Tongue-tie is a condition in which the free movement of the tongue is restricted due to abnormal attachment of lingual frenulum towards the tip of the tongue. The frenulum may be too short and taut, or it may be attached too far along the base of the tongue. Tongue tie can cause feeding problems in infants, and may cause speech impairments as a child learns to speak. In many cases tongue tie diminishes on its own, however, and surgery is often unnecessary. Please see Tongue-Tie (Ankyloglossia) for more information on tongue tie.
In years past, midwives were reported to have kept a sharp fingernail in order to slash the membranes under the tongues of all newborn babies. "Snipping of tongues" was routinely performed in order to prevent lisping and speech impediments, according to the medics of centuries past.
Tongue tie often resolves on its own after two or three years of age, however. As a child grows and develops, the frenulum often continues to recede (normally it recedes before birth), lessening the abnormality. Unless feeding is a problem, we usually recommend waiting at least a year before considering surgery.
If tongue tie interferes with a baby’s feeding, feeding difficulties may include problems breastfeeding and sucking, poor weight gain for the baby, and poor milk supply for the mother. In such cases, early intervention is usually warranted.
In toddlers, an experienced speech pathologist should evaluate your child to determine whether tongue tie may be hindering language development. If the speech pathologist finds that your child’s speech is impaired, then frenulectomy is usually recommended. If there is no speech impediment, you may wish to consider surgery for cosmetic reasons.
At the Pediatric Division of the Department of Otolaryngology at Columbia Presbyterian, our team of speech pathologists and pediatric otolaryngologists carefully evaluate infants and children with tongue tie to assess the necessity of surgery. We may recommend speech therapy as a first step, as some toddlers will improve their speech without needing surgery.
Overall, the procedure of cutting the lingual frenulum is relatively simple, and babies may breastfeed immediately afterwards. The surgery may even be done in the office in children less than 3 months of age. Risks of frenulectomy are very low but may include pain, bleeding, or infection.
For children who do require frenulectomy, we use a brief general anesthesia, and cautery to divide the frenulum. A few dissolvable stitches may be placed to re-approximate the mucous membrane of the tongue. The whole procedure takes approximately 15 minutes.