Tongue binding in children: causes, symptoms, and treatment

Tongue-tie, clinically known as ankylosing spondylitis, is a condition in which the tongue binds to the floor of the mouth. The tissue that connects the language to the bottom of the mouth is called the frenulum. In healthy children, the frenulum retracts to the back of the tongue and is observed when the tongue is raised to look under it.

In tongue-tied infants, the phrenum extends to the tip of the tongue and binds tightly to the floor of the mouth (1). It inhibits the movement of the language, thus leading to ankylosing spondylitis, which affects the way a baby eats, swallows, and speaks. Therefore, parents will often look for the proper measures to help resolve the situation.

This post will discuss the causes of tongue formation in children, its identification, and proper management.

What causes tongue sticking in children?

Language separates from language before the baby is born. However, in some children, it does not happen. The etiology is incomplete and, in some cases, related to specific genetic factors (2) (3).

A congenital disability is generally considered a factor in tongue formation because more research is needed to determine if genetics cause this condition.

What are the symptoms of tongue formation in children?

Doctors classify the tongue dive according to the size of the palate. The condition is categorized into four classes. Class I mild ankylosing spondylitis, Class II moderate ankylosing spondylitis, Class III severe ankylosing spondylitis, and Class IV complete ankylosing spondylitis.

Here are the signs and symptoms that indicate your baby has a tongue tie and needs pediatrician attention (4) (5).

  1. Problem with sealing the breast: The built-in tongue makes it challenging to maintain absorption in the nipple. A child with a tongue-tie may not suck for a long time and may retreat frequently. If your baby is primarily formula-fed or drinks that express breastmilk from a bottle, you will not notice that condition as the bottle nipples slip easily into the mouth.
  2. Nipple pain during breastfeeding: Tongue-tied babies tend to chew or bite the nipple. This can cause pain and discomfort every time you breastfeed.
  3. Inadequate weight gain: They will show poor growth because your baby does not get enough milk.
  4. V-shaped tongue: The tongue attached to the base forms a kink in the center. So, when the tongue-tied baby cries, you will find a ‘V-shaped’ language with a deep, vertical fold in the center.
  5. Loss of interest in breastfeeding: Breastfeeding can become a painful job for both mother and baby. The baby loses interest in feeding, and the mother finds it painful, eventually leading to bottle feeding.
  6. Dental Problems: Malignant incisions in the lower center of the tongue-tie (lower front teeth) can cause a gap between two teeth. The tongue-tied baby may not be able to remove any food debris from the mouth to prevent tooth decay.
  7. Speech problems: If the tongue-tie is not detected early, your child may have difficulty pronouncing the letters r, d, t, ch, th, z, and l. The interpretation of these sounds requires a complex tongue movement called rolling, which is not possible for a tongue-tied child.
  8. Difficulty in eating certain foods: Older children, who can eat a variety of foods, may not be able to do it properly. For example, a toddler should not lick ice cream, lollipops, or popsicles.
  9. Caking and shortness of breath: The tongue helps tilt food down the throat in a controlled manner. A tied tongue cannot do that; swallowing hard can sometimes lead to severe caking and shortness of breath.
  10. Chewing problem: The food rolls, and the tongue moves between the teeth. A stiff language can do none of these, making it difficult for an older toddler to chew solid food.

It is good to diagnose the problem and treat it promptly.

How is tongue-tie diagnosed in children?

If you suspect tongue-tie, take your child to a pediatrician who may refer you to an otolaryngologist, also referred to as an ENT specialist. The doctor will use the following steps to confirm ankylosing spondylitis:

  • Examine the tongue: Examination of the language is sufficient for the doctor to diagnose the presence of a tongue-tie. Class III and IV tongue-tie are severe and obvious (5).
  • Learn about the baby’s eating habits: Bad weight gain can also support a tongue-in-cheek diagnosis. The doctor will ask about the baby’s eating habits and if they have a problem with the occasional nipple grip.
  • Test speech and tongue movement: In the case of older children, the doctor may ask the toddler to perform specific actions, such as rolling the tongue, or saying a few simple words, to identify limitations in tongue movement.

Should a tongue bandage be treated?

Doctors sometimes follow a wait-and-see policy if tongue-in-cheek feeding does not lead to problems. In many cases, the tongue tie is asymptomatic; This condition can resolve spontaneously, or the affected person may learn to compensate adequately for the decrease in their linguistic mobility. In such cases, no specific treatment is done. However, as children grow, physicians evaluate the impact of tongue-building on a child’s speech or personal or social development. If any problems are found, immediate action is recommended to resolve the issues.

In some cases, surgical procedures may be required.

Furthermore, the tongue plays a vital role in speech development and the intake of these solid foods; children may require speech therapy and regular tongue exercises.

According to the researchers, it is not clear whether a frenotomy is mandatory or whether it is OK to leave the baby with the condition (6). Also, if the tongue-tie is not observed, the mother may stop breastfeeding during the first week and seek bottle feeding to avoid pain (7).

How is tongue-tie treated in children?

Surgical removal of the tongue is the only way to treat this condition. This procedure is called a frenotomy, also known as a phrenulotomy or adrenalectomy. Severe cases of tongue congestion may require another surgical procedure called frenuloplasty.

Continue reading for more information about each procedure (8).


  • If a tongue tie is found, the doctor may perform surgery immediately after the baby is born.
  • Anesthesia is not required as the frenum is a thin tissue with pain-inducing nerve endings. However, in severe cases of ankylosing spondylitis, the doctor may choose to give local anesthesia. Older infants and children with hysteria may need local or general anesthesia.
  • The doctor cuts off the excess frenulum with sterile scissors, and the surgery is complete.
  • Frenotomy takes a few minutes, and no sutures are required. Blood loss during surgery is minimal (no more than a drop or two).
  • You may be asked to breastfeed after surgery so the doctor can check if the latch is improving and the baby will get some relief from the pain. Antibodies in milk also act as a disinfectant for wounds.


  • If the frenulum is too thick or attached to remove extra tissue, the baby should be subjected to a frenuloplasty.
  • The procedure is similar to a frenotomy, but the baby may need local or general anesthesia.
  • The doctor cuts the tissue with sterile scissors and closes the wound with absorbent sutures (sutures). Some hospitals use a laser to cut the frenulum, which leads to minor swelling and eliminates the need for sutures.
  • The time it takes to wear the anesthetic and the time it takes for the baby to regain the sensation of the mouth and tongue is long in this practice. The doctor will tell you the exact time to start breastfeeding again.

Complications of surgery

Complications in phrenotomy and frenuloplasty are rare, but they cannot be completely ruled out. Some potential problems (9) include:

  • Excessive bleeding
  • Infection of the surgical wound
  • Severe swelling
  • Damage to the tongue and salivary glands
  • Scar
  • Reattaching the frenulum to the base of the tongue

Some children may also have an allergic reaction to the anesthetic. But these complications occur infrequently, and your baby may have improved tongue movement after surgery. Also, as a person gets older, the risk of complications increases as the phenol becomes thicker.

Frequently Asked Questions

1. How common is tongue sticking in children?

According to the UK National Health Service, about 4-11% of newborns suffer from tongue bites. It sometimes runs in families and is more common among boys than girls (10).

2. Can the baby live with a tongue bandage and avoid surgery?

Yes, but tongue sticking does not cause problems or interfere with the healthy growth and development of the baby. Some infants can do tongue-dive well and do not require intervention. It said that only long-term observation could determine whether tongue-tie is a problem.

3. Are tongue-building treatments safe for children?

Yes, tongue licking treatment is considered safe for children. Although rare, some complications may occur.

A doctor can check for a lump in the tongue at birth, and it is usually the parents who detect the symptoms. Getting a diagnosis early and treating the problem surgically ensures minimal complications and quick recovery.

Do you have any tips on how to identify tongue dive in children? Please share them in our comments section.

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