A restrictive tongue-tie can have a significant impact on your child's life. This page will help you understand the potential consequences and why an intervention might be necessary.
Summary
To cut or not to cut?
Let’s start with a key reminder: if a tongue-tie is not restrictive, there is absolutely no need to cut it.
Only a tie that has been properly diagnosed as restrictive should be considered for intervention.
The idea of cutting a part of your baby’s tongue may seem brutal at first—and some parents are strongly opposed to it...
They fear subjecting their baby to unnecessary pain. After all, if Nature gave baby a tongue-tie, there must be a reason for it, right?
To better understand the usefulness of a frenectomy, we can draw a parallel with syndactyly.
Syndactyly (a condition where two fingers are fused together at birth) results from the same incomplete apoptosis process as ankyloglossia (tongue-tie).
In utero, when the hand is developing, all fingers are initially connected. Later, a programmed cell death process helps separate them into five distinct digits.
When apoptosis is incomplete, the baby is born with fingers still fused.
A surgeon will perform a procedure to separate them so the child can enjoy normal mobility.
No one questions whether the child will need all five fingers, or whether the pain of the procedure is justified.
The long-term impact of such a malformation is obvious—making the decision easier.
In the case of ankyloglossia, untrained pediatricians often advise the mother to simply switch from breastfeeding to bottle-feeding. In their view, that resolves the issue, and no surgery is needed.
However, breastfeeding difficulties are far from the only known consequence of a tongue-tie.
To assess whether a frenectomy is necessary, it's important to take a closer look at the potential impact of the tie on the child’s overall development.
Tongue-Tie and Breastfeeding
As we've seen, the first signs of a tongue-tie usually appear at the very beginning of breastfeeding.
Pain and nipple cracks caused by Baby’s ineffective latch are often the first alert for the mother, and slow weight gain provides another important clue.
Good to know: weight gain patterns for breastfed babies differ from those of bottle-fed babies.
If you're unsure, compare your baby’s growth curve to the WHO reference curves for breastfed babies.
Other signs may also point to a restrictive tongue-tie.
Some babies suffer from colic or gastroesophageal reflux (GER), two conditions closely linked to tongue and lip ties.
Tongue-Tie and Colic
Due to the tie, Baby’s latch is inefficient. Feeding requires considerable effort, and it's not uncommon for them to give up mid-feed, too tired to empty the breast.
Did you know?
Foremilk—the milk at the beginning of a feed—is very watery and rich in lactose. Hindmilk, which comes later, is much richer in fat and essential nutrients for digestion.
If Baby can’t finish the feed, they may consume too much lactose without the fats and enzymes needed to digest it properly.
This can result in digestive colic.
If your little one cries excessively after meals, squirms a lot, and seems chronically uncomfortable, a restrictive tongue-tie could be the underlying cause.
→ Discover our top tips for relieving infant colic here.
Tongue-Tie and Gastroesophageal Reflux (GER)
The human body is an extraordinary machine, capable of adapting in countless ways to ensure survival.
When Baby can’t feed properly, they don’t receive enough milk, which can endanger their health.
In some cases, the mother’s body finds a clever workaround. It releases milk very quickly and in large volumes, so that Baby can still get enough: this is the famous forceful let-down reflex (FLR).
→ Click here to learn more about FLR.
This mechanism—though helpful in providing milk despite the tie—comes with a significant downside.
In trying to handle the rapid milk flow, Baby often swallows large amounts of air.
This air may then come back up, bringing stomach contents with it.
If these regurgitations occur too often, they can cause burning in the esophagus.
This is known as gastroesophageal reflux (GER).
If you suspect you have a forceful let-down reflex, or if Baby shows signs of GER, a tongue-tie should not be ruled out.
Tongue-Tie and Bottle-Feeding
Very often, when Baby struggles to latch or their weight gain doesn’t follow typical patterns, your pediatrician may suggest supplementing with bottle feeds.
Bottle-feeding usually requires less effort: there’s no need to trigger a let-down reflex, and the milk flows on its own.
As a result, Baby can feel full more easily.
However, introducing this new feeding method often means giving up breastfeeding entirely.
With less stimulation, your milk supply will quickly decrease.
And Baby may experience nipple confusion, outright refusing the breast.
Why work harder to nurse when the alternative (formula milk) is available with little to no effort?
Are you ready to stop breastfeeding for Baby’s well-being?
That’s totally understandable: enduring daily pain from breastfeeding is one thing—but seeing Baby’s weight plateau makes any mother question her choices.
Still, switching to the bottle won’t necessarily solve Baby’s issues.
While some babies do find relief this way, others go from bad to worse.
Their tongue-tie may prevent them from handling the faster flow of the bottle: they may cough and choke during feeds.
You may even notice milk leaking from the corners of their mouth—their only way to release the excess.
So, keep in mind that while some babies thrive after transitioning to the bottle, others encounter a whole new set of challenges.
In such cases, a slow-flow nipple may help minimize the risks.
Whatever you choose, switching to bottle-feeding will never resolve the underlying issue.
Baby’s tongue-tie may come back to haunt you sooner than expected.
Tongue-Tie and Solid Foods
Around 6 months of age, babies naturally transition to more substantial foods.
At this stage, the role of the tongue begins to evolve—and restrictions caused by a tongue-tie may introduce new challenges.
To better understand this, let’s use our imagination for a moment.
Picture yourself chewing a fresh piece of bread.
The soft center melts on your tongue, the crust softens and breaks into small, easy-to-swallow pieces... It’s the perfect food for a teething toddler!
Now focus on your tongue’s movements. Without even realizing it, your tongue is performing an elaborate dance inside your mouth.
It pushes large chunks of food toward your molars to be crushed, retrieves crumbs stuck between your gums and cheeks, and cleans between your teeth…
Not to mention its essential role in swallowing!
All of this results from training that begins at birth and requires full mobility of all oral muscles.
Babies with a restrictive tongue-tie are significantly hindered in developing these skills.
They often develop compensation strategies, relying heavily on their cheeks and lips to get the job done.
But this takes time (they may seem to take forever to finish a meal) and a great deal of energy!
And, of course, some textures (like those infamous corn chips mentioned earlier) are simply unmanageable. These children tend to stick to soft, easy-to-swallow foods.
As a result, they’re often labeled as “picky eaters.” It seems like they “don’t like anything.”
However, studies conducted after frenectomy show that this is usually not a matter of taste—but a matter of texture.
Once their tongue-tie is released, many children quickly begin to enjoy the foods they previously rejected as “inedible”!
Tongue-Tie and Speech Disorders
Feeding isn’t the only function of the tongue.
In humans, it also plays a crucial role in communication.
For children who were never breastfed, a tongue-tie is often first detected when they begin to speak.
Certain sounds are simply impossible to pronounce if the tongue lacks sufficient mobility.
In such cases, repeated speech therapy sessions may prove completely ineffective—and sometimes very frustrating or even humiliating for the child.
If you’re lucky, your child’s speech therapist will be trained to recognize tongue-ties and may refer you to a qualified professional for a frenectomy.
It’s important to understand that after the procedure, further speech therapy is often necessary to help the child learn how to use their tongue correctly.
Orthodontics and Breathing
Beyond eating and speaking, the tongue also plays a key role in the development of a child’s facial structure.
At birth, a baby’s palate is shaped like a narrow triangle. Over time, it flattens and widens thanks to the upward pressure of the tongue, which naturally rests against the roof of the mouth.
If a tongue-tie is so restrictive that the tongue can’t assume this resting position, the development of the face and jaws can be significantly impaired: the palate remains narrow and high-arched, leaving insufficient space for adult teeth.
These teeth may then erupt misaligned, often requiring years of expensive—and painful—orthodontic treatment.
Because the palate also forms the floor of the nasal cavity, this underdevelopment can lead to additional breathing issues.
Importantly, a malformed palate is one of the consequences that cannot be corrected by a frenectomy if it’s performed too late.
Up to about 9 months of age, a baby’s bones and cartilage remain soft and malleable to allow continued cranial growth after birth.
By the end of the first year, the skull’s rapid development slows significantly, the bones harden, and the shape of the head becomes largely fixed.
If a frenectomy is performed after this period, the newly gained tongue mobility will no longer influence the shape of the palate.
Tongue-tie and sleep
Finally, it’s worth noting that in some cases, a tongue-tie can lead to sleep issues.
Children (and even adults) with a tongue-tie often tend to breathe through their mouth.
At night, when the tongue can’t rest against the palate, it stays low, lying against the floor of the mouth.
Sometimes it may roll back and partially block the airway — making it harder to breathe!
This often causes the sleeper to wake up… and this can happen many times throughout the night.
If you notice that your child tends to breathe through their mouth, even during the day, it may be worth investigating the possibility of an undiagnosed restrictive tongue-tie.
As we’ve seen, a restrictive tongue-tie can cause a wide range of issues — some of which may persist well into adulthood.
Releasing your baby’s tongue-tie takes only a few seconds (between 15 to 30 seconds in most cases) and typically results in only mild discomfort, quickly forgotten.
The idea of cutting your baby’s tongue-tie might feel scary at first…
Let’s walk through the few simple steps that can help you finally get rid of that little cord that’s been causing so much trouble.