Tongue Tie

April 23, 2021

Tongue Tie


  • Lingual – relating to the tongue

  • Sublingual frenulum / lingual frenulum – a fold of tissue, under the tongue, that arises as the tongue lifts and places tension on the floor of the mouth. The fold is always composed of oral mucosa.

  • Ankyloglossia – another word for tongue tie

A sublingual frenulum is a common and normal anatomic structure. Everyone has one. When does a sublingual frenulum become a tongue tie?

According to the 2021 Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads:1

“A tongue-tie exists when the tongue is limited in its range of movement, and subsequent function, due to the presence of a restrictive sublingual frenulum.”

A tongue-tie is a functional diagnosis.

A detailed clinical breastfeeding assessment, including direct observation of breastfeeding, should be conducted before a decision to treat a tongue tie is made.

Subjective complaints from mothers who are breastfeeding an infant with a tongue-tie can include:

  • Latching difficulties

  • Nipple pain

  • Poor breast drainage

  • Prolonged duration of individual breastfeeding sessions

  • Inadequate infant satisfaction when directly feeding at the breast

Objective findings include:

  • Nipple compression

  • Damaged nipples

  • Milk stasis within the breast

  • Sub optimal infant weight gain due to inefficient milk transfer or intake at the breast

Here is a picture of an infant’s mouth showing a sublingual (or lingual) frenulum. A detailed breastfeeding assessment would be necessary to determine if the tongue has limited range of motion and function.

Several more pictures:

Lip tie


  • Labial – lip

  • Labial frenulum – a strand of tissue that connects the upper lip to the gum tissue above or between the two front teeth

  • Lip tie – restrictive labial frenulum

From the 2021 Academy of Breastfeeding Medicine Position Statement, “The upper labial frenulum is a normal structure with poor evidence for intervention improving breastfeeding and therefore cannot be recommended. Additionally, surgery to release a “buccal tie” should not be performed.” (Reference 1)

Here is a picture of my second grandson’s mouth sent to me by my son who wondered what the string was and what “the thing” was on Luke’s upper lip. (Answer - labial frenulum, sucking callous). This little guy breastfed just fine and is still breastfeeding at a year of age. He does now, however, have an adorable gap between his upper front teeth.


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LeFort Y, Evans A, Livingstone V, Douglas P, Dahlquist N, Donnelly B, Leeper K, Harley E, Lappin S, and the Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads. Breastfeed Med 2021;16(4):278-281.