Tongue Tie, Lip Tie, and What Parents Really Need to Know

One of the most common things we see online is parents posting a photo of their baby’s mouth and asking, “Does this look like a tongue tie?” It’s completely understandable to want quick answers. Feeding struggles are stressful. But neither IBCLCs nor experienced moms can diagnose a tongue tie or lip tie from a photo. Oral restrictions are functional diagnoses, not visual ones.

If you suspect your baby may have a tie, here are important principles to understand.

First, a frenum is not automatically a tie. Every human has oral frena. There are seven in total: the lingual frenum under the tongue, the upper and lower labial frena under the lips, and four buccal frena in the cheeks. These are normal stabilizing tissues. They are supposed to be there.

A frenum only becomes a tie when its structure restricts normal function. The key word is function. How does the tongue move? Can it elevate, extend, lateralize? Can the baby maintain suction? Is milk transfer effective? Structure without functional restriction is not a problem.

It’s also important to understand that a true tie will not stretch. Parents are sometimes told to “wait and see” if it loosens. Restrictive tissue does not simply stretch away. However, tension can change, which leads to another critical point.

If bodywork such as chiropractic care, osteopathy, craniosacral therapy, or craniofacial therapy resolves oral tension and that tension does not return, the issue was not caused by a tie. Many babies carry tension from pregnancy or birth that affects feeding but is unrelated to restrictive tissue.

Parents frequently suspect a lip tie. However if there truly is a restrictive upper lip frenum impacting feeding, there is almost always an underlying tongue tie as well, and often buccal ties in the cheeks. When restrictions are present, all functionally significant ties must be addressed for proper resolution.

Because ties are functional diagnoses, a skilled IBCLC must perform a comprehensive functional assessment. This includes observing a full feeding, assessing latch mechanics, evaluating milk transfer, and performing a detailed oral exam. This can be done in person or remotely by someone trained in oral function. A quick peek in the mouth is not sufficient.

Pediatricians, through no fault of their own, are usually not trained in detailed oral functional assessment. If they refer out, it is often directly to an ENT. Best practice is referral to an IBCLC first. Without a functional feeding assessment, it is impossible to determine whether a restriction is truly impacting breastfeeding.

ENTs and dentists vary widely in skill and philosophy. Some perform incomplete releases. Some use unnecessary anesthesia. Some release tissue without understanding feeding mechanics. Any provider who does not require a functional IBCLC assessment before proceeding is not following best practice. Release decisions should never be made in isolation from feeding evaluation.

Preparation matters. No ties should be released unless the baby has been prepared by both an IBCLC and a bodyworker skilled in oral function and habilitation. When releases are done without preparation, many mothers report breast refusal, reattachment, persistent pain, or ongoing feeding issues. A release changes structure. The baby must be ready to use that new mobility.

It is also crucial to recognize that many babies have oral tension that has nothing to do with ties. In utero constraint can play a role. A petite mother carrying a large baby. A twin pregnancy. Breech, transverse, or posterior positioning. A very fast labor. A prolonged labor. Induction with pitocin. Vacuum extraction. Cesarean birth. All of these scenarios can create tension patterns in a baby’s body that affect feeding. Skilled bodywork often resolves these issues completely without surgical intervention.

When ties are truly present, they can have whole body implications. An experienced clinician will look beyond the mouth. At the breast, mothers may compensate in many ways. Some pump to maintain supply because their baby cannot effectively remove milk. Some develop oversupply, which allows the baby to passively feed despite poor tongue function. Others are told they have low supply when in reality the baby is inefficient at feeding.

Beyond infancy, restricted tongue mobility can impact range of motion, posture, breathing patterns, sleep quality, oral rest posture, and even motor development. Some babies demonstrate open mouth breathing, reflux symptoms, slow gut motility, restless sleep, or delayed milestones. That is why a thorough history and complete functional assessment are essential before developing a care plan.

The role of the IBCLC in this process is central. The release provider performs the procedure, but it is not their role to prepare the baby for release. It is the IBCLC’s responsibility to educate the family, teach targeted oral exercises prior to release, reduce inflammation, optimize feeding mechanics, and coordinate care with a skilled bodyworker. Together, the team determines when the baby is truly ready.

The IBCLC also ensures the baby is gaining appropriately, determines whether supplementation is needed, guides the safest method of supplementation, supports milk supply, manages maternal pain, and creates both a pre release and post release care plan. After release, the dyad must replace compensatory feeding patterns with functional ones. Ongoing collaboration with bodywork continues until both mother and baby are no longer compensating.

Families who go directly to a dentist without this support are statistically more likely to experience poor outcomes. Oral function is a specialized area within lactation. Not all IBCLCs have advanced training in ties and habilitation. Parents should ask about specific continuing education and experience in oral function before scheduling a release.

Be cautious about provider skill sets. In some institutional settings such as hospitals, clinics, or WIC offices, IBCLCs may face restrictions that limit their ability to openly discuss oral restrictions. In other cases, time constraints prevent thorough two hour functional assessments. Some lactation staff in institutional environments may not have advanced training in complex feeding issues because they primarily see newborns and do not pursue specialized coursework.

If you suspect a tie, the next step is a comprehensive functional assessment with a skilled IBCLC experienced in oral restrictions. When done properly, with preparation, collaboration, and follow up, outcomes can be excellent. When rushed or incomplete, families often struggle unnecessarily.

Education, skilled assessment, and team based care can make all the difference.