What Does Tongue-Tie Look Like?
Tongue-tie, or ankyloglossia, occurs when the small piece of tissue under the tongue (called the lingual frenulum) is unusually short, thick, or attached close to the tip of the tongue. This can limit how freely the tongue moves.
Most babies with tongue-tie do not need treatment.
However, if the tongue’s movement is restricted enough to interfere significantly with breastfeeding despite skilled lactation support and other strategies, a doctor may recommend a frenotomy. During this quick procedure, the frenulum is released to allow the tongue greater freedom of movement.
Is Tongue-Tie Becoming Over Diagnosed?
There is increasing concern that it may be.
In 2024, the American Academy of Pediatrics (AAP) released a clinical report because of the dramatic increase in tongue-tie diagnoses and frenotomy procedures.
The AAP concluded that:
- tongue-tie is being diagnosed more often
- many infants may be undergoing procedures unnecessarily
- breastfeeding difficulties should first receive a thorough assessment
- a frenotomy should generally be reserved for babies with persistent, significant breastfeeding problems after conservative approaches have been tried
Why Are More Babies Being Diagnosed with Tongue-Tie?
No one knows for certain.
Researchers have suggested several possible reasons, including increased awareness of breastfeeding difficulties, greater public discussion of tongue-tie, broader definitions of what constitutes a tongue-tie, and the lack of a universally accepted method of diagnosing it.
One thing most researchers agree on is that diagnosing tongue-tie is not always straightforward. Two experienced clinicians may not always reach the same conclusion when examining the same baby.
During my career, parents occasionally brought babies to me after being told they had a tongue-tie. In some cases, I wasn’t convinced, so we sought additional opinions from other speech-language pathologists. Sometimes none of us felt the baby had a tongue-tie severe enough to explain the feeding concerns.
That experience taught me that diagnosing tongue-tie is not always as clear-cut as parents might expect.
It’s also important to remember that breastfeeding is a complex skill involving both the baby and the mother. Positioning, latch, milk supply, infant coordination, and many other factors can all affect nursing success.
Tongue-tie can certainly contribute to breastfeeding difficulties for some babies, but most infants with feeding problems do not have tongue-tie, and not every infant with tongue-tie has feeding problems.
Does Tongue-Tie Affect Speech?
This is where the research becomes especially interesting.
Despite the attention tongue-tie receives online, the evidence linking tongue-tie to later speech disorders is surprisingly weak. Current research does not support the idea that most tongue-tied children will develop articulation problems or require a frenotomy to prevent future speech difficulties.
Why?
Because producing English speech sounds does not usually require the tongue to stick very far out of the mouth.
Most English consonants require:
- tongue elevation
- slight forward movement
- shaping of the tongue
- lateral bracing against the teeth
Very few speech sounds require significant tongue protrusion.
Children are also remarkably good at making tiny adjustments in tongue position to produce clear speech.
Research has described many examples of:
- adults with obvious tongue-ties and perfectly normal speech
- children with significant tongue-ties who have no articulation problems
- children with speech sound disorders whose tongue movement is completely normal
In other words, the appearance of the frenulum does not necessarily predict how well the tongue functions for speech.
If your child is already talking and you’re wondering whether a tongue-tie is affecting their speech, the most important question isn’t what the tongue looks like—it’s how well it functions. A speech-language pathologist evaluates whether a child can actually produce speech sounds clearly, not simply whether the frenulum appears short.
Something You Can Do Today
If your baby is having difficulty breastfeeding, I completely understand wanting to try anything that might help.
Before deciding on a frenotomy, make sure you’ve had a thorough breastfeeding assessment and have tried other recommended strategies.
In my experience, some babies who were initially referred for a frenotomy went on to breastfeed successfully over the following weeks without needing the procedure.
Every baby is different, but my advice would be to think of a frenotomy as one possible option when breastfeeding difficulties persist—not necessarily the first solution.
A Thought from Cheryl
One of the things I learned over more than 40 years as a speech-language pathologist is that healthcare is always evolving.
As new research emerges, clinicians often become more aware of certain conditions, and diagnoses may increase. Over time, additional research helps us better understand which children truly benefit from particular treatments.
That’s why I always encourage parents to ask questions, seek reliable information, and, if necessary, obtain a second opinion before deciding on any procedure for their baby.
The Bottom Line
In more than 40 years as a speech-language pathologist, I never personally met a child whose tongue-tie alone prevented them from producing all of the speech sounds used in English.
That experience is consistent with the current research, which has not shown that tongue-tie is a common cause of speech sound disorders.
If you and your healthcare team decide that a frenotomy is the right choice because your baby is continuing to struggle with breastfeeding despite other interventions, it may well improve feeding.
However, based on the current evidence, it should not be performed simply because of concerns about future speech development.