Clinical features of ankyloglossia (tongue-tie) include inability to lift the tongue to the upper dental alveolus, impaired protrusion of the tongue, impaired side-to-side movement of the tongue, and a notched or heart shape to the tongue when it is protruded. The natural history is unknown. 

●Potential sequelae of ankyloglossia include difficulty breastfeeding, articulation problems, and mechanical problems (eg, inability to lick the lips or sweep food debris from the teeth). Ankyloglossia does not cause speech or language delay. 

●Indications for surgical release of ankyloglossia may include breastfeeding difficulty, articulation problems, or mechanical/social problems. The goal of surgery is to increase mobility, not to improve the contour. The optimal timing for surgery is controversial. 

●For infants with ankyloglossia and breastfeeding difficulty whose mothers wish to continue breastfeeding, we suggest consultation with a lactation consultant as the first step in the management rather than surgical intervention. For affected infants who continue to have problems with breastfeeding despite lactation support, we suggest frenotomy . If frenotomy is undertaken, it should be performed by appropriately-trained personnel. 

●Evaluation by a speech pathologist is an essential component of the management of children with articulation problems and concomitant ankyloglossia.

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