How to Spot a Tongue Tie: Signs Parents and Therapists Look For

Tongue tie — the medical term is ankyloglossia — is one of the most talked-about topics in infant feeding, and one of the most misunderstood. Roughly 1 in 10 babies is born with some degree of tongue tie: a lingual frenulum (the small band of tissue under the tongue) that is tighter, or attached further forward, than usual. Here is the part that gets lost in the noise: only about half of those babies have any trouble feeding because of it. A visible tie is not automatically a problem — what matters is function.

What a tongue tie can affect

To feed well, a baby has to lift the tongue to the roof of the mouth, cup the nipple, and move milk backwards in a wave. A restrictive frenulum can interfere with exactly those movements. Reported feeding difficulties in infants with tongue tie include:

• poor or shallow latch, or repeatedly losing the latch;
• long, unsettled feeds — the baby works hard, tires, and feeds again soon after;
• poor weight gain despite frequent feeding;
• maternal nipple pain or trauma — often the first sign anyone notices;
• clicking sounds, milk spilling, or excessive wind during feeds.

Breast- and bottle-feeding difficulties are reported in roughly 25–44% of infants who have a tongue tie — significant, but far from universal.

How professionals actually assess it

A proper assessment looks at what the tongue can do, not just what the frenulum looks like. A trained professional — a speech-language therapist, lactation consultant or doctor — will check whether the tongue can:

• lateralise — move side to side;
• elevate — lift toward the palate;
• extend — reach out past the gum line or lips;
• cup and wave — form around a finger and move in the rippling pattern that transfers milk.

They will also weigh the whole picture: prematurity, reflux, torticollis (neck tightness) and general neurodevelopment often travel alongside feeding difficulty and can be the real driver. Standardised scoring tools exist to make this assessment consistent rather than impressionistic.

In older children

An untreated restrictive tie occasionally shows up later as difficulty with specific tongue movements — licking an ice cream, clearing food from the cheeks, or producing sounds that need tongue elevation. A heart-shaped or notched tongue tip when the tongue stretches forward is a classic visual sign. But be careful with hindsight diagnoses: many speech difficulties have nothing to do with the frenulum, and a competent assessment separates the two.

Does every tie need a procedure?

No — and this is where current professional guidance is emphatic. Recent clinical guidance (including the American Academy of Pediatrics’ 2024 clinical report) cautions against over-diagnosis and reflexive surgery, recommending skilled feeding support first and reserving frenotomy for cases where a functional restriction is clearly contributing to the problem. The right order of operations: assess function → support feeding → treat only what is genuinely restricting.

Where to get help in South Africa

Start with a lactation consultant or speech-language therapist experienced in infant feeding — they can assess function, support the feeding relationship, and refer for release only when warranted. For therapists and interested parents who want to go deeper, SpeechLab carries the self-study course Be a “Tongue Tie Detective!”: How to Identify a Tongue Tie and Its Impact, and a full range of tongue-tie courses in the learning library.

This article is general information and not a diagnosis. If your baby is feeding poorly or losing weight, see a healthcare professional promptly. Sources: American Academy of Pediatrics clinical report on ankyloglossia (2024); Mayo Clinic Health System; Cleveland Clinic; NIH-published reviews of ankyloglossia and breastfeeding.