7 Key Signs and Symptoms of Tongue-Tie (Ankyloglossia) in Babies and Adults

Tongue-tie, medically known as ankyloglossia, is a congenital condition where an unusually short, thick, or tight band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth. This restriction can interfere with tongue movement and may affect breastfeeding in infants, as well as eating, speaking, and oral hygiene in older children and adults. While some cases of tongue tie are mild and cause no problems, others can lead to significant functional difficulties.

Understanding the symptoms of tongue-tie is crucial for early identification and appropriate management. The condition affects approximately 4-11% of newborns and can vary greatly in severity. Parents, caregivers, and healthcare providers should be aware of the key signs that may indicate a baby or individual has ankyloglossia. This article explores the seven most common symptoms of tongue-tie to help you recognize this condition.

1. Limited Tongue Movement and Restricted Range of Motion

One of the most obvious symptoms of tongue-tie is the inability to move the tongue freely. The restricted lingual frenulum prevents the tongue from extending beyond the lower gum line or touching the roof of the mouth. When a tongue tied baby tries to stick out their tongue, it may appear heart-shaped or notched at the tip due to the frenulum pulling the center of the tongue down.

In older children and adults with tongue tie, this limitation becomes more apparent during specific movements:

• Difficulty touching the tongue to the upper teeth or roof of the mouth
• Inability to stick the tongue out past the lower lip or teeth
• Trouble moving the tongue from side to side
• The tongue tip may appear flat or square instead of pointed when extended
• A characteristic heart or V-shape at the tongue tip when protruded

This restricted mobility can impact various oral functions and is often the first sign that prompts further evaluation for ankyloglossia.

2. Breastfeeding Difficulties in Infants

For tongue tied babies, breastfeeding problems are among the most common and distressing symptoms. The infant’s inability to properly latch and create adequate suction can lead to a frustrating feeding experience for both mother and baby. A proper latch requires the baby to extend their tongue over the lower gum to draw the nipple into the mouth effectively.

Common breastfeeding symptoms associated with baby tongue tie include:

• Poor latch: The baby cannot maintain a deep, secure attachment to the breast
• Slipping off the nipple: Frequent loss of suction during feeding
• Extended feeding times: Nursing sessions that last excessively long without the baby seeming satisfied
• Clicking or smacking sounds: Audible noises during feeding indicating loss of suction
• Inadequate weight gain: The baby may not gain weight appropriately due to inefficient milk transfer
• Frequent feeding: The baby wants to nurse constantly because they’re not getting enough milk
• Gumming or chewing: The baby may chew on the nipple rather than using proper sucking motions

These breastfeeding challenges often lead to maternal symptoms as well, including nipple pain, damage, and decreased milk supply due to inadequate breast stimulation.

3. Maternal Pain and Nipple Damage

While this symptom affects the mother rather than the tongue tied baby directly, it’s an important indicator of ankyloglossia. When a baby cannot extend their tongue properly, they may compensate by using their jaw and gums to compress the nipple, resulting in significant maternal discomfort.

Mothers of tongue tied babies often experience:

• Severe nipple pain: Pain that persists throughout the feeding, not just at the initial latch
• Nipple trauma: Cracked, bleeding, or misshapen nipples
• Flattened or creased nipples: The nipple appears compressed or has a lipstick-like shape after feeding
• White or blanched nipples: Reduced blood flow due to compression
• Mastitis or blocked ducts: Incomplete breast drainage can lead to inflammation or infection
• Decreased milk supply: Ineffective milk removal can signal the body to produce less milk

While some nipple discomfort is common in early breastfeeding, persistent severe pain and damage beyond the first few weeks often indicates an underlying problem such as tongue tie.

4. Speech and Articulation Problems

As children with tongue tie grow older, speech difficulties may emerge as a prominent symptom. The tongue’s restricted mobility can interfere with the articulation of certain sounds that require the tongue to touch specific parts of the mouth. However, it’s important to note that not all individuals with ankyloglossia will experience speech problems, and the severity varies widely.

Common speech-related symptoms include:

• Difficulty with specific sounds: Particular trouble with sounds that require tongue elevation, such as “t,” “d,” “z,” “s,” “th,” “n,” and “l”
• Lisping: A frontal lisp where “s” and “z” sounds are pronounced with the tongue between the teeth
• Unclear speech: Overall articulation may be imprecise or difficult for others to understand
• Compensatory speech patterns: The child may develop alternative ways of producing sounds that are less efficient
• Speech delay: In some cases, tongue tie may contribute to delayed speech development
• Rapid speech fatigue: The extra effort required for articulation may cause the speaker to tire quickly

Speech difficulties typically become noticeable between ages 2-4 years when language development is rapidly progressing. A speech-language pathologist can assess whether tongue-tie is contributing to articulation problems.

5. Feeding and Eating Challenges Beyond Infancy

What is tongue tie’s impact on eating as children grow? Beyond breastfeeding difficulties in infancy, tongue-tie can continue to affect eating and swallowing throughout childhood and into adulthood. The limited tongue mobility can make certain eating tasks challenging and may influence food preferences.

Eating-related symptoms of tongue tie include:

• Difficulty with solid foods: Problems moving food around the mouth for chewing
• Messy eating: Food may fall out of the mouth or remain on the lips
• Slow eating pace: Meals may take considerably longer than peers
• Gagging or choking: Difficulty manipulating food to the back of the mouth for swallowing
• Food pocketing: Food becoming stuck between the teeth and cheeks
• Preference for soft foods: Avoiding foods that require extensive chewing or tongue manipulation
• Difficulty licking: Unable to lick ice cream cones, lollipops, or lips effectively
• Swallowing problems: Inefficient swallowing patterns that may persist into adulthood

These challenges can impact nutrition, social situations involving eating, and overall quality of life.

6. Dental and Orthodontic Issues

The restricted tongue movement associated with ankyloglossia can contribute to various dental and orthodontic problems over time. The tongue plays a crucial role in oral development, helping to shape the palate and guide tooth positioning. When tongue mobility is limited, normal oral development may be affected.

Dental symptoms and complications may include:

• Gap between lower front teeth: The tight frenulum may create or maintain a space between the lower incisors
• Poor oral hygiene: Difficulty sweeping the tongue across teeth to clean them naturally
• Increased tooth decay: Food debris and bacteria may accumulate more easily
• Gum recession: The frenulum tension can pull on the gum tissue
• High or narrow palate: The tongue’s restricted position may not provide normal palatal stimulation during development
• Malocclusion: Improper bite alignment, including open bite or crossbite
• Lower jaw positioning: The jaw may develop differently due to altered tongue posture

Regular dental check-ups are important for individuals with tongue tie to monitor and address these potential complications.

7. Social and Mechanical Difficulties

Beyond the functional impairments, tongue-tie can cause various social and mechanical difficulties that affect daily life and self-esteem. These symptoms are often overlooked but can significantly impact an individual’s comfort and confidence.

Additional symptoms and challenges include:

• Difficulty kissing: The limited tongue extension can affect intimate relationships
• Problems playing wind instruments: Musical pursuits requiring tongue control may be challenging
• Inability to lick envelopes or stamps: Simple tasks requiring tongue extension become difficult
• Trouble cleaning teeth with the tongue: Natural oral cleansing is impaired
• Choking hazard awareness: Increased anxiety about eating certain foods
• Self-consciousness: Embarrassment about eating in public or speaking
• Mouth breathing: The tongue’s low, forward posture may contribute to breathing through the mouth
• Sleep disturbances: In some cases, tongue position may contribute to sleep-related breathing issues

These quality-of-life issues can have psychological impacts and may motivate older children or adults to seek evaluation and potential intervention for their tongue-tie.

Main Causes of Tongue-Tie

Understanding what causes tongue-tie helps explain why this condition occurs and who may be at higher risk. Ankyloglossia is a congenital condition, meaning it’s present at birth, though it may not be diagnosed until later when symptoms become apparent.

Genetic Factors: Tongue-tie tends to run in families, suggesting a strong hereditary component. If one parent had tongue-tie, there’s an increased likelihood that their children may also be affected. Some studies indicate that males are 2-3 times more likely to have tongue-tie than females, though the exact genetic mechanisms remain under investigation.

Developmental Factors: During fetal development, the lingual frenulum is supposed to recede and thin out before birth, allowing the tongue to move freely. In tongue-tied babies, this developmental process is incomplete, resulting in the frenulum remaining thick, short, or attached too far forward on the tongue or too close to the tongue tip.

Unknown Factors: In many cases, there’s no clear explanation for why some babies develop tongue-tie while others don’t. The condition appears to occur randomly in families with no previous history. Environmental factors during pregnancy have not been definitively linked to tongue-tie development.

Associated Conditions: While tongue-tie most commonly occurs as an isolated finding, it may occasionally be associated with certain genetic syndromes or craniofacial conditions. However, in the vast majority of cases, ankyloglossia occurs independently without other abnormalities.

It’s important to note that tongue-tie is not caused by anything the mother did or didn’t do during pregnancy. It’s simply a variation in normal anatomical development that occurs during fetal growth.

Prevention

Unfortunately, there are currently no known methods to prevent tongue-tie, as it is a congenital anatomical variation that develops during fetal growth. The condition cannot be prevented through dietary measures, prenatal vitamins, or maternal behaviors during pregnancy.

However, early recognition and management can prevent complications:

Prenatal Awareness: While tongue-tie itself cannot be prevented, families with a history of ankyloglossia should inform their healthcare providers. This awareness allows medical professionals to examine newborns carefully for signs of tongue-tie shortly after birth.

Early Screening: Routine examination of newborns’ oral anatomy can identify tongue-tie before feeding difficulties become established. Many hospitals now include tongue-tie assessment as part of standard newborn examinations, particularly if breastfeeding problems arise.

Prompt Evaluation: When breastfeeding difficulties occur, seeking evaluation from a lactation consultant or healthcare provider experienced in identifying tongue-tie can lead to earlier diagnosis and management, potentially preventing the cascade of feeding problems, poor weight gain, and maternal complications.

Family Planning: Families with a known history of tongue-tie can inform their pediatrician or midwife before delivery, ensuring that the baby is carefully examined and that support is available if feeding difficulties emerge.

While prevention isn’t possible, awareness and early detection can minimize the impact of tongue-tie on infant feeding, growth, and development.

Frequently Asked Questions

How can I tell if my baby has a tongue tie?

Common signs include difficulty breastfeeding, a heart-shaped tongue tip when the baby cries, inability to stick the tongue out past the lower gum, clicking sounds during feeding, and poor weight gain. If you suspect tongue-tie, have your baby evaluated by a pediatrician or lactation consultant.

What does a normal tongue tie look like?

There’s no such thing as a “normal” tongue-tie—it’s either present or not. However, there is a normal range for the lingual frenulum in babies without tongue-tie: it should be thin, flexible, and attached toward the back underside of the tongue, allowing free tongue movement. In tongue-tie, the frenulum is too short, thick, or attached too far forward.

Can tongue-tie resolve on its own?

In some cases, mild tongue-tie may improve as a child grows and the mouth develops. However, significant tongue-tie typically does not resolve without intervention. The frenulum doesn’t usually stretch or detach on its own sufficiently to eliminate functional problems.

Does tongue-tie always cause problems?

No. Some individuals with tongue-tie experience no significant difficulties with feeding, speech, or oral function. The severity of symptoms depends on the degree of restriction and individual anatomy. Not everyone with ankyloglossia requires treatment.

Can tongue-tie affect bottle feeding?

Yes, tongue tied babies may also have difficulty with bottle feeding, though it’s often less problematic than breastfeeding. Symptoms may include long feeding times, excessive air swallowing, milk leaking from the mouth, and fussiness during feeds.

At what age do speech problems from tongue-tie become apparent?

Speech difficulties related to tongue-tie typically become noticeable between ages 2-4 years when children are developing more complex speech sounds. However, not all children with tongue-tie will have speech problems, and speech therapy may help in some cases.

Is tongue-tie painful for babies?

The tongue-tie itself is not painful for the baby. However, the feeding difficulties it causes may lead to frustration and hunger. Some babies may develop jaw tension or fatigue from the extra effort required to feed.

Can adults have tongue-tie?

Yes, adults can have tongue-tie, either because it was never diagnosed in childhood or because it didn’t cause significant problems until later. Adult symptoms may include speech difficulties, eating challenges, dental problems, or social discomfort.

Will my other children have tongue-tie if one child has it?

Tongue-tie has a genetic component, so there is an increased risk for siblings. However, it doesn’t mean all children in the family will be affected. Each pregnancy is independent, though awareness of family history helps with early detection.

Can tongue-tie cause reflux or colic?

While tongue-tie itself doesn’t directly cause reflux or colic, the feeding difficulties associated with it may lead to excessive air swallowing, incomplete feeding, and fussiness that can mimic these conditions. Proper evaluation can help distinguish between tongue-tie-related feeding issues and true reflux or colic.

References:

• Mayo Clinic – Tongue-tie (ankyloglossia)
• National Center for Biotechnology Information – Ankyloglossia
• American Academy of Pediatrics – Tongue-Tie and Breastfeeding
• NHS – Tongue-tie
• KidsHealth – Tongue-Tie