Tongue tie when to intervene?

What is it?

The lingual frenulum is a fold of tissue that attaches the ventral surface of the tongue to the floor of the mouth.

. Ankyloglossia, or tongue-tie, occurs when the frenulum is unusually anterior, thick, tight, or short, resulting in limitation of the tongue’s mobility


What are the symptoms?

Subjective complaints reported by breastfeeding mothers of children with restrictive tongue-tie include issues with latching, longer feeding sessions, poor breast drainage, and nipple pain. The mother may have damage from compression of the nipple, including ulceration and associated mastitis, and the child may have poor weight gain

What to note?


On physical examination, it is important to look for any restricted tongue movements, inability of the child to protrude the tongue, and a thickened short frenulum (Fig 1). The ABM emphasizes the importance of a detailed breastfeeding assessment that includes observation of feeding.

Learning point

The bottom line here is that the 3% to 4% of children born with a tight anterior frenulum do not all need surgical intervention.

The decision to cut the “tied tongue” should be based not on its appearance but on whether it significantly interferes with function: either feeding or speech articulation.

And even when an infant has difficulty breastfeeding, or an older child has problems with articulation, measures more conservative than frenotomy should also be proposed: lactation support and speech therapy may well obviate the need for cutting.



About Dr. Jayaprakash

Asst. Prof. of Pediatrics, ICH. Institute of Child Health. Gov. Medical College Kottayam. Kerala, India.

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