Tongue Tie
A short lingual frenulum (frenulum linguae breve) restricts the mobility of the tongue. It can cause breastfeeding difficulties in newborns and later affect speech, swallowing and myofunctional patterns. Speech therapy assessment and accompanying treatment are beneficial at any age.
What is a tongue tie?
The lingual frenulum is the band of tissue connecting the underside of the tongue to the floor of the mouth. When it is too short, too thick, or attached too far forward, tongue movement is restricted – this is known as ankyloglossia or tongue tie.
Severity varies widely: from a mild restriction with minimal impact to complete ankyloglossia that significantly impairs breastfeeding and speech development.
Effects by age
- Infant: breastfeeding difficulties (poor latch, maternal pain, insufficient weight gain), feeding problems
- Toddler: restricted tongue movement, possible effects on swallowing pattern and chewing
- School-age child / adolescent: lisping (especially S, Z, T, D, N, L), myofunctional disorders, jaw development
- Adult: persistent articulation difficulties, swallowing pattern issues, restrictions when playing wind instruments
When is a frenulotomy appropriate?
A frenulotomy (division of the lingual frenulum) is a minor procedure often performed on infants as an outpatient without general anaesthesia. It is indicated when the frenulum significantly impairs breastfeeding or orofacial development.
Not every tongue tie requires surgery. In mild cases, speech therapy exercises to improve tongue mobility are often sufficient. If a procedure is carried out, speech therapy follow-up is recommended to ensure the child makes use of the newly gained mobility.
Our approach
We assess tongue mobility, swallowing pattern, articulation and – in infants – breastfeeding behaviour as part of a speech therapy assessment.
Depending on the findings, we recommend targeted tongue mobilisation exercises, myofunctional therapy, or referral to a paediatrician, ENT specialist or orthodontist for surgical assessment. We also provide follow-up care after a procedure.
Therapy process
- 1Assessment: tongue mobility, swallowing pattern, articulation, breastfeeding behaviour (infants)
- 2Counselling: severity, treatment options, prognosis
- 3Conservative therapy: mobilisation exercises, myofunctional therapy
- 4Referral where needed: paediatrician, ENT specialist, orthodontist
- 5Post-operative follow-up after frenulotomy
- 6Progress review and discharge
Frequently asked questions
My baby has breastfeeding difficulties – could tongue tie be the cause?
Yes. A short lingual frenulum is a common but often overlooked cause of breastfeeding difficulties. Signs include: pain when breastfeeding, poor latch, frequent feeding breaks, insufficient weight gain or a clicking sound when sucking. Early speech therapy assessment is recommended.
Does tongue tie always need to be operated on?
No – not every tongue tie requires a procedure. What matters is the severity and functional impact. In mild cases, speech therapy exercises to improve tongue mobility may be sufficient. We advise individually and refer on when needed.
From what age can speech therapy for tongue tie begin?
Speech therapy support can begin in infancy – particularly for breastfeeding difficulties. Myofunctional exercises after a frenulotomy can be started from toddler age, at the latest from preschool age, depending on the child.
Does health insurance cover the costs?
Speech therapy for tongue tie is reimbursable by statutory health insurance with a doctor's prescription. Referrals can be issued by paediatricians, ENT specialists or midwives.
Ready for the next step?
Book your first appointment online or get in touch with our practice in Erding.