Baby Tongue Tie (Ankyloglossia)
Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist
Content reviewed against published AAP, AAP, AAP guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect baby tongue tie (ankyloglossia), here is what the evidence says.
The short answer
Tongue tie occurs when the strip of tissue (frenulum) connecting the tongue to the floor of the mouth is shorter or tighter than usual, potentially restricting tongue movement. It is present in about 4-10% of newborns. Many tongue ties cause no problems at all, but when they do, feeding difficulties (especially breastfeeding) are the most common concern.
Key takeaways
- Tongue tie occurs when the strip of tissue (frenulum) connecting the tongue to the floor of the mouth is shorter or tighter than usual, potentially restricting tongue movement. It is present in about 4-10% of newborns. Many tongue ties cause no problems at all, but when they do, feeding difficulties (especially breastfeeding) are the most common concern.
- Usually normal when: Your baby has a visible frenulum but can breastfeed or bottle-feed effectively and is gaining weight well
- Call your doctor if: Your baby is losing weight or not gaining weight and you suspect tongue tie is preventing effective feeding
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to AAP guidelines, tongue tie occurs when the strip of tissue (frenulum) connecting the tongue to the floor of the mouth is shorter or tighter than usual, potentially restricting tongue movement. It is present in about 4-10% of newborns. Many tongue ties cause no problems at all, but when they do, feeding difficulties (especially breastfeeding) are the most common concern. At 0-1 month, this is when tongue tie most commonly presents as a breastfeeding challenge. Signs include painful latch for the mother, clicking sounds during feeding, poor milk transfer leading to slow weight gain, or the baby sliding off the breast repeatedly. A lactation consultant can help determine whether a tongue tie is actually contributing to feeding difficulties, as latch issues can have many causes. It is generally considered normal when your baby has a visible frenulum but can breastfeed or bottle-feed effectively and is gaining weight well. However, you should contact your pediatrician promptly if your baby is losing weight or not gaining weight and you suspect tongue tie is preventing effective feeding.
Normal vs. Concerning
By Age
What to expect by age
0-1 month
This is when tongue tie most commonly presents as a breastfeeding challenge. Signs include painful latch for the mother, clicking sounds during feeding, poor milk transfer leading to slow weight gain, or the baby sliding off the breast repeatedly. A lactation consultant can help determine whether a tongue tie is actually contributing to feeding difficulties, as latch issues can have many causes.
1-6 months
If breastfeeding has been going well, a tongue tie may not need treatment even if one is present. For babies struggling to feed, a frenotomy (a quick snip of the frenulum) can be performed, often in the pediatrician's office. Bottle-fed babies with tongue tie usually have fewer difficulties, though some may have trouble forming a seal around the nipple.
6-12 months
As babies begin solids, a significant tongue tie may occasionally affect their ability to move food around in their mouth. However, many babies with untreated tongue ties manage solids without any problems. If a frenotomy was not done earlier and your baby is feeding and growing well, treatment is generally not needed.
12 months+
Tongue tie rarely affects speech development in toddlers, despite common misconceptions. Most children with tongue tie develop normal speech. If speech difficulties arise later, they can be evaluated at that time. The frenulum can also stretch and thin out over time, reducing any restriction.
What to Tell Your Pediatrician
- Describe when you first noticed baby tongue tie (ankyloglossia) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if your baby has a visible tongue tie and you are experiencing persistent breastfeeding pain or latch difficulties despite working with a lactation consultant.
- Mention if your baby is not gaining weight adequately and tongue restriction is suspected as a contributing factor.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- Your baby has a visible frenulum but can breastfeed or bottle-feed effectively and is gaining weight well
- Your baby's tongue can extend past the lower gum line and lift to the roof of the mouth
- A lactation consultant or pediatrician has assessed the tongue and determined it is not causing functional problems
- Your baby had a frenotomy and feeding has improved (it may take a few days to see full benefit)
- Your baby has a visible tongue tie and you are experiencing persistent breastfeeding pain or latch difficulties despite working with a lactation consultant
- Your baby is not gaining weight adequately and tongue restriction is suspected as a contributing factor
- Your baby's tongue appears heart-shaped when they try to stick it out, or they cannot lift their tongue past the lower lip
- You want an evaluation to determine whether the tongue tie is contributing to feeding challenges
- Your baby is losing weight or not gaining weight and you suspect tongue tie is preventing effective feeding
- Your newborn is unable to latch at all and you are struggling to feed them by any method
What You Can Do at Home
- Keep track of when you notice baby tongue tie (ankyloglossia) — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that your baby has a visible frenulum but can breastfeed or bottle-feed effectively and is gaining weight well — 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 your baby is losing weight or not gaining weight and you suspect tongue tie is preventing effective feeding.
Related Resources
Milestone Checklists by Age
Track your baby's developmental milestones from birth to 5 years with age-specific checklists.
Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is baby tongue tie (ankyloglossia) normal?
When should I call the doctor about baby tongue tie (ankyloglossia)?
When is baby tongue tie (ankyloglossia) normal?
What causes baby tongue tie (ankyloglossia)?
What should I mention to my pediatrician about baby tongue tie (ankyloglossia)?
Is baby tongue tie (ankyloglossia) normal at 0-1 month?
Is baby tongue tie (ankyloglossia) normal at 1-6 months?
Should I go to the ER for baby tongue tie (ankyloglossia)?
Does baby tongue tie (ankyloglossia) go away on its own?
References
- [1]American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics, 2012. AAP
- [2]HealthyChildren.org. Tongue-Tie in Babies. AAP
- [3]Srinivasan A, et al. Ankyloglossia in Breastfeeding Infants: The Effect of Frenotomy on Maternal Nipple Pain and Latch. Breastfeeding Medicine, 2006. AAP
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Baby Tongue Tie (Ankyloglossia).
Things to mention
- Describe when you first noticed baby tongue tie (ankyloglossia) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if your baby has a visible tongue tie and you are experiencing persistent breastfeeding pain or latch difficulties despite working with a lactation consultant.
- Mention if your baby is not gaining weight adequately and tongue restriction is suspected as a contributing factor.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- Your baby has a visible tongue tie and you are experiencing persistent breastfeeding pain or latch difficulties despite working with a lactation consultant
- Your baby is not gaining weight adequately and tongue restriction is suspected as a contributing factor
- Your baby's tongue appears heart-shaped when they try to stick it out, or they cannot lift their tongue past the lower lip
Urgent signs to report immediately
- Your baby is losing weight or not gaining weight and you suspect tongue tie is preventing effective feeding
- Your newborn is unable to latch at all and you are struggling to feed them by any method
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 baby tongue tie (ankyloglossia) are normal. Talk to your pediatrician if your baby is losing weight or not gaining weight and you suspect tongue tie is preventing effective feeding.
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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