulum) is too short or tight, potentially restricting tongue movement. It affects about 4-10% of newborns and can sometimes cause difficulty with breastfeeding. Not all tongue ties require treatment, but if feeding is significantly affected, a simple procedure called a frenotomy can help.
Key takeaways
- Tongue tie (ankyloglossia) occurs when the tissue connecting the tongue to the floor of the mouth (frenulum) is too short or tight, potentially restricting tongue movement. It affects about 4-10% of newborns and can sometimes cause difficulty with breastfeeding. Not all tongue ties require treatment, but if feeding is significantly affected, a simple procedure called a frenotomy can help.
- Usually normal when: A visible frenulum under the tongue that does not restrict tongue movement or feeding
- Call your doctor if: Baby is not gaining weight or is losing weight due to feeding difficulties potentially related to tongue tie
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to AAP, NIH guidelines, tongue tie (ankyloglossia) occurs when the tissue connecting the tongue to the floor of the mouth (frenulum) is too short or tight, potentially restricting tongue movement. It affects about 4-10% of newborns and can sometimes cause difficulty with breastfeeding. Not all tongue ties require treatment, but if feeding is significantly affected, a simple procedure called a frenotomy can help. At 0-1 month, tongue tie is typically identified in the first days to weeks of life, often when breastfeeding difficulties arise. Signs that tongue tie may be affecting feeding include: painful latch for the mother, baby sliding off the breast frequently, poor weight gain, clicking sounds during feeding, and prolonged feeding sessions. However, many babies with tongue tie breastfeed successfully. If feeding difficulties are present, a lactation consultant can help assess whether tongue tie is contributing. Treatment (frenotomy) is a quick procedure where the frenulum is clipped, usually with minimal bleeding and immediate improvement in latch. It is generally considered normal when a visible frenulum under the tongue that does not restrict tongue movement or feeding. However, you should contact your pediatrician promptly if baby is not gaining weight or is losing weight due to feeding difficulties potentially related to tongue tie.
Normal vs. Concerning
By Age
What to expect by age
0-1 month
Tongue tie is typically identified in the first days to weeks of life, often when breastfeeding difficulties arise. Signs that tongue tie may be affecting feeding include: painful latch for the mother, baby sliding off the breast frequently, poor weight gain, clicking sounds during feeding, and prolonged feeding sessions. However, many babies with tongue tie breastfeed successfully. If feeding difficulties are present, a lactation consultant can help assess whether tongue tie is contributing. Treatment (frenotomy) is a quick procedure where the frenulum is clipped, usually with minimal bleeding and immediate improvement in latch.
1-3 months
If tongue tie was treated early, feeding should improve within days. If untreated, some babies compensate and feeding improves as they grow and develop better oral motor control. If feeding difficulties persist, it is still possible to perform a frenotomy at this age. Working with a lactation consultant can help optimize feeding technique regardless of whether the tie is released.
3-6 months
By this age, feeding is usually well-established. Residual tongue tie that did not affect feeding in the newborn period is unlikely to cause problems now. As your baby begins exploring solid foods around 6 months, a significant tongue tie could potentially affect eating, though this is less common.
6-12 months
A tongue tie may become relevant again as solid foods are introduced. In some cases, tongue tie can affect speech development later on, though many children with tongue tie speak normally. If you have concerns, your pediatrician can evaluate and refer to a specialist if needed.
What to Tell Your Pediatrician
- Describe when you first noticed tongue tie affecting feeding (ankyloglossia) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if baby is having difficulty latching or maintaining a latch during breastfeeding.
- Mention if feeding sessions are consistently prolonged (over 30-40 minutes) and baby seems frustrated.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- A visible frenulum under the tongue that does not restrict tongue movement or feeding
- Successful breastfeeding or bottle-feeding despite a visible tongue tie
- Baby gaining weight well and producing adequate wet and dirty diapers
- Mother not experiencing persistent nipple pain during feeding
- Baby is having difficulty latching or maintaining a latch during breastfeeding
- Feeding sessions are consistently prolonged (over 30-40 minutes) and baby seems frustrated
- You notice clicking sounds during feeding or baby's tongue cannot extend past the lower gum
- Baby is not gaining weight or is losing weight due to feeding difficulties potentially related to tongue tie
- Mother has severely damaged nipples, mastitis, or is considering stopping breastfeeding due to pain from poor latch
What You Can Do at Home
- Keep track of when you notice tongue tie affecting feeding (ankyloglossia) — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that a visible frenulum under the tongue that does not restrict tongue movement or feeding — this is generally within the range of normal.
- At 0-1 month, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
- While monitoring at home, seek immediate care if baby is not gaining weight or is losing weight due to feeding difficulties potentially related to tongue tie.
Related Conditions
Upper Lip Tie in Newborns
An upper lip tie occurs when the tissue connecting the upper lip to the upper gum (labial frenulum) is thick, tight, or extends close to the gum line. While all babies have a labial frenulum, a restrictive one may sometimes contribute to breastfeeding difficulties. The significance and treatment of lip ties is more debated among medical professionals than tongue tie.
Newborn Not Latching
Difficulty latching is one of the most common breastfeeding challenges for new parents and newborns. Many factors can contribute, including the baby's positioning, tongue tie, flat or inverted nipples, engorgement, or the baby being sleepy or overstimulated. Most latching problems can be resolved with proper support from a lactation consultant. In the meantime, expressing colostrum or milk by hand or pump ensures the baby receives adequate nutrition.
High Arched Palate Concerns in Newborns
A high arched palate (roof of the mouth) in a newborn can sometimes contribute to feeding difficulties because the baby may have trouble compressing the breast or bottle nipple effectively. Many babies with a high palate feed successfully with positioning adjustments, and the palate shape often changes as the baby grows. In some cases, a high palate is associated with other conditions that your pediatrician may evaluate.
Related Resources
Frequently asked questions
Is tongue tie affecting feeding (ankyloglossia) normal?
When should I call the doctor about tongue tie affecting feeding (ankyloglossia)?
When is tongue tie affecting feeding (ankyloglossia) normal?
What causes tongue tie affecting feeding (ankyloglossia)?
What should I mention to my pediatrician about tongue tie affecting feeding (ankyloglossia)?
Is tongue tie affecting feeding (ankyloglossia) normal at 0-1 month?
Is tongue tie affecting feeding (ankyloglossia) normal at 1-3 months?
Should I go to the ER for tongue tie affecting feeding (ankyloglossia)?
Does tongue tie affecting feeding (ankyloglossia) go away on its own?
References
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Tongue Tie Affecting Feeding (Ankyloglossia).
Things to mention
- Describe when you first noticed tongue tie affecting feeding (ankyloglossia) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if baby is having difficulty latching or maintaining a latch during breastfeeding.
- Mention if feeding sessions are consistently prolonged (over 30-40 minutes) and baby seems frustrated.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- Baby is having difficulty latching or maintaining a latch during breastfeeding
- Feeding sessions are consistently prolonged (over 30-40 minutes) and baby seems frustrated
- You notice clicking sounds during feeding or baby's tongue cannot extend past the lower gum
Urgent signs to report immediately
- Baby is not gaining weight or is losing weight due to feeding difficulties potentially related to tongue tie
- Mother has severely damaged nipples, mastitis, or is considering stopping breastfeeding due to pain from poor latch
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of tongue tie affecting feeding (ankyloglossia) are normal. Talk to your pediatrician if baby is not gaining weight or is losing weight due to feeding difficulties potentially related to tongue tie.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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Related Medical Concerns
Upper Lip Tie in Newborns
An upper lip tie occurs when the tissue connecting the upper lip to the upper gum (labial frenulum) is thick, tight, or extends close to the gum line. While all babies have a labial frenulum, a restrictive one may sometimes contribute to breastfeeding difficulties. The significance and treatment of lip ties is more debated among medical professionals than tongue tie.
Newborn Not Latching
Difficulty latching is one of the most common breastfeeding challenges for new parents and newborns. Many factors can contribute, including the baby's positioning, tongue tie, flat or inverted nipples, engorgement, or the baby being sleepy or overstimulated. Most latching problems can be resolved with proper support from a lactation consultant. In the meantime, expressing colostrum or milk by hand or pump ensures the baby receives adequate nutrition.
High Arched Palate Concerns in Newborns
A high arched palate (roof of the mouth) in a newborn can sometimes contribute to feeding difficulties because the baby may have trouble compressing the breast or bottle nipple effectively. Many babies with a high palate feed successfully with positioning adjustments, and the palate shape often changes as the baby grows. In some cases, a high palate is associated with other conditions that your pediatrician may evaluate.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.