When you bring a new baby home, one of the first concerns is making sure they are eating well. For some infants, a tight frenum of the tongue makes nursing difficult from the beginning. Good news, though: a tight frenum is easy to treat and can help make feeding time easier.

What causes a tight frenulum of the tongue?

Also known as ankyloglossia or tight lingual frenulum, a tight frenum occurs when the thin membrane that anchors the tongue to the floor of the mouth extends well past the base of the tongue towards the tip.

There are four main classes of tight lingual frenulum.

Class 1

This type indicates that the lingual frenulum attaches to the very tip of the tongue. When people refer to a tongue-tie, a Class 1 tongue-tie is most often what they mean.

Class 2

The lingual frenulum attaches just behind the tip of the tongue.

Class 3

Located closer to the base of the tongue, this type of tight frenum may not cause any difficulty in infancy at all. Because of this, it may not even be identified.

Class 4

This type occurs underneath the mucous membrane and must be felt to be diagnosed. This can make the tongue appear shorter and result in a misdiagnosis.

Tight frenulum of the tongue occurs in an estimated three to four percent of infants, with boys diagnosed more frequently. The cause is congenital, meaning it is present from birth. Other than genetics, there have not been any risk factors identified for a tight frenum. Some children are born with it, while most others are not.

What are the risks of a tight lingual frenulum?

The area where the frenum attaches can vary widely. In many cases, this variety does not cause a problem that needs intervention.

For some babies with a tight lingual frenulum, problems can occur almost immediately, including:

  • Difficulty latching on: While most babies and mothers struggle with latching on at first, babies with a tight frenum may never quite get it right
  • Cracked, bleeding, or sore nipples: Babies will suck harder to try to get more milk because they cannot get a proper seal on the nipple
  • Excessive gas: The baby is sucking more air than milk as they nurse which can lead to gas
  • Poor weight gain: Not enough milk means that the baby is not able to gain weight
  • Fussiness: All babies fuss at one point or another, but babies who are hungry for lack of adequate nutrition and excessive gas may be even fussier
  • Poor milk supply: Milk supply depends on demand, so if the baby is not able to drain the breast at a feeding, your supply may drop

These symptoms can be very frustrating for a hungry baby and tired mother. As the baby gets older, a tight frenum can cause more problems. These issues include the following.

Difficulty speaking

While many children who grow up with a tight lingual frenulum learn to adapt, some may have difficulty speaking clearly.

The tongue is primarily an instrument of speech, and without free movement this can impede communication.

Eating challenges

The tongue also helps to move food from one ar