When a small fold restricts a lot.
Tongue-tie and lip-tie are surprisingly common and surprisingly under-diagnosed. The fix is quick. The downstream improvement in feeding, speech, sleep, and breathing is usually substantial.
Key points
Infants
A tongue-tie or lip-tie can prevent a proper latch, prolong feeds, and cause sore nipples for the nursing parent.
Older kids
Restricted tongue movement can affect speech development, eating certain textures, and even posture of the mouth at rest.
Frenectomy
A quick in-office procedure that releases the restrictive tissue. Healing takes a couple of weeks with simple exercises.
Details
What this is
A frenum is a small fold of tissue connecting one part of the mouth to another. The lingual frenum runs from the underside of the tongue to the floor of the mouth. The labial frenum runs from the inside of the upper or lower lip to the gum. Most are normal and unremarkable. Some are thick or short enough to restrict movement, and that is when we call it a tongue-tie (ankyloglossia) or lip-tie.
The effect of a restrictive frenum depends on the age. In infants, it shows up as a feeding problem: the baby cannot get a good seal, feeds take forever, weight gain is slow, and the parent is in pain. In toddlers and older children, it shows up as speech difficulty, picky eating with certain textures, or a persistent gap between the upper front teeth from a thick labial frenum.
Restrictive tongue posture also has long-term effects on the shape of the mouth and the airway. The tongue is supposed to rest against the roof of the mouth most of the time. When it cannot, the upper palate may narrow during growth, which contributes to mouth breathing and disordered sleep.
Signs of tongue-tie or lip-tie
- Infant feeding difficulty: poor latch, clicking sounds, prolonged feeds, slow weight gain, sore or cracked nipples for the nursing parent.
- A heart-shaped or rounded tongue tip when the child sticks the tongue out.
- A child who cannot lift the tongue to touch the upper lip.
- A child who cannot move the tongue side-to-side easily, or sweep it across the teeth.
- Speech difficulty with sounds that require tongue elevation: L, R, T, D, N, S, Z, TH.
- A persistent gap between the upper front teeth caused by a thick labial frenum running between them.
- Mouth breathing, snoring, or disrupted sleep that does not improve with allergy or ENT treatment.
What we do
- A careful assessment to determine whether the frenum is genuinely restrictive (not every short frenum needs release).
- Coordination with lactation consultants, speech-language pathologists, or ENTs when relevant.
- Frenectomy in-office with appropriate anesthesia for the age (topical numbing for infants, local for older kids).
- Tongue exercises to teach during healing to prevent the tissue from reattaching.
- Follow-up at one to two weeks to confirm healing is on track.
Common questions
How do I know if my newborn has a tongue-tie?+
A pediatric exam, a lactation consultant consultation, or both will identify it. Signs to share with us: feeding takes more than 30 to 45 minutes, the baby falls asleep mid-feed without finishing, weight gain is on the low side, you hear clicking during feeds, or your nipples are sore in a way that does not match a normal newborn adjustment. We will do the assessment in the office.
Will my child outgrow it?+
Some short frenums stretch with age and do not need release. Others remain restrictive forever. We assess function (what the tongue can actually do) rather than appearance to decide. If the frenum is causing real-world problems with feeding, speech, sleep, or growth, releasing it is usually the better path than waiting.
Is the procedure painful?+
For infants, the procedure takes a couple of minutes with topical numbing; most babies are nursing again within 10 minutes. For older kids, local anesthesia handles it. There is mild discomfort for a day or two afterward, easily managed with age-appropriate pain relief.
How long is the recovery?+
Soft tissue heals in two to three weeks. The exercises we send you home with are critical: they keep the tissue from reattaching in the wrong position. We see you back at one to two weeks to make sure healing is going well.
Related
If you suspect a tongue-tie or lip-tie, start with a consultation. Not every short frenum needs to be released; the decision is based on whether it is actually restricting function.