WHAT IS A TONGUE TIE?
Hint... It is more than just appearance...
A tongue tie (ankyloglossia) is a condition present at birth in which the thin band of tissue under the tongue (the lingual frenulum) is unusually short, thick, or tight. Lip or buccal (cheek) ties can occur alongside it; together these are called "Tethered Oral Tissues" (TOTs). TOTs may restrict the mouth’s muscle movement needed for effective feeding — like trying to run a marathon with your shoes tied together.
Because the tongue plays a key role in feeding, swallowing, speech, and oral development, restrictions can lead to difficulty latching or transferring milk, nipple pain, long or inefficient feeds, gassiness, or poor weight gain. Some children and adults may also experience speech or oral function concerns.
Oral tethers vary in severity, and not all need treatment. When symptoms are present, evaluation by a trained Infant Feeding Specialist (such as a TOTS-certified IBCLC, SLP, OT, or pediatric dentist) can help determine whether supportive care, therapy, or a simple release procedure may be beneficial.
Common Symptoms of tongue ties
Common symptoms of a Oral Tethers / tongue tie (ankyloglossia) can vary depending on age and severity. Not all individuals with a tongue tie experience problems, but when symptoms are present, they often relate to feeding and oral function.
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In Breast/Chestfeeding Infants
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Difficulty latching or staying latched
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Shallow latch or frequent slipping off the breast
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Clicking sounds while feeding
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Frequently coughing and pulling off and gasping throughout feeds
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Prolonged feeds or very frequent feeding
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Falling asleep quickly at the breast but seeming unsatisfied
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Poor milk transfer or slow weight gain
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Excessive gassiness, reflux-like symptoms, or fussiness
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Milk leaking from the mouth during feeds
In the Nursing Parent
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Nipple pain, pinching, or damage (cracks, blisters, compression lines)
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Misshapen nipples after feeds
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Recurrent plugged ducts or mastitis
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Low milk supply or decreasing supply over time
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Feeling that feeding is exhausting or ineffective
In Bottle-Fed Infants
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Difficulty maintaining suction on the bottle
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Clicking, gulping, or coughing during feeds
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Excessive air intake leading to gassiness
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Milk leaking from the sides of the mouth
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Prolonged feeding times
In Older Babies and Children
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Difficulty managing solids or textured foods
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Gagging or choking on foods
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Messy eating or difficulty moving food around the mouth
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Speech articulation challenges (in some cases)
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Difficulty licking lips, ice cream, or cleaning food from teeth
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Mouth breathing or open-mouth posture
In Adults
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Ongoing speech or oral function concerns
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Jaw tension, clenching, or discomfort
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Difficulty with oral hygiene or certain oral movements
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Poor sleep quality (sleep apnea, snoring, etc.)
Because symptoms can overlap with many other conditions, a comprehensive feeding and oral function assessment by a qualified provider is important to determine whether a tongue tie is contributing to the concerns and what support may help.
What does the research say?
Not Every Tongue Tie Needs Treatment
Many babies with tongue ties feed normally and never require a release.
Professional guidelines emphasize that intervention is most appropriate when significant feeding problems are present.
Assessment Matters More Than Appearance
Tongue-tie decisions should be based on how the tongue functions during feeding — not simply how it looks.
In one study, a comprehensive feeding evaluation prevented surgery in over 60% of infants referred for release, because other causes of feeding difficulty were identified.
Support Before and After the Procedure Is Important
Research consistently shows better outcomes when families receive skilled feeding support both before and after a release.
Babies may need time to learn new movement patterns once restriction is removed.
Results Can Be Immediate or Gradual
Some families notice rapid improvement, while others experience gradual progress over days or weeks as coordination and milk transfer improve.
Objective feeding measures have been shown to improve within about 10 days in some studies.
When a Release May Be Most Helpful
Research suggests frenotomy is most beneficial when BOTH are present:
Restricted tongue movement AND Clear feeding difficulties (pain, poor milk transfer, slow weight gain, etc.)
Our approach
Step 1: Initial Assessment
We want to hear the whole story. Evaluating for a tongue tie and determining the best steps forward is much more complex than a quick glance in your baby's mouth. Our initial evaluation includes:
- Full History of Baby's Feeding Journey
- Functional Oral Assessment
- Latch / Feeding Evaluation
- Weighted Feed
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Every step of a thorough feeding assessment is essential in determining whether your baby’s ORAL FUNCTION is being impacted by their ANATOMY. Many parents are told, “But so many people examined my baby in the hospital and said there was no tongue tie.” What’s often not explained is that many of the most common symptoms do not appear until days or weeks after discharge, when milk supply increases and feeding demands change.
Identifying a tongue tie requires a detailed functional evaluation by an Infant Feeding Specialist — a level of assessment that goes far beyond what hospital staff can reasonably provide, as their primary role is to ensure a safe birth and immediate postpartum recovery (a role for which we are deeply grateful).
Hospital-based lactation support, when available, is invaluable for getting feeding off to a strong start; however, establishing comfortable, effective breastfeeding is an evolving process that typically unfolds over 4–6 weeks. Ongoing, specialized support during this time is often essential to fully assess feeding challenges and determine whether oral restrictions are affecting your baby’s ability to feed well.
Step 2: Connect
If your baby is showing signs that indicate a possible Tongue Tie that is impacting ORAL FUNCTION, we will connect you to a provider who can provide a Tongue Tie Release procedure (aka Frenectomy). Typically we work closely with Pediatric Dentists who can diagnose and treat (we are not doctors, so we cannot diagnose).
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Commonly the procedure itself may not be an immediate fix to every feeding issue, therefore we frequently recommend ​additional therapies such as bodywork, or support provided by an Occupational Therapist, or Speech Language Pathologist.
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There are also situations in which it is appropriate to START with bodywork, OT or SLP prior to moving forward with a procedure, and we work together with you to determine what would be best for your specific situation.
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We strongly believe that the Gold Standard for Tongue Tie Care should include a collaborative TEAM APPROACH and we have a wonderful community of practitioners who specialist in optimizing your baby's feeding and your experience.
Step 3: Ongoing Lactation Support
We strongly recommend following up with us after a procedure or treatment from another supporting practitioner so we can continue to evaluate that your feeding journey is moving in the right direction, whether that means no longer needing a nipple shield, eliminating the need for supplemental feeds, triple feeding or eliminating nipple pain.
Continued Lactation Support is critical until you feel fully comfortable and that your feeding plan is sustainable and realistic for your life.
Ready to Schedule Your Initial Assessment?
Remember... you deserve to have an enjoyable and sustainable feeding experience with your baby. We are here to optimize that experience and work alongside you to make that happen. You do not need to suffer through pain, stressful feeds or endless pumping to make breastfeeding work.
ADDITIONAL Resources
What is a Tongue Tie
Alabama Tongue Tie Center - Images of tethered oral tissues
​Health Latch - Why Babies Suck Book
​​​​​The Research:
Buryk et al. Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial. Pediatrics, 2011.
Emond et al. Randomised controlled trial of early frenotomy in breastfed infants.
Ghaheri et al. Objective Improvement After Frenotomy for Posterior Tongue-Tie.
BMC Pregnancy & Childbirth. Effect of frenotomy on breastfeeding variables.
UNICEF Baby Friendly Initiative. Tongue-Tie Research Summary.
Canadian Paediatric Society. Ankyloglossia and breastfeeding position statement.
Webb et al. Systematic review of tongue-tie division for breastfeeding.
Caloway et al. Comprehensive feeding evaluation and frenotomy rates.
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