What is tongue-tie, and does it need treatment?

Everyone has a frenulum, the fold of tissue joining the underside of the tongue to the floor of the mouth. In tongue-tie it is short or tight enough to limit how far the tongue can lift, stick out or move side to side. Signs include:

• A tongue tip that looks notched or heart-shaped when stuck out
• Difficulty lifting the tongue to the upper teeth or moving it side to side
• Trouble sticking the tongue out past the lower front teeth

Cleveland Clinic, citing the American Academy of Pediatrics, reports that anywhere from 1% to 11% of newborns have signs of tongue-tie, and it appears more common in boys. It often runs in families. Importantly, Cleveland Clinic notes it is diagnosed only when the frenulum is restrictive and the tongue's function is actually limited, not on appearance alone.

Feeding is where tongue-tie most often matters. The NHS lists these signs in babies:

• Trouble latching on or staying on the breast or bottle teat
• Long, frequent feeds
• Dribbling a lot during feeds, or clicking, coughing or choking sounds
• Taking only small amounts of milk
• Poor weight gain or weight loss

Breastfeeding parents may have sore or cracked nipples, painful swollen breasts or low milk supply. MedlinePlus notes that most breastfeeding problems can be managed with help from a lactation consultant, and that providers usually consider tongue-tie after difficulties persist despite 2-3 days of lactation support, because many other things can cause feeding problems. Cleveland Clinic also notes it rarely causes problems with bottle feeding.

The relationship between tongue-tie and speech is often overstated. Cleveland Clinic states that tongue-tie usually does not affect speech, and an NHS children's speech and language service adds that there is no evidence tongue-tie is related to delayed speech and language skills. The same service notes some children find certain sounds, such as "l," harder, and speech can be less clear when talking fast.

MedlinePlus notes that, rarely, tongue-tie has been linked to problems with tooth development, swallowing or speech, and the NHS notes it can make it hard to lift the tongue, move it side to side or stick it out. If speech is unclear, a speech and language therapist is the right first step, as many difficulties have other causes, including hearing problems.

Tongue-tie is usually picked up in infancy, but some adults only discover it later. Possible issues include:

• Difficulty keeping teeth and gums fully clean; Cleveland Clinic advises a dentist evaluation when tight frenula make cleaning hard
• Difficulty with some speech sounds, especially when talking quickly
• Limited ability to lift the tongue, move it side to side or stick it out (NHS)
• Difficulty sticking the tongue out to clean it

Be wary of online claims linking adult tongue-tie to a long list of unrelated problems. For example, Cleveland Clinic notes there is currently no evidence that tongue-tie causes sleep apnea. The NHS suggests adults who think they have tongue-tie speak to a GP, and dentists can assess whether it affects oral hygiene.

Treatment is only recommended when tongue-tie is causing a problem.

Complications are uncommon but include bleeding, infection, scarring, feeding aversion and, rarely, injury to the saliva ducts or reattachment. MedlinePlus notes surgery is rarely needed for breastfeeding problems once good lactation support is in place.

For a baby with feeding difficulties, talk to your pediatrician, midwife or a lactation consultant early rather than waiting. For a child with unclear speech, start with a speech and language assessment. For adults, a dentist or doctor can tell you whether the frenulum is genuinely restricting function. Be cautious of anyone offering a release for vague symptoms without first checking how the tongue actually moves.