Are you overwhelmed with the information available about tongue ties and oral restrictions or concerned your baby has ties? Many myths and misinformation are circulating on the topic, which can make it more confusing for parents. Let’s take a deep dive into how the tongue functions during feeding, what happens when it is restricted, and how to navigate the tongue tie release process for best results.
Ankyloglossia is the scientific term for tongue tie. The tongue is made up of a group of eight muscles and is always at work. The tongue is involved in feeding, swallowing, jaw development, and speech and impacts our breathing. Being able to move correctly and without restriction is essential for all its functions to be performed properly. When it can not move freely, it affects our whole system.
The lingual frenulum connects the tongue to the floor of the mouth. The frenulum is a band of tissue which is part of the fascial system. (1) Everyone has a frenulum under their tongue, and it is a normal part of our anatomy. A tongue tie refers to a frenulum that restricts the tongue’s ability to move and properly function.
Did You Know?
The tongue is connected through the fascial system through the body all the way down to the toes.(3) This is very important to understand. It means that if there is a tongue tie, there is likely tightness in other areas of the body that can also impact the babies ability to comfortably and efficiently nurse.
Fascia is a system of connective tissue below the skin that surrounds and supports muscles, organs, nerves and bones. When the fascia is tight, it impacts the ability of our body to move freely and comfortably. It is like wearing clothes that are too tight making it hard to bend and move. We want our fascia to be loose, unrestricted and able to bend and move with ease. If we pull one part of the fascia tight, like having a tongue tie, the consequence is it pulls on everything else connected to it.(4) Breastfeeding is a whole body experience for your baby and not just about what their latch might look like.
The tongue normally separates from the floor of the mouth in utero. Tongue tie is a birth defect found in 4% - 10% of babies.(2) This may be on the low side because not all practitioners are proficient at assessing ties and many ties go undiagnosed until later in life. Undiagnosed oral restrictions have led many parents to stop their breastfeeding experience short. There are solutions!
The tongue during breastfeeding
As your baby opens their mouth nice and wide and you bring them towards you to latch, their tongue will be out over their bottom gum line and cup the areolar tissue, drawing it into their mouth. The nipple extends back toward where the hard palate meets the soft palate on the roof of the mouth. The lips form a seal at the breast. While the tongue remains extended, cupping the breast, it begins to compress the breast tissue, moving in a rhythmic wave-like pattern front to back, requiring the entire tongue to have the freedom to move upward away from the floor of the mouth.
If the tongue is tied down and unable to lift properly, the baby may compensate by not latching as deeply onto the breast. A more shallow latch also reduces the amount of milk they are able to remove, which can decrease the parent’s milk supply as well as cause poor weight gain for the baby.
As your baby continues to suck, a bolus of milk collects, and the tongue aids in swallowing while allowing the baby to breathe. (7) When a baby has a full range of motion of the tongue, the process of suck - swallow - breathe sounds smooth and comfortable. When there is a restriction, it may sound disorganized or sporadic rather than rhythmic. Without being able to use the back of the tongue, swallowing can be challenging, and your baby may sound like they are sputtering or gagging. Clicking is heard when there is a loss of suction. If the tongue loses contact with the breast tissue, suction is broken, and you will hear a clicking sound.
When not active, the tongue should rest on the roof of the mouth. The muscle of the tongue is what helps to spread the palate wide and away from the nasal cavity. (5) When the tongue remains low in the mouth, the palate remains high, and the jaw develops in a narrow rather than a wide arch. Babies can sound stuffy or like they have nasal congestion when their palate is high. This narrow, high palate impeding on the nasal cavity can make breathing harder, and you may see your baby keep their mouth open. Sometimes, an open-mouth posture is noticed only while they are sleeping.
A tongue tie can not be identified by just looking at a baby’s latch, just looking in their mouth, and definitely not from just a photo.
Symptoms the parent may experience:
Pain while nursing
Lipstick-shaped nipple after nursing
Plugged ducts or mastitis
Low milk supply
Cracked, bleeding, or damaged nipples
Symptoms the baby may have:
Difficulty latching
Shallow latch
Clicking sound while nursing
Lip blister(s)
Gas and hiccups
Tires quickly while feeding
Low weight gain
Falls asleep quickly at the breast
Reflux
Difficulty handling milk flow, choking or sputtering
Strong gag reflex
Torticollis
Seems hungry all the time
Difficulty drinking from a bottle
Difficulty with solid food
If you are checking off any of the symptoms above, it is time to find an IBCLC (International Board Certified Lactation Consultant) experienced with oral function and habilitation. Not all lactation consultants or pediatric providers have taken the continuing education required to obtain the skill sets needed for assessment and to help correct compensations babies and parents make when ties are present. Your IBCLC will recommend, communicate, and coordinate with the other care providers required to resolve the oral restrictions correctly and the effects oral restrictions have throughout the rest of the body. The best results in resolving ties come from a team-based approach led by your IBCLC.
The Role of the IBCLC
An IBCLC spends the time to take a complete health history for you, your baby, and your feeding experience. Not everyone experiences the same symptoms with tongue ties, so this information collection is very important for helping determine other areas of the body that are being affected due to the tightness under the tongue. Together, you will develop a care plan that is individualized and specifically designed for you and your baby. An IBCLC is the only provider who considers the dyad when assessing breastfeeding and improving feeding problems. Other care providers on your care team can play a role in the care plan, but it is the IBCLC who should guide the process.
Seeing how your baby nurses and/or bottle feeds and listening to the symptoms you and your baby are experiencing is essential since each parent and baby dyad is unique. An oral assessment can be performed in person or virtually as your IBCLC guides you. An oral assessment includes looking for signs of restriction under the tongue and the other frenum in the mouth: the upper lip (labial), lower lip, and 4 areas of the cheeks (buccal).
Your IBCLC will also assess your baby’s reflexes, observing their whole body to determine where muscle tension and strain patterns are contributing to their feeding challenges. Babies and parents make compensations during positioning and latching for more effective feeding and milk transfer. Although these compensations help to feed the baby, they are not optimal for comfortable and efficient milk removal, milk supply, or the baby's development.
After Assessment
Your IBCLC will give oral and body exercises to begin loosening tension and tight fascia. There is no one-size-fits-all plan, and the exercises may change as you work together.
Bodywork will be a part of the care plan to address structural issues.
Release provider - If the release provider does not require you to work with an IBCLC and have bodywork done before and after the procedure, discuss this with your IBCLC or find a different release provider. It can indicate their lack of understanding of how the whole body matters and lack of preparation can result in an incomplete release or less optimal outcomes.
The preparation done by you at home with instruction from your IBCLC and the bodywork your baby gets allows the release provider, often a pediatric dentist, to do their work more easily. Preparation helps the baby gain as much mobility with their tongue as possible, relax muscles being overworked, and strengthen other muscles needed for better outcomes after the tissue is released. When the prep work is not done, it can result in no change in symptoms, worse symptoms, tissue reattachment, or breast refusal.
"Tongue-tie release is a process, not a procedure."
Jennifer Tow, IBCLC, LMT, CSOM
Your IBCLC will give you information on what to expect during the process of releasing tongue ties and the aftercare involved. When your baby is restricted, it is like having a rubber band that, if we stretch it, may loosen, but the tension is not gone. When the tie is released, oral exercises and bodywork therapy continue. The tongue muscle learns how to move properly with its full range of motion. The body has more freedom of movement with less tightness, making positioning at the breast more comfortable.
Symptoms in older children & adults
Tongue tie symptoms extend beyond breastfeeding. If restrictions and strain patterns exist, they can be maintained but will only go away by addressing the cause. Some parents experience no pain during feeding, and their baby gains weight just fine. Symptoms may not be recognized until later in life. (6)
Difficulty with solid foods
Gag on foods or throwing up after eating
Speech delays
Difficulty forming certain sounds
Mouth breathing
Cavities
Crowded teeth
Poor sleep
Allergies
Behavior problems
Difficulty concentrating
Bedwetting
Chronic sinus infections
Enlarged adenoids or tonsils
Headaches
Chronic neck and shoulder pain
TMJ pain
Jaw clicking
Recessed gums
Sleep apnea
Myths about tongue tie
Your baby will outgrow the tongue tie
Tongue ties stretch over time
You have to wait until your child is 1 - 2 years old to release a tie
Lip ties don’t affect feeding
If your baby is gaining weight, there is no need to release a tongue tie
If the baby can stick their tongue out over their bottom gum line, they aren’t tongue-tied
Posterior tongue tie doesn’t exist
Treating tongue ties is just a new fad
Buccal ties do not impact breastfeeding
Buccal ties should not be released in babies
Many myths and misinformation are given to parents about tongue ties and oral restrictions. Understanding how the tongue works and its connection to the rest of the body can help connect the dots of symptoms experienced by the parent and baby if you suspect a tongue tie. Remember, not all providers have the same continuing education or skill sets for proper assessment. If you recognize symptoms of ties affecting you and your baby, step one is to call an IBCLC who has experience in oral function. Correcting a tongue tie with the proper preparation and follow-up care can lead to better overall growth, development, and wellness.
We had a rough time because I didn’t know this information beforehand. My older son even had a tie which was “released” in the NICU and I never really gave it another thought but now he suffers so so many problems because of it (and can’t get it released due to not having enough room for his tongue if it is released.) My daughter had hers released at 5 weeks old, and it failed so had it redone at 5 months. By then she was so old that she was still unable to transfer to breast but I hope that she will still avoid some of the problems later on that come with being tied.
I got my tie released as well, after doing all the research for my daughter. (34 years old!) And I regret going through life for so long with a tie – I didn’t even realize I had one. So many issues could have been avoided for me! I wish that it was more commonly checked for and that more people were trained to release and work with those who have had a release. ——— Legendairy Milk replied: ❤️ Thank you for sharing your journey! We are so glad to hear you are doing so well after getting your tie released as well!
I would love to use this as a handout to give to parents! Could you make this printable and give permission?
Thank you: this is spot on!
Everything you wrote here, I had to work really hard at finding myself.
I’d like to add that pediatricians and ENTs are usually not qualified at diagnosing it. Not even lCs. Only when I went to an LC and an Orthodontist that specialize in oral ties, I finally got a diagnosis.
They have to feel baby’s mouth, not only look at it and suggest bottle feeding untill solids…
Save yourself the time and go to one if you have any suspension
*These statements have not been evaluated by the Food and Drug Administration. Our products are not intended to diagnose, treat, cure, or prevent any disease.
Choosing a selection results in a full page refresh.
