Identify a Tongue-Tie

Normal Tongue

Tongue-tie (ankyloglossia, tight frenulum) is a condition in which the bottom of the tongue is tethered (or attached) to the floor of the mouth by a membrane (frenulum) so that the tongue’s range of motion is unduly restricted. This may result in various oral development, feeding, speech, swallowing, and associated problems.

Tongue-ties can be divided into four types, according to how close to the tip of the tongue the leading edge of the frenulum is attached:

 The Four Types of Tongue-Tie

Type 1 is the attachment of the frenulum to the tip of the tongue, usually in front of the alveolar ridge (jaw bone) in the lower lip sulcus.

Type 2 is two to four mm behind the tongue tip and attaches on or just behind the alveolar ridge (jaw bone).

Type 3 tongue-tie is the attachment to the mid-tongue and the middle of the floor of the mouth and is usually tighter and less elastic.

Type 4 is essentially against the base of the tongue, and is thick, shiny and very inelastic.

Here is a slide from Dr. Larry Kotlow with pictures of the four types of tongue tie.


Types 1 and 2, considered “classical” tongue-tie, are the most common and obvious tongue-ties, and probably account for 75% of incidence.

Types 3 and are less common, and since they are more difficult to visualize are the most likely to go untreated. Type 4 is most likely to cause difficulty with bolus (food, whether solid or liquid) handling and swallowing, resulting in more significant symptoms for other and infant

(The above information was taken directly from American Academy of Pediatrics, Summer 2004 Edition. I encourage you to read the newsletter in its entirety. It also includes pictures).

Heart-like Shape of Type 1 or 2 Tongue-Tie (Classical)

How to Check for a Tongue-Tie

Type 1 and 2 Tongue Ties (aka Classic) are obvious. When the tongue is extended, it creates a heart-like shape.

Type 3 and 4 (aka Simple) are not so obvious. Even if you have a general idea what it may look like, it’s easy to second guess yourself. But the International Affiliation of Tongue-Tie Professionals (IATP) make it a little easier on us!  Dr. James G Murphey describes in his video on their website a simple way to see for yourself if a tongue tie is present. This is a long video that also includes information on how to clip tongue-ties. He discusses the method for checking a tongue-tie within the first three minutes. Writen instructions are also included below the video.

Written Instructions for Dr. Murphy’s Tongue-Tie Examination

  1. Using your pinky finger, pad down, insert into the left side of the mouth, under the tongue. Youw ant to advance it until you feel some resistance but not to the point of discomfort.
  2. Move your finger gently to the right side of the tongue.
    1. If you can freely move it from one side to the other, then there is not a tongue tie.
    2. If there is a slight “speed bump,” then the tongue may shudder a little when you move your finger. That’s associated with a small risk of having problems that can be fixed by clipping the tongue.
    3. If when you move past the “speed bump,” the tongue deviates from the mid-line (the tongue moves over to one side until your finger passes the frenulum, then it snaps back), then that is a large tongue tie. It has a very likely and large contribution to breastfeeding problems that can be fixed by clipping the tongue.
    4. If the frenulum is so long and tight that you must withdraw your finger to get to the other side of the tongue, that is known as a “fence.” That is always a significant problem and needs to be released.

Type 4/Posterior Tie

Below is another video. This one is by Dr. Kotlow. There isn’t any sound, but he shows how to tell if a baby has a posterior tie. This type of tie can be hidden and thereby easily overlooked.

4 responses

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