Tongue Tie Explained: What Parents Should Know About Feeding, Speech, and Treatment

As social media has increased awareness of tongue tie in babies, it has also spread misinformation about the condition.

“Social media has made tongue tie seem far more common and far more urgent than it actually is,” said Alexis Rieber, MD, a Cedars-Sinai pediatric otolaryngologist based in Pasadena.

Although parents may first encounter tongue tie concerns at a pediatrician or dentist’s office, pediatric ear, nose, and throat specialists (ENTs) like Rieber are uniquely qualified to deliver the most comprehensive evaluation and care. Trained in the intricate anatomy and function of the head and neck, pediatric ENTs bring a deeper understanding of how tongue mobility impacts not only feeding, but also airway function, swallowing, and speech development.

Rieber cuts through the noise with expert insight into what tongue tie is, how it can affect babies, and when intervention is truly necessary.

Q: What is tongue tie, and how do you know when it’s actually a problem?

Dr. Rieber: Tongue tie, or ankyloglossia, happens when the thin band of tissue under the tongue (the frenulum) restricts normal tongue movement. What matters most isn’t how the tongue looks – it’s whether it’s causing problems.

In babies, the most notable symptoms of tongue tie are poor or painful latch during breastfeeding, inefficient feeding, and poor weight gain. If a baby is growing well and feeding comfortably, even if the frenulum looks prominent, treatment usually isn’t necessary.

That’s why I start by listening carefully to the parents’ story and working closely with pediatricians and lactation consultants. Breastfeeding challenges can come from many sources, such as milk supply, maternal recovery, infant positioning, reflux, jaw size, or airway issues. Tongue tie should never be diagnosed in isolation.

Q: Why is a pediatric ENT uniquely qualified to make this diagnosis?

Dr. Rieber: These specialists perform the procedure frequently and are trained to decide when it is truly needed. In addition to breastfeeding challenges, a pediatric ENT evaluates other causes of breathing difficulties, such as laryngomalacia (a condition causing noisy breathing), cleft palate, craniofacial differences, or tone abnormalities.

Q: What are some common misconceptions you’ve seen about tongue tie?

Dr. Rieber: One major misconception is that every feeding or speech problem must be tongue tie. Another is that releasing it will “prevent future problems,” which isn’t supported by scientific studies.

I’m especially concerned when families are pushed into expensive procedures without a full evaluation. Dentists often perform releases but don’t assess the airway, jaw development, or other ENT-related causes of feeding difficulty. Missing those issues can mean doing an unnecessary procedure that doesn’t help the baby.

The best advice is simple: trust your pediatrician and use them as your home base. They will refer you to a specialist if there is real concern.

Q: How old are the patients you typically see for tongue tie evaluations?

Dr. Rieber: I see patients of all ages. Most referrals are newborns in the first three months, when feeding issues are most urgent. I also see older babies, young children, teenagers, and occasionally adults.

It’s important to keep in mind that tongue tie does not cause global speech delay. It may affect the articulation of specific sounds, like T, D, or L. However, if a toddler isn’t talking at all, that points to hearing, developmental, or neurologic causes – not tongue tie. Children with those symptoms need a much broader evaluation.

Teenagers sometimes seek treatment for social or comfort reasons. For example, they might have difficulty sticking out the tongue or embarrassment, even when a tongue tie wasn’t an issue earlier in life.

Q: What does the tongue tie release procedure involve?

Dr. Rieber: For babies under six months, the procedure is very quick – about 90 seconds and typically done in our office. The baby is swaddled, given sugar-water for comfort, and the area is numbed. I carefully release the frenulum using a specialized tool. There may be a small amount of bleeding, but babies typically calm quickly and can feed right afterward. Parents often say, “That was it?”

Recovery is usually mild: up to 24 hours of fussiness and a temporary wound under the tongue. We check babies again at two weeks.

For children between six months and eight years, I typically perform the procedure at Huntington Ambulatory Surgery Center, where the staff is experienced in supporting and comforting babies (and their parents). They offer sedation for comfort. For patients eight years and older, I typically do the procedure in our office.

Q: When is treatment necessary?

Dr. Rieber: Tongue tie release is most beneficial when a baby is struggling to feed despite good lactation support and other causes have been ruled out. When done thoughtfully and for the right reason, it can be life-changing for families. But many babies with tongue tie feed just fine, and they don’t need surgery. I encourage parents to stay calm, informed, and look to information backed by science to protect parents and babies from unnecessary anxiety and procedures.

To learn more about Cedars-Sinai ENT specialty care at Huntington, go to: https://www.huntingtonhealth.org/our-services/outpatient/meet-your-ear-nose-throat-team/