Tongue Tie (Ankyloglossia)

A congenital condition where the lingual frenulum is abnormally short, tethering the tongue tip to the floor of the mouth/alveolar process and restricting tongue mobility to a variable degree. Boys affected 2:1. See also infant feeding & speech pathology.

History — assess for significant tongue tie

• Mother: nipple pain/trauma; misshapen or flattened nipple after feeds; ineffective milk transfer (→ low supply, recurrent blocked ducts, mastitis).
• Baby: difficulty achieving/maintaining latch; clicking or loss of suction, noisy feeding, poor suck-swallow-breathe coordination; aerophagia or colic/wind/reflux-like symptoms from a poor mouth seal; breast refusal; gagging during feeds.

Examination

Assess for poor weight gain (see failure to thrive). Examine the mouth: palate (length, uvula, midline lift); tongue (extension beyond the lips, elevation — tip may be notched/heart-shaped); suck strength and tongue function (gloved finger in the mouth). Observe a feed directly.

Management

• Tongue tie present but breastfeeding unaffected → no frenotomy needed. Reassure that many tongue ties are asymptomatic and don’t need referral.
• Poor weight gain → refer for paediatric review/failure-to-thrive workup.
• Feeding problems present → conservative measures first: paediatric speech pathology review, lactation consultant support.
• If breastfeeding problems are confirmed and persist despite the above → refer to a tongue-tie release provider (public option: surgical clinic at JHH, or the local equivalent).