AIMS OF THE STUDY Tongue lacerations are common in children, occurring mostly from falls or sports injuries. Optimal treatment of tongue lacerations is a challenge for paediatricians due to contradictory recommendations and a lack of current guidelines. It remains unclear which tongue lacerations should be sutured and which would benefit from spontaneous healing, which is a promising alternative. In recent years, the treatment of choice in our paediatric emergency department (ED) has shifted from generally suturing the wounds to more frequently advising secondary wound healing. The aim of this study was to analyse tongue lacerations treated at our ED in order to develop guidance for the optimal management of tongue lacerations in children. METHODS This retrospective study was conducted to assess tongue lacerations at the ED of a University Children's Hospital Zurich from January 2010 to August 2015. All families were contacted for informed consent and photo documentation of the healed tongue. Clinical records of all the patients included were reviewed and different variables were defined and analysed. RESULTS A total of 73 children with tongue lacerations were included (75.3% boys, mean age ± standard deviation 4.0 ± 2.6 years). The mean size of the lacerations was 12.4 ± 8.3 mm, with affected tongue borders in 51 cases (69.9%) and a through-and-through laceration in 23 patients (31.5%). A primary wound closure was performed in 12 children (16.4%). These wounds were significantly larger than those of the secondary wound healing group (21 ± 10 mm compared to 10.8 ± 6.8 mm), presented gaping wound edges with the tongue at rest more frequently (91.7% compared to 32.8%), and showed through-and-through lacerations more often (91.7% compared to 19.7%). The group with wound suturing needed longer to recover (median 13 days compared to 6.2 days) and had a higher rate of complications (25 vs 3.3%). CONCLUSIONS Suturing is not required in gaping tongue lacerations less than 2 cm long that do not involve the tip of the tongue. The Zurich Tongue Scheme was developed as a guide for clinicians when deciding which tongue lacerations need suturing.