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Frenulum / Frenotomy


A lingual frenulum is a band that attaches the tongue to the base of the mouth. The tighter the frenulum, the less mobility the tongue has. Having a tight frenulum ("tongue tie") can be genetic.

A frenotomy or frenulectomy is a surgical procedure to release the band. Usually an in-office procedure.

There are 4 grades of tongue tie.

  1. In a type 1 tongue tie, the frenulum can extend to the tip of the tongue; when the tongue is extended or lifted during crying, the tip of the tongue may be pulled and cause the tongue to look "heart" shaped. With this type of tongue tie, a baby may not be able to get the tongue passed the lower gum.
  2. In type 2, the band is a little further back from the tip and may still cause a "heart" shape when crying.
  3. Type 3 tongue ties are even further back. When the baby cries, the tip of the tongue may be flat.
  4. Type 4 may be behind the mucosa, wider and not visible, only palpable.

Problems caused by a tight frenulum


A breastfeeding baby uses the tongue in a wavelike motion to express milk out of the breast. When the tongue motion is constricted by a tight frenulum, it may be difficult for the baby to express milk from the breast or it may require more energy to do this, so the baby may tire easily while feeding. This may cause slow or poor weight gain and may also drive a mothers milk production down.

Nipple pain and/or trauma

With a tight frenulum, it is most comfortable for the tongue to stay at the back of the mouth, rather than extend forward during nursing. This position of the tongue will cause it to rub on the nipple tip. The nipple may then be compressed and have a crease at the tip, best seen directly when the baby delatches. The nipple may develop skin breakdown and have open wounds, cracks, scabs, bleeding or blisters.


A baby with a tight frenulum may have problems with proper speech development.


If your baby is diagnosed with a tight frenulum and you have nipple trauma and/or the baby is not feeding effectively from the breast, consider having the frenulum released (frenotomy / frenulectomy). Speak with your pediatrician about a referral to a pediatric ENT or other specialist to have the baby evaluated. The procedure is minor, usually done in the doctor's office, takes seconds and is usually well tolerated by babies.

If your baby is tongue tied but does not cause nipple trauma and is feeding well and gaining weight at an appropriate rate, speak with your pediatrician about the severity of the tongue tie and whether or not it may cause speech issues in the future. If so, the peditrician will usually refer you to a pediatric ENT.

Some general pediatricians still perform fenotomies in the office.