Posterior Tongue Tie – Symptoms, Risks & Treatments

What is a Posterior Tongue Tie?

A tongue tie (ankyloglossia) is when the connective tissue attaching the tongue to the mouth’s floor is too short or tight. This can limit the mobility of a baby’s tongue, making it harder for them to latch on during breastfeeding.

Anterior (front) tongue ties are easy to see when a baby raises their tongue. The connective band underneath the tongue, called a frenum or frenulum, will be noticeably short. This is what restricts the motion of the baby’s tongue.

Posterior (back) tongue ties can be harder to detect. This is because the frenulum is not as readily visible. But like anterior tongue ties, they can cause feeding problems.

Symptoms of Posterior Tongue Tie

A thin membrane or band of tissue (frenulum) with a posterior tongue tie may not be visible. However, you may notice that when your baby raises their tongue, the front and sides of the tongue go up, but the middle part doesn’t.

You may also notice that your baby can’t stick their tongue out or lick their lips or teeth. Their tongue may bend or wrinkle when they try to do so.

Trouble moving the tongue can lead to other symptoms, such as:

• Difficulty latching onto the breast
• Fussiness
• Slow or no weight gain

A tongue tie can contribute to speech impediments as a child begins to talk. Making certain sounds might also be difficult due to the lack of tongue mobility.

When to See a Doctor

Consult a pediatrician if your baby experiences:

• Difficulty latching onto the breast
• Signs of constant hunger or poor weight gain
• Physical signs and symptoms of tongue tie

There may be other reasons your child is having difficulty breastfeeding. A pediatrician should be able to diagnose a tongue tie easily.

How is a Posterior Tongue Tie Treated?

The treatment approach to tongue tie will depend on the severity of symptoms, based on the judgment of your pediatrician or lactation specialist. They may suggest certain positions or techniques to help your baby latch, even with a tongue tie.

Your pediatrician may recommend a frenotomy. This simple surgical procedure involves making a small cut in the connective tissue under your baby’s tongue. The released tissue will then have room to regrow, allowing more tongue mobility.

A similar procedure is known as frenectomy or frenulectomy. In this case, an entire piece of connective tissue will be removed rather than released.

These procedures have a high success rate and minimal complications. They’re also associated with improvements in breastfeeding.^{2, 3} If necessary, they should occur as early in the baby’s life as possible.^{4, 5}

Frenotomy is usually not recommended if your child has issues such as micrognathia or other tongue or jaw development concerns. In these cases, the procedure is likely to be ineffective or worsen the problem.⁴

Can You Outgrow a Posterior Tongue Tie?

In many cases, a tongue tie gradually disappears once a baby becomes a toddler. As their mouth grows and changes in shape, the connective tissue under their tongue may lengthen on its own.

A lactation consultant can recommend breastfeeding tips if your baby has a tongue tie. Some studies suggest that most women who experience difficulty breastfeeding could see improvements simply from better positioning.⁴

If your baby’s tongue tie isn’t severe and you can still breastfeed, you may opt-out of a frenotomy. Likely, they won’t have any issues when they get older.

Complications 

An untreated tongue tie might continue to cause newborn feeding problems. This may make it hard for babies to receive adequate nourishment.

Young children with speech difficulties and a tongue tie may benefit from releasing the tongue tie. However, there isn’t much evidence that tongue tie alone is a major cause of speech impediments. Speech therapy is the first line of treatment in many cases. 

Procedures like frenotomy and frenectomy may also have complications, including:

• Pain
• Minor bleeding
• Scar formation
• Infection

These complications are rare, but they do sometimes occur. It’s also possible you won’t experience any improvement in breastfeeding after your baby’s tongue tie is treated.⁷ In these cases, the difficulties may be due to another cause, such as a lip tie.

Prevention

There’s no known way to prevent tongue tie. Tongue ties in babies occur as part of their natural development.

To prevent feeding problems associated with tongue tie, keep the following in mind:

• Early and accurate diagnosis
• Proper treatment, whether conservative (no surgery) or surgical (frenotomy or frenectomy)

Note: If your baby has no or minimal signs of tongue tie, frenotomy is unlikely to prevent possible feeding problems in the future.⁴

Causes and Risk Factors

Most tongue tie cases appear in babies who have no other health problems. Experts are unsure how tongue tie develops in these cases, but some evidence suggests genetic factors are involved. Some studies have found that tongue ties may run in families.¹

However, tongue tie is sometimes specifically associated with certain genetic conditions, such as a cleft palate. Mothers who use cocaine during pregnancy also put their children at risk for developing this condition.¹

Summary

A tongue tie is a condition where the tongue lacks mobility because of connective tissue that is too short or tight. This can make feeding hard for babies, leading to poor weight gain.

Posterior tongue tie refers to tongue ties that are less visible due to their position under the tongue.

Consult a pediatrician if your baby shows signs of a tongue tie, such as trouble feeding or latching.

Tongue ties can sometimes be managed while tongue mobility develops over time. They can also be treated effectively with a simple procedure that releases the connective tissue.