Identifying a Tongue Tie in Your Child

Tongue tie may be hard to recognize. A child may look healthy, be gaining some weight, and still have feeding, speech, or oral challenges due to limited tongue movement. Recognizing tongue ties helps parents see patterns and know when it is time to seek professional help.

What Tongue Tie Is

Tongue tie, also known as ankyloglossia (click over here now), is present when the tissue band on the underside of the tongue is tight, thick, or short. It can limit how well the tongue lifts, stretches out to the front, cups back, or moves side-to-side.

Not every child who has a band of tissue under their tongue has a tongue tie. Tongue tie is about function. It is important to look at your child’s tongue not only in terms of appearance, but also what your child can and cannot do with their tongue.

Signs of Tongue Tie in Babies

In babies, signs of tongue tie can come up during feeding. Your child may want to feed frequently, but look tired, frustrated, or unsettled during feeds. Your child may take a long time to feed or may fall asleep quickly during the feeding.

baby showing feeding signs related to tongue tie

Other signs include:

• Difficulty latching or staying latched
• Clicking during the feeding
• Milk leaking from the mouth during feeds
• Coughing, choking, pulling away
• Long feedings, slow weight gain
• Gassiness, reflux-type symptoms, or irritability after feeds

Breastfeeding parents may also see pain or sore nipples, a flattened nipple after feeds, nipple cracking, or plugged milk ducts that come back repeatedly. It does not prove tongue tie, but it is still a helpful detail to share with a specialist.

Tongue Tie Symptoms in Toddlers and Older Kids

Some babies make up for tongue tie quite well. For them, the signs do not become apparent as eating and speech develop and become more complex. A child may have trouble moving food around their mouth, licking their lips, clearing food out from their teeth, and managing different foods with varying textures. Your child may take a long time to eat or may select some foods to avoid. The tongue can also play a role in speech, which is why a child may have speech delay or difficulties producing sounds that require the tongue to lift up or press to different spots in the mouth, such as “t,” “d,” “l,” “r,” “n,” “s,” or “th.” Keep in mind that speech difficulties and articulation disorders (there is a helpful breakdown at asha.org/public) can have many causes, and it cannot be assumed that a tongue tie is to blame without proper assessment.

“People see the function first,” says Jenna Morales, a pediatric feeding therapist. “If your child is feeding, eating, or speaking with unusual difficulty, it is worth investigating tongue mobility.”

Things You Can Look for as a Parent

You do not have to be a tongue tie expert to do your own checks at home, but you can watch for your child’s tongue movement and report your findings at your child’s appointment.

Notice how you think your child moves their tongue. Can your child:

parent checking child tongue movement for tongue tie signs

1. Lift their tongue up to their palate (roof of the mouth)?
2. Lift their tongue out over the lower lip?
3. Move their tongue side-to-side?
4. Lick around their lips?
5. Maintain a rounded tip of their tongue as opposed to a heart-shaped look?

A heart-shaped or notched tongue tip may be the result of a short, tight frenulum band pulling on the underside of your child’s tongue. Some children can move their tongue forward but may not be able to lift the back half of the tongue, which is often needed for feeding, but not always for speech.

Why Tongue Tie Is Overlooked

Some tongue ties can be seen near the front of the tongue, where the frenulum is longer and thicker, but there may be others that are located further behind the tongue, making them more difficult to detect visually. This is why paying attention to your child’s function may be very helpful. Your child may have a visible frenulum and not seem to have any major issues. Your child may not have a visible frenulum band to the naked eye, but may struggle with feeding, eating, or speech. A full evaluation would help to determine the extent of the condition.

When to See a ProfessionalBefore learning how to spot tongue tie in your child, it’s important to know that an evaluation may involve different healthcare professionals depending on your child’s symptoms and age. This could include a pediatrician, lactation consultant, speech-language pathologist, pediatric dentist, ENT, or feeding therapist. Depending on the severity, the child may be offered feeding support, oral-motor or speech therapy, monitoring, or, in some cases, a tongue tie release. The decision ultimately comes down to the child’s feeding, speech, and eating symptoms, as well as their ability to feed, eat, and speak.Pay Attention to the Patterns

To find tongue tie in your child, you should look at the whole picture over time. Feedings, speech, and eating issues that occur in combination with tongue tie, or that occur repeatedly, are signs of concern and worth a discussion. Keep notes of your child’s feeding, eating, or speech history, when it occurs, and frequency, so you can better explain your concerns to a professional and get help sooner.