A: Melissa, thanks for your question. This condition, also known as “ankyloglossia,” means your baby’s frenulum—the tissue that secures the underside of the tongue to the floor of the mouth—is tighter than usual. As a result, your baby’s tongue may appear heart-shaped and may not be able to extend out past his gums. Approximately 1 to 2% of newborns are born with it.

In the old days, when doctors saw that a newborn had a tight frenulum, they used to clip it in the nursery or the office. This minor surgery was quick, safe and involved relatively little blood. Although clipping the frenulum usually improved the tongue’s mobility, there were occasional complications with healing. When doctors followed babies who didn’t get their frenulum clipped as newborns, they actually found that many babies’ frenulums naturally stretched out over time. They outgrew the condition and didn’t need surgery.

Currently, experts recommend having the frenulum clipped only if your baby is experiencing problems such as:

• Having difficulty sucking, not getting enough milk and failing to grow properly. This is usually apparent in the newborn period.
• Problems with speech. This is usually apparent by 2 to 3 years of age.

Talk with your pediatrician about whether and when to do the surgery. Since your baby is 5 months old, you and your pediatrician should be able to assess how well your baby is feeding and growing. Together, you should observe your child’s language development over the next year to two. Your baby should be cooing and beginning to babble now; starting to say single words like “dada,” “mama” and “bye-bye” around 1 year, and saying two-word sentences by 2 years. If you have any questions about whether his tongue is affecting his speech development, ask the pediatrician if evaluation by a speech therapist might help. The pediatrician might also refer your child to an ear, nose and throat surgeon to evaluate whether your child might need his frenulum clipped.