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The tongue is secured to the front of the mouth partly by a band of tissue called the lingual frenulum. If the frenulum is short, it can restrict the movement of the tongue. This is commonly called a tongue-tie.

Children with a tongue-tie can’t stick their tongue out past their lower lip, or touch their tongue to the top of their upper teeth when their mouth is open. When they stick out their tongue, it looks notched or heart-shaped. Since babies don’t routinely stick out their tongues, a baby’s tongue may be tied if you can’t get a finger underneath the tongue.

How common are tongue-ties?

Tongue-ties are common. It’s hard to say exactly how common, as people define this condition differently. About 8% of babies under age one may have at least a mild tongue-tie.

Is it a problem if the tongue is tied?

This is really important: tongue-ties are not necessarily a problem. Many babies, children, and adults have tongue-ties that cause them no difficulties whatsoever.

There are two main ways that tongue-ties can cause problems:

• They can cause problems with breastfeeding by making it hard for some babies to latch on well to the mother’s nipple. This causes difficulty with feeding for the baby and sore nipples for the mother. It doesn’t happen to all babies with a tongue-tie; many of them can breastfeed successfully. Tongue-ties are not to blame for gassiness or fussiness in a breastfed baby who is gaining weight well. Babies with tongue-ties do not have problems with bottle-feeding.
• They can cause problems with speech. Some children with tongue-ties may have difficulty pronouncing certain sounds, such as t, d, z, s, th, n, and l. Tongue-ties do not cause speech delay.

What should you do if think your baby or child has a tongue-tie?

If you think that your newborn is not latching well because of a tongue-tie, talk to your doctor. There are many, many reasons why a baby might not latch onto the breast well. Your doctor should take a careful history of what has been going on, and do a careful examination of your baby to better understand the situation.

You should also have a visit with a lactation specialist to get help with breastfeeding — both because there are lots of reasons why babies have trouble with latching on, and also because many babies with a tongue-tie can nurse successfully with the right techniques and support.

Talk to your doctor if you think that a tongue-tie could be causing problems with how your child pronounces words. Many children just take some time to learn to pronounce certain sounds. It is also a good idea to have an evaluation by a speech therapist before concluding that a tongue-tie is the problem.

What can be done about a tongue-tie?

When necessary, a doctor can release a tongue-tie using a procedure called a frenotomy. A frenotomy can be done by simply snipping the frenulum, or it can be done with a laser.

However, nothing should be done about a tongue-tie that isn’t causing problems. While a frenotomy is a relatively minor procedure, complications such as bleeding, infection, or feeding difficulty sometimes occur. So it’s never a good idea to do it just to prevent problems in the future. The procedure should only be considered if the tongue-tie is clearly causing trouble.

It’s also important to know that clipping a tongue-tie doesn’t always solve the problem, especially with breastfeeding. Studies do not show a clear benefit for all babies or mothers. That’s why it’s important to work with a lactation expert before even considering a frenotomy.

If a newborn with a tongue-tie isn’t latching well despite strong support from a lactation expert, then a frenotomy should be considered, especially if the baby is not gaining weight. If it is done, it should be done early on and by someone with training and experience in the procedure.

What else should parents know about tongue-tie procedures?

Despite the fact that the evidence for the benefits of frenotomy is murky, many providers are quick to recommend them. If one is being recommended for your child, ask questions:

• Make sure you know exactly why it is being recommended.
• Ask whether there are any other options, including waiting.
• Talk to other health care providers on your child’s care team, or get a second opinion.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Chocolates and flowers are great gifts for Valentine’s Day. But what if the gifts we give then or throughout the year could be truly life-changing? A gift that could save a life or free someone from dialysis?

You can do this. For people in need of an organ, tissue, or blood donation, a donor can give them a gift that exceeds the value of anything that you can buy. Fittingly, Valentine’s Day is also known as National Donor Day, a time for blood drives and sign-ups for organ and tissue donation. Have you ever wondered what can be donated? Had reservations about donating after death or concerns about risks for live donors? Read on.

The enormous impact of organ, tissue, or cell donation

Imagine you have kidney failure requiring dialysis 12 or more hours each week just to stay alive. Even with this, you know you’re still likely to die a premature death. Or, if your liver is failing, you may experience severe nausea, itching, and confusion; death may only be a matter of weeks or months away. For those with cancer in need of a bone marrow transplant, or someone who’s lost their vision due to corneal disease, finding a donor may be their only good option.

Organ or tissue donation can turn these problems around, giving recipients a chance at a long life, a better quality of life, or both. And yet, the number of people who need organ donation far exceeds compatible donors. While national surveys have found about 90% of Americans support organ donation, only 40% have signed up. More than 103,000 women, men, and children are awaiting an organ transplant in the US. About 6,200 die each year, still waiting.

What can you donate?

The list of ways to help has grown dramatically. Some organs, tissues, or cells can be donated while you’re alive; other donations are only possible after death. A single donor can help more than 80 people!

After death, people can donate:

• bone, cartilage, and tendons
• corneas
• face and hands (though uncommon, they are among the newest additions to this list)
• kidneys
• liver
• lungs
• heart and heart valves
• stomach and intestine
• nerves
• pancreas
• skin
• arteries and veins.

Live donations may include:

• birth tissue, such as the placenta, umbilical cord, and amniotic fluid, which can be used to help heal skin wounds or ulcers and prevent infection
• blood cells, serum, or bone marrow
• a kidney
• part of a lung
• part of the intestine, liver, or pancreas.

To learn more about different types of organ donations, visit Donate Life America.

Becoming a donor after death: Questions and misconceptions

Common misconceptions about becoming an organ donor limit the number of people who are willing to sign up. For example, many people mistakenly believe that

• doctors won’t work as hard to save your life if you’re known to be an organ donor — or worse, doctors will harvest organs before death
• their religion forbids organ donation
• you cannot have an open-casket funeral if you donate your organs.

None of these is true, and none should discourage you from becoming an organ donor. Legitimate medical professionals always keep the patient’s interests front and center. Care would never be jeopardized due to a person’s choices around organ donation. Most major religions allow and support organ donation. If organ donation occurs after death, the clothed body will show no outward signs of organ donation, so an open-casket funeral is an option for organ donors.

Live donors: Blood, bone marrow, and organs

Have you ever donated blood? Congratulations, you’re a live donor! The risk for live donors varies depending on the intended donation, such as:

• Blood, platelets, or plasma: If you’re donating blood or blood products, there is little or no risk involved.
• Bone marrow: Donating bone marrow requires a minor surgical procedure. If general anesthesia is used, there is a chance of a reaction to the anesthesia. Bone marrow is removed through needles inserted into the back of the pelvis bones on each side. Back or hip pain is common, but can be controlled with pain relievers. The body quickly replaces the bone marrow removed, so no long-term problems are expected.
• Stem cells: Stem cells are found in bone marrow or umbilical cord blood. They also appear in small numbers in our blood and can be donated through a process similar to blood donation. This takes about seven or eight hours. Filgrastim, a medication that increases stem cell production, is given for a number of days beforehand. It can cause side effects such as flulike symptoms, bone pain, and fatigue, but these tend to resolve soon after the procedure.
• Kidney, lung, or liver: Surgery to donate a kidney or a portion of a lung or liver comes with a risk of complications, reactions to anesthesia, and significant recovery time. It’s no small matter to give a kidney, or part of a lung or liver.

The vast number of live organ donations occur without complications, and donors typically feel quite positive about the experience.

Who can donate?

Almost anyone can donate blood cells –– including stem cells –– or be a bone marrow, tissue, or organ donor. Exceptions include anyone with active cancer, widespread infection, or organs that aren’t healthy.

What about age? By itself, your age does not disqualify you from organ donation. In 2023, two out of five people donating organs were over 50. People in their 90s have donated organs upon their deaths and saved the lives of others.

However, bone marrow transplants may fail more often when the donor is older, so bone marrow donations by people over age 55 or 60 are usually avoided.

Finding a good match: Immune compatibility

For many transplants, the best results occur when there is immune compatibility between the donor and recipient. Compatibility is based largely on HLA typing, which analyzes genetically-determined proteins on the surface of most cells. These proteins help the immune system identify which cells qualify as foreign or self. Foreign cells trigger an immune attack; cells identified as self should not.

HLA typing can be done by a blood test or cheek swab. Close relatives tend to have the best HLA matches, but complete strangers may be a good match as well.

Fewer donors among people with certain HLA types make finding a match more challenging. Already existing health disparities, such as higher rates of kidney disease among Black Americans and communities of color, are worsened by lower numbers of donors from these communities, an inequity partly driven by a lack of trust in the medical system.

The bottom line

You can make an enormous impact by becoming a donor during your life or after death. In the US, you must opt in to be a donor after death. (Research suggests the opt-out approach many other countries use could significantly increase rates of organ donation in this country.)

I’m hopeful that organ donation in the US and throughout the world will increase over time. While you can still go with chocolates for Valentine’s Day, maybe this year you can also go bigger and become a donor.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

When measles broke out in 31 states several years ago, health experts were surprised to see more than 1,200 confirmed cases –– the largest number reported in the US since 1992.

Measles is a very contagious, preventable illness that may cause serious health complications, especially in younger children and people who are pregnant, or whose immune systems aren’t working well. While a highly effective vaccine is available, vaccination rates are low in some communities across the US. This sets the stage for large outbreaks.

Here are four things that everyone needs to know about measles.

Measles is highly contagious

This is a point that can’t be stressed enough. A full 90% of unvaccinated people exposed to the virus will catch it. And if you think that just staying away from sick people will do the trick, think again. Not only are people with measles infectious for four days before they break out with the rash, but the virus can live in the air for up to two hours after an infectious person coughs or sneezes. Just imagine: if an infectious person sneezes in an elevator, everyone riding that elevator for the next two hours could be exposed.

It’s hard to know that a person has measles when they first get sick

The first symptoms of measles are a high fever, cough, runny nose, and red, watery eyes (conjunctivitis), which could be confused with any number of other viruses, especially during cold and flu season. After two or three days people develop spots in the mouth called Koplik spots, but we don’t always go looking in our family members’ mouths. The characteristic rash develops three to five days after the symptoms begin, as flat red spots that start on the face at the hairline and spread downward all over the body. At that point you might realize that it isn’t a garden-variety virus — and at that point, the person would have been spreading germs for four days.

Measles can be dangerous

Most of the time, as with other childhood viruses, people weather it fine, but there can be complications. Children less than 5 years old and adults older than 20 are at highest risk of complications. Common and milder complications include diarrhea and ear infections (although the ear infections can lead to hearing loss), and one out of five will need to be hospitalized, but there also can be serious complications:

• One in 20 people with measles gets pneumonia. This is the most common cause of death from the illness.
• One in 1,000 gets encephalitis, an inflammation of the brain that can lead to seizures, deafness, or even brain damage.
• One to three in 1,000 children who get it will die.

Another possible complication can occur seven to 10 years after infection, more commonly when people get the infection as infants. It’s called subacute sclerosing panencephalitis, or SSPE. While it is rare (four to 11 out of 100,000 infections), it is fatal.

Vaccination prevents measles

The measles vaccine, usually given as part of the MMR (measles-mumps-rubella) vaccine, can make all the difference. One dose is 93% effective in preventing illness; two doses gets that number up to 97%. 

• Usually, the first dose is given between ages 12 to 15 months.
• A second (booster) dose is commonly given between ages 4 to 6, although it can be given as early as a month after the first dose.
• If an infant ages 6 to 12 months will be going to a place where measles regularly occurs, a dose of vaccine can be given as protection. This extra dose will not count as part of the required series of two vaccines.

The MMR is overall a very safe vaccine. Most side effects are mild, and it does not cause autism. Most children in the US are vaccinated, with 91% of 24-month-olds having at least one dose and about 93% of those entering kindergarten having two doses.

Herd immunity occurs when enough people are vaccinated that it’s hard for the illness to spread. It helps protect those who can’t get the vaccine, such as young infants or those with weak immune systems. To achieve this you need about 95% vaccination, so the 93% isn’t perfect — and in some states and communities, that number is even lower. Most of the outbreaks we have seen over the years have started in areas where there are high numbers of unvaccinated children.

If you have questions about measles or the measles vaccine, talk to your doctor. The most important thing is that we keep every child, every family, and every community safe.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Are online gambling and sports betting new to your area? Are gambling advertisements catching your eye? Have you noticed sports and news shows covering the spread? Recent changes in laws have made gambling widely accessible, and its popularity has soared.

Occasional bets are rarely an issue. But uncontrolled gambling can lead to financial, psychological, physical, and social consequences, some of which are extreme. Understanding whether gambling is becoming a problem in your life can help you head off the worst of these issues and refocus on having more meaning, happiness, and psychological richness in your life. Gambling screening is a good first step.

Can you screen yourself for problem gambling?

Yes. Screening yourself is easy. The Brief Biosocial Gambling Screen (note: automatic download) is a validated way to screen for gambling disorder. It has three yes-or-no questions. Ask yourself:

• During the past 12 months, have you become restless, irritable, or anxious when trying to stop/cut down on gambling?
• During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
• During the past 12 months, did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends, or welfare?

What do your answers mean?

Answering yes to any one of these questions suggests that you are at higher risk for experiencing gambling disorder. Put simply, this is an addiction to gambling. Like other expressions of addiction, for gambling this includes loss of control, craving, and continuing despite bad consequences. Unique to gambling, it also often means chasing your losses.

A yes doesn’t mean that you are definitely experiencing a problem with gambling. But it might be valuable for you to seek a more in-depth assessment of your gambling behavior. To find an organization or person qualified to help, ask a health care provider, your local department of public health, or an advocacy group like the National Council on Problem Gambling.

Are you ready for change?

Your readiness to change a behavior matters when deciding the best first steps for making a change. If someone asks you whether you want to change your gambling, what would you say?

Depending on your answer, you might seek out different solutions. What’s most important initially is choosing a solution that feels like the right fit for you.

What if you don’t feel ready to change? If you haven’t thought about your gambling or only occasionally think about changing your gambling, you might explore lower intensity actions. For example, you could

• read more about how gambling could create a problem for you
• listen to stories of those who have lived experience with gambling disorder.

If you are committed to making a change or are already trying to change, you might seek out more engaging resources and strategies to support those decisions, like attending self-help groups or participating in treatment.

Read on for more details on choices you might make.

What options for change are available if you want to continue gambling?

If you want to keep gambling in some way, you might want to stick to lower-risk gambling guidelines:

• gamble no more than 1% of household income
• gamble no more than four days per month
• avoid regularly gambling at more than two types of games, such as playing the lottery and betting on sports.

Other ways to reduce your risk of gambling harm include:

• Plan ahead and set your own personal limits.
• Keep your entertainment budget in mind if you decide to gamble.
• Consider leaving credit cards and debit cards at home and use cash instead.
• Schedule other activities directly after your gambling to create a time limit.
• Limit your use of alcohol and other drugs if you decide to gamble.

What are easy first steps toward reducing or stopping gambling?

If you’re just starting to think about change, consider learning more about gambling, problem gambling, and ways to change from

• blogs, like The BASIS
• books like Change Your Gambling, Change Your Life
• podcasts like After Gambling, All-In, and Fall In, which offer expert interviews, personal recovery stories, and more.

Some YouTube clips demystify gambling, such as how slot machines work, the limits of skill and knowledge in gambling, and how gambling can become an addiction. These sources might help you think about your own gambling in new ways, potentially identifying behaviors that you need to change.

What are some slightly more active steps toward change?

If you’re looking for a slightly more active approach, you can consider engaging in traditional self-help experiences such as helplines and chatlines or Gamblers Anonymous.

Another option is self-help workbooks. Your First Step to Change is a popular workbook that provides information about problem gambling, self-screening exercises for gambling and related conditions like anxiety and depression, and change exercises to get started. A clinical trial of this resource suggested that users were more likely than others to report having recently abstained from gambling.

Watch out for gambling misinformation

As you investigate options, keep in mind that the quality of information available can vary and may even include misinformation. Misinformation is incorrect or misleading information. Research suggests that some common types of gambling misinformation might reinforce harmful beliefs or risky behaviors.

For example, some gambling books, websites, and other resources exaggerate your likelihood of winning, highlight win and loss streaks as important (especially for chance-based games like slots), and suggest ways to change your luck to gain an edge. These misleading ideas can help you to believe you’re more likely to win than you actually are, and set you up for failure.

The bottom line

Taking a simple self-screening test can start you on a journey toward better gambling-related health. Keep in mind that change can take time and won’t necessarily be a straight path.

If you take a step toward change and then a step back, nothing is stopping you from taking a step forward again. Talking with a care provider and getting a comprehensive assessment can help you understand whether formal treatment for gambling is a promising option for you.

About the Author

Debi LaPlante, PhD, Contributor

Dr. Debi LaPlante is director of the division on addiction at the Cambridge Health Alliance, and an associate professor of psychiatry at Harvard Medical School. She joined the division in 2001 and is involved with its … See Full Bio View all posts by Debi LaPlante, PhD