Learn About Tongue Tie
Tongue tie is when the bottom of the tongue is attached to the floor of the mouth.
This may make it hard for the tip of the tongue to move freely.
Ankyloglossia
The tongue is connected to the bottom of the mouth by a band of tissue called the lingual frenulum. In people with tongue tie, this band is overly short and thick. The exact cause of tongue tie is not known. Your genes may play a role. The problem tends to run in some families.
In a newborn or infant, the symptoms of tongue tie are similar to the symptoms in a child who is having problems with breastfeeding. Symptoms may include:
- Acting irritable or fussy, even after feeding.
- Difficulty creating or keeping suction on the nipple. The infant may become tired in 1 or 2 minutes, or fall asleep before eating enough.
- Poor weight gain or weight loss.
- Problems latching onto the nipple. The infant may just chew on the nipple instead.
- There may be speech and pronunciation difficulties in older children.
The breastfeeding mother may have problems with breast pain, plugged milk ducts, or painful breasts, and may feel frustrated.
Most breastfeeding problems can be managed easily. A person who specializes in breastfeeding (lactation consultant) can help with breastfeeding issues.
Tongue tie surgery, called a frenulotomy, is rarely needed. The surgery involves cutting and releasing the tethered frenulum under the tongue. It is most often done in the surgeon's office. Infection or bleeding afterward is possible, but rare.
Surgery for more severe cases or for older children is done in a hospital operating room. A surgical procedure called a z-plasty closure may be needed to prevent scar tissue from forming.
Johns Hopkins Outpatient Center
"Pediatric otolaryngologist Jonathan Walsh specializes in head and neck masses, thyroid disorders, vascular malformations, tracheostomy, tracheal stenosis, aerodigestive disorders, chronic ear disease (ear infections), sinus disease (sinusitis), hearing loss, ankyloglossia (tongue-tie), sleep apnea and laryngeal cleft, as well as the full spectrum of pediatric head and neck disorders. He offers minimally invasive endoscopic ear surgery and minimally invasive surgeries of the airway, ear and sinus. Dr. Walsh earned a medical degree from Virginia Commonwealth University School of Medicine and completed residency training in otolaryngology at University of Rochester Medical Center. He served two years of active-duty service as a major in the U.S. Army at Fort Gordon in Georgia, after which he completed fellowship training in pediatric otolaryngology at the University of North Carolina. His research interests are in novel imaging technology applications for head and neck disorders; outcomes and health care disparities; ankyloglossia and lip tie; head and neck masses; and airway imaging and modeling. Dr. Walsh is director of the Johns Hopkins pediatric aerodigestive team and surgical director of the pediatric thyroid team. Additionally, he is an active participant in the vascular anomalies team, fetal therapy multidisciplinary team and pediatric sarcoma tumor board. Dr. Walsh is also the residency program director for the Department of Otolaryngology-Head and Neck Surgery. Videos Meet Our Expert - Dr. Jonathan Walsh Recent News Articles and Media Coverage More babies getting their tongues clipped to help breastfeed. But is it necessary? Today Show (7/11/2019) To Improve Breastfeeding, Babies Get Their Tongues Clipped, Is it Necessary? Podast WYPR (3/19/2019) Snipping an infant's ""tongue tie"" can improve breastfeeding. But is surgery being overused? The Inquirer (3/12/2019) Why so Many Babies are Getting Their Tongues Clipped Atlantic, (3/12/2019) The Tongue Tie Conundrum, Slate (2/6/2018) An Incisionless Approach to Ear Drum Repair, Johns Hopkins Medicine (10/2/2018)". Dr. Walsh is rated as an Elite provider by MediFind in the treatment of Tongue Tie. His top areas of expertise are Tongue Tie, Infant Hearing Loss, Laryngomalacia, Adenoidectomy, and Endoscopy.
Advanced ENT & Allergy
Ryan Walker is a Pediatric Otolaryngologist provider in Voorhees Township, New Jersey. Dr. Walker is rated as a Distinguished provider by MediFind in the treatment of Tongue Tie. His top areas of expertise are Tongue Tie, Laryngeal Cleft, Enlarged Adenoids, and Auditory Neuropathy Spectrum Disorder.
Proliance Surgeons
Adrienne Laury, MD, is a board-certified otolaryngologist who manages a wide range of adult and pediatric disorders of the ear, nose and throat. She is also a fellow of the American Academy of Otolaryngic Allergy and treats patients with environmental and food allergies. Dr. Laury has a particular interest and significant research experience in the medical and surgical management of sleep disorders, sinonasal diseases, as well as sinus/barometric pressure headaches.Dr. Laury originally grew up in Allentown, Pennsylvania. She attended Villanova University where she graduated summa cum laude. She received her medical degree from the University of Pennsylvania Perelman School of Medicine and then completed her residency training at Emory University in Atlanta, Georgia. Dr. Laury then served as an Otolaryngologist in the United States Air Force for four years. While stationed in San Antonio, Texas, Maj. Laury was an Assistant Professor of Otolaryngology and instructed numerous residents and medical students. She also served a tour in Afghanistan where she managed facial trauma injuries for deployed American troops.Dr. Laury has received numerous distinctions in teaching and brings that excellence in education to her patients. She is also a nationally recognized lecturer on allergy and sinus headache. Additionally, her extensive research endeavors have enabled her to utilize the most current techniques to care for her patients.Dr. Laury is married and has two young boys and a baby girl. Her husband, originally from Germany, works in software development for Amazon. Dr. Laury enjoys cooking, cycling, traveling, and her guilty pleasure - reality TV. Dr. Laury is rated as an Advanced provider by MediFind in the treatment of Tongue Tie. Her top areas of expertise are Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), Sinusitis, Nasal Polyps, and Empyema.
On rare occasions, tongue tie has been linked to problems with tooth development, swallowing, or speech.
Summary: The goal of this randomized control trial is to determine the impact of post-frenotomy manual manipulation on revision rates and breastfeeding outcomes. We hypothesize that post-frenotomy manipulation will reduce the rate of sublingual frenulum regrowth, and subsequently frenotomy revision rates, thereby improving breastfeeding performance. Infants with ankyloglossia undergoing frenotomy will be r...
Published Date: July 28, 2025
Published By: Ashutosh Kacker, MD, FACS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Dhar VK. Common lesions of the oral soft tissues. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 361.
Lawrence RA, Lawrence RM. ABM clinical protocol #11: guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad: The Academy of Breastfeeding Medicine: ABM Protocols. In: Lawrence RA, Lawrence RM, eds. Breastfeeding: A Guide for the Medical Profession. 9th ed. Philadelphia, PA: Elsevier; 2022:870-873.
Newkirk GR, Newkirk MJ. Tongue-tie snipping (frenotomy) for ankyloglossia. In: Fowler GC, eds. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 169.