Two babies can have almost identical-looking bands of tissue under the tongue, and one may feed without a hitch while the other struggles. That is the central fact about tongue-tie. Its presence tells you very little on its own, and what matters is how well the tongue works for that particular baby.
Tongue-tie, or ankyloglossia, describes a lingual frenulum (the fold of tissue joining the underside of the tongue to the floor of the mouth) that is short, tight or attached near the tip. Studies report it in somewhere around 4 to 11 percent of newborns, and the range is wide because there is no single agreed definition. Boys are affected more often than girls, and it can run in families.
Ties vary in thickness, length and position
Some frenula are thin and translucent and attach close to the tongue tip. When a baby with this type cries or tries to poke the tongue out, the tip may look notched or heart-shaped. Others are thicker and sit further back. A few are hard to see at all and can only be felt.
The term "posterior tongue-tie" is used for ties that sit further back under the tongue. It is a contested idea. The Australian Dental Association's 2020 consensus statement says the term should not be used as a diagnosis and can lead to normal frena being labelled abnormal, so it deserves a careful second opinion. The same caution applies to "lip-tie", the band between the upper lip and the gum. That band is present in almost all babies, and the Australian Dental Association's policy statement on ankyloglossia and oral frena notes insufficient evidence to support releasing it in infants for feeding, speech or tooth spacing.
Function is judged by watching the tongue move
A useful assessment looks beyond the frenulum. A clinician checks how far the tongue can lift towards the roof of the mouth with the mouth open, how far it can extend over the lower gum, whether it can move side to side, and whether it cups around a finger when the baby sucks. Recognised assessment tools score both how the tie looks and how the tongue functions. The Australian Dental Association's policy and its 2020 consensus statement say diagnosis should not rest on appearance alone and should include a functional assessment and a case history.
For a breastfed baby, the most informative part is usually watching a feed. A lactation consultant or experienced midwife or child and family health nurse can see how the baby attaches, whether the latch holds, and how the feeding parent is coping. Our article on breastfeeding and dental care covers related questions about feeding and the mouth.
Many ties never cause a problem
Many breastfed babies with a tongue-tie feed without difficulty, and they need nothing done. For babies who do have trouble latching, or whose feeding parent has ongoing nipple pain, adjustments to positioning and attachment with skilled help are the first step and often solve the problem. If a tie seems to be part of a feeding problem that continues despite good feeding support, next steps are discussed with the family and their GP or a relevant specialist. Our separate guide on tongue-tie and feeding goes into feeding support in more detail.
As your child grows
Australian dental guidance notes that there is no good evidence that tongue-tie causes speech articulation problems, and treating a tie in infancy to prevent possible future problems is not supported. A small number of older children have trouble licking the lips or clearing food from around the teeth, or have difficulty with particular sounds. If speech is a concern, a speech pathologist can assess whether tongue movement is really the cause, since speech difficulties have many sources. Early dental visits, described in our first dental visit guide, are a good chance to ask about the tongue and how it is moving.
What parents ask
Can a tongue-tie be seen at birth?
Often, yes, as part of the newborn check. Seeing one is a reason to keep an eye on feeding, not a reason for treatment by itself.
Does a heart-shaped tongue tip mean treatment is needed?
No. The notch shows where the frenulum attaches. What matters is whether feeding is affected.
Does tongue-tie affect bottle feeding?
It can. Dribbling, long feeds or poor seal around the teat are worth having assessed.
Having your child's mouth checked
If you have questions about your baby's tongue, our dentists and OHTs can examine the mouth, screen for tongue-tie and help you find the right feeding support. Read about children's dentistry at Lumi Dental, or see the current deals page to book. Asking early about feeding worries is always reasonable.
