Congenital Tongue-tie and Its Impact on Breastfeeding

Elizabeth Coryllos, MD, MSs, FAAP, FACS, FRCSc, IBCLC
Catherine Watson Genna, BS, IBCLC
Alexander C. Salloum, MD, MA

Newsletter of the American Academy of Pediatrics – Summer 2004


Many of today’s practicing physicians were taught that treatment of tongue-tie, (ankyloglossia) is an outdated concept – a relic of times past. Among breastfeeding specialists tongue-tie has emerged as a recognized cause of breastfeeding difficulties – and a very easily corrected one.
During the last several decades of predominant bottle-feeding, tongue-tie was relegated to the status of a “non-problem” because of the lack of significant impact upon bottle feeding behaviors.
The goal of this article is to alert pediatricians to the potential link between tongue-tie and breastfeeding problems in order to expedite intervention in symptomatic cases.

Background Information

Tongue-tie (ankyloglossia, tight frenulum) is a condition in which the bottom of the tongue is tethered to the floor of the mouth by a membrane (frenulum) so that the tongue’s range of motion is unduly restricted. This may result in various oral development, feeding, speech, swallowing, and associated problems. Genetic factors are suspected, as tongue-tie is frequently familial.
Tongue-ties can be divided into four types, according to how close to the tip of the tongue the leading edge of the frenulum is attached:

Type 1 is the attachment of the frenulum to the tip of the tongue, usually in front of the alveolar ridge in the lower lip sulcus.

Type 2 is two to four mm behind the tongue tip and attaches on or just behind the alveolar ridge.

Type 3 tongue-tie is the attachment to the mid-tongue and themiddle of the floor of the mouth and is usually tighter and less elastic.

Type 4 is essentially against the base of the tongue, and is thick, shiny and very inelastic.

Types 1 and 2, considered “classical” tongue-tie, are the most common and obvious tongue-ties, and probably account for 75% of incidence. Types 3 and 4 are less common, and since they are more difficult to visualize are the most likely to go untreated.
Type 4 is most likely to cause difficulty with bolus handling and swallowing, resulting in more significant symptoms for mother and infant (see section on Diagnostic Assessment).