Normal Tongue Placements in Infants

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Thank you for this question. Your report of tongue behavior of your 3 month old child sounds very normal to me, and I would encourage you to not worry about what you are observing. I don't know how you determined that your daughter has a submucosal tongue tie, but this is most likely not an accurate description of her since you also report that her tongue seems long and can typically extend between her lips when she smiles.

The good news is that your daughter has a long tongue, that she nurses well, and that she can extend her tongue between her lips -- all very normal findings. Your observation that she does not close her lips very often is also a very normal finding and nothing at all to be concerned about. Any sounds that she is producing would be expected to resemble vowels and a few consonants, so she is progressing beautifully in vocal play.

Here is some background information about the tongue that you might find helpful: All infants and young children start out with an undeveloped nervous system. The most primitive movement pattern of the tongue is a forward projection. As children grow and mature, they develop the added ability to move the tongue tip up against the upper gum ridge for speaking and swallowing. In infancy, they will push the tongue forward to suck and swallow -- this is a normal finding and a normal developmental stage. If the tongue is restricted in its forward movement, you could suspect a short lingual frenum. This situation is also referred to as a tongue tie, as you mentioned in your question. The lingual frenum is the connective tissue strand that runs on the underside of the tongue, extending from beyond the tongue tip, back and down to the floor of the mouth. The frenum is located within a connective tissue sheath or bed, so that is where the term "submucosal" comes from (within or under the mucosa, or the covering over the base of the tongue and floor of the mouth). Your report that your daughter freely protrudes her tongue and you consider it long, extending between the lips, is a excellent indicator that her lingual frenum is normal in length; that is, she does not have a tongue tie.. Please do not worry about the need for clipping the lingual frenum in your daughter, as it is not indicated -- and for your information, if ever a lengthening procedure is needed for a child, a "clipping" would not be the procedure of choice. Although the term "clipping the tongue" is familiar to the public, the usual procedure is a surgical lengthening procedure at the base of the floor of the mouth. In plastic surgery, this is called a Z-plasty.

Let me assure you that the tongue patterns that you are seeing in your daughter are very normal for a 3 month old, and the sounds she is making are also quite normal. I would like to encourage you not to look so carefully at how she is functioning. There is no need for worry. As you report, she is sucking and feeding normally and is protruding her tongue. This is what is expected and hoped for at 3 months of age, and I am delighted to read this description of your baby. If you have other concerns about whether your daughter is functioning normally, you should share your concerns with your pediatrician. The next time you visit your pediatrician, you might want to share my response to your question, as your pediatrician is always interested in your concerns and any advice you have received.

Thank you again for this question, and I hope that my response to it gives you some comfort and peace of mind. Please relax and enjoy this special time in your life and the life of your daughter.

Robert M. Mason, DMD, Ph.D. is a speech-language pathologist, a dentist, and orthodontist. He is a Past President of the American Cleft Palate-Craniofacial Association, a professional, interdisciplinary organization specializing in problems associated with facial and oral deformities. Dr. Mason has studied and written extensively about developmental problems related to the tongue. His reports have appeared in speech, dental, medical, and plastic surgical journals and texts. He is considered to be an expert in tongue thrusting, tongue tie, and other problems related to tongue functions and speech.