Tongue-Ties
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What is a Tongue-Tie?
A tongue-tie is the common term for ankyloglossia, and refers to a condition present from birth where there is a band of tissue under the tongue that is restricting the tongues ability to move properly. In severe cases, the tongue may be anchored to the floor all the way to the tip of the tongue.
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Why Do Tongue-Ties Matter?
A tongue-tie can interfere with a baby's ability to properly nurse as well as bottle feed. In some cases, a tongue-tie can impact someone throughout their whole life. Using this resource page, check the symptoms’ chart below, and if you feel you need to be assessed, schedule a Virtual Breastfeeding Consultation.
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Is it Always a Tongue-Tie?
I or my baby have some of these symptoms, is it tongue-tie? I really wish it was that simple. Assessing a tongue-tie involves looking for visual clues in the mouth, assessing if baby has full range of motion and use of the tongue, and if baby is capable of properly eating at the breast and/or bottle. Oral dysfunction is complicated.
Symptoms of a Tongue-Tie
What We See While Feeding
Baby Cannot Establish Latch or Maintain a Deep Latch
Biting Down at Breast, particularly in response to letdown.
Choking/Gagging on Milk
Chomping/Piston Motion with Jaw
Clicking or Popping Noise
Dimpling in Cheeks (should be rounded)
Easily Frustrated at Breast
Frequent Feeds (more than 12 in 24 hours should be assessed)
Long Feeds Lasting More than 30 Minutes on Average.
Maternal Discomfort or Nipple Damage While Nursing
Misshapen Nipple After Feeding
Nipple Vasospasms
Popping On/Off Breast (Not Distracted)
Tires Easily or Falls Asleep at Breast
Unable to Maintain Deep Latch
Parent’s Symptoms of a Tongue-Tied Baby:
Cracked or Bleeding Nipples
Low Milk Supply
Nipple pain when nursing
Nipples look pinched or lipstick shape after nursing
Overactive Let-down
Pain in breasts
Painful Oversupply
Recurrent Plugged Ducts, Blisters/Blebs, Mastitis
Recurrent Thrush
Vasospasms
Baby's Symptoms of a Tongue-Tie:
Breast refusal or bottle preference
Cannot Hold Pacifier in Mouth
Colic, Irritability or Reflux-Like Symptoms
Constant Need for Holding/Seems Overstimulated
Difficulty Latching/Insecure Latch
Dislikes Carseat or Swings/Bouncers
Dislikes Tummy Time
Disrupted Sleep
Gassy Baby/Difficulty Passing Gas
Heart-Shaped Tongue
Leaking Milk While Eating
Lip Blisters
Open Mouth Posture and Drooling
Poor Weight Gain/Excessive Weight Gain
Tension in Body
Adult/Sibling Symptoms of a Tongue-Tie
Allergies/Asthma
Bad Breath
Cavities or Oral Decay
Choking on Liquids of Certain Textures of Food
Chronic Tension in Neck, Back, or Jaw (TMJ)
Crowded Teeth/Need Braces
Difficulties Eating Comfortably
Difficulty with Kissing
Headaches/Migraines
Mouth Breathing
Obstructive Sleep Apnea
Recessed Gums with Age
Recessed Jaw/Chin
Reflux/Digestive Concerns
Speech Issues
What Should I Expect for Care if I am Concerned About My Baby Having a Tongue-Tie?
To learn more about the specifics of things to know and consider before you embark on this path see the E-book linked below.
While the journey for tongue-tie care is heavily influenced by your baby’s needs there is typically an established flow to care that has been proven to generate the improved oral function you are looking to achieve.
IBCLC with Specialized Tongue-Tie Training
Lactation consultants are infant feeding specialists with specialized training in the mechanics of effective feeding at the breast and the bottle. The lactation consultant is responsible for coordinating the care plan to assure the breastfeeding dyad can meet their breastfeeding goals.
Tongue-ties are complicated, and their impact on infant feeding requires specialized training to create and monitor a care plan that ensures breastfeeding success.
Oftentimes, the care plan involves addressing the milk supply issues that frequently occur with a tongue-tie.
The lactation consultant is uniquely qualified to provide care for both members of the dyad.
You should be hesitant of any member of the care team that dismisses the role or discourages you from seeing a highly trained lactation consultant. That demonstrates a fundamental lack of training and understanding about the complex care needs of a dyad struggling with a tongue-tie.
Why Body Work Helps
A helpful part of an oral restriction care plan is considering Body Work. This is a personal decision that needs to be made by the parents.
Body Work is work on tensions and misalignments provided by chiropractors, cranial sacral therapists, physical therapists, or massage therapists. This work is done to help the baby gain full use of their tongue and appropriate oral functioning, which is not always achieved by simply releasing the tongue. Even in utero, oral restrictions force compensatory oral movements which result in dysfunctional suck patterns, muscle tightness, and overdevelopment/underdevelopment of particular muscles.
So is Body Work supported by evidence? Yes!
We actually have a fairly decent body of literature (and it's constantly growing) that suggests Body Work can be an essential part of getting the outcomes with oral releases that we desire.
Clinical practice and observed outcomes are also part of the evidence base, and both of these show Body Work encourages more favorable outcomes.
A Guide to Tongue-Ties E-Book
Handling a situation where your baby potentially has a tongue-tie can be stressful for parents. The largest source of this stress is the feeling of being overwhelmed by everything you need to know and consider when making your decisions. A Guide to Tongue Ties is designed to help support you as the parent as you decide on the care your baby needs. This guide walks you through:
What is a tongue tie and how it can impact breastfeeding?
Strategies for feeding at the breast before and after a revision.
Things to consider when deciding to revise.
Questions to ask potential lactation consultants and revision providers to make sure you find the right fit for your family.
How to identify if you have been given bad advice from a poorly informed provider?
Samples of what care plans and assessments should look like so you can assure you are receiving the high quality care you deserve.
Resources to help you learn more.
This resource is provided at no cost to you as the family to help support your breastfeeding success. A tongue-tie does not mean you cannot meet your breastfeeding goals. With high quality care and support, breastfeeding is still possible. Use this guide to empower yourself to advocate for your baby and achieve your infant feeding goals.
Tongue-Tie FAQs
+ Will my baby outgrow their tongue-tie over time?
No, this is a myth that would require bodily tissue to defy laws of physics and biological realities. If the frenulum is too short or too tight it will not stretch over time, and you can’t outgrow the frenulum restricting movement.
What can happen though is some babies do learn how to compensate very effectively for the lack of mobility in their tongues. That doesn’t mean the tongue-tie has no impact, it means your baby may learn how to work around it. Unfortunately we have no way to predict which babies will learn to do this and which babies will continue to be heavily impacted by the lack of mobility in their tongue.
+ Will getting a revision fix my breastfeeding issues?
There is no guarantee that a revision will fix your issues entirely. The reason for this is the revision is only part of the care plan to increase your baby’s mobility with their tongue. There may be other issues with muscular weakness, neurological concerns, or other medical concerns contributing to breastfeeding difficulties that may not be impacted by increased mobility in the tongue.
If you choose to revise your baby’s tongue-tie often you will need to complete pre and post revision work with a highly trained IBCLC and a bodyworker to get the full benefit of the tongue-tie release.
+ My pediatrician says my baby doesn’t have a tongue-tie, or that the tongue-tie is mild. We still have issues with breastfeeding, so what do I do?
One of my favorite lines I’ve ever heard from much more experienced and seasoned IBCLC’s in regards to this type of dismissal on concerns is this, “If it isn’t caused by a tongue-tie, what is causing it, and what is the course of action needed to fix it?”
If they don’t have a solid answer on that question, they don’t have the skill set and training to be offering this opinion on what it isn’t. And just to be clear and prevent further issues, formula isn’t an answer to breastfeeding problems. Bottle feeding isn’t an answer to breastfeeding problems. Pumping to compensate isn’t an answer to breastfeeding problems. These are infant feeding and milk supply management solutions we use to protect an infant WHILE working to identify and address the issues.
Are there cases where these are the solutions the parents opts for? Absolutely, but parents can’t consent to these solutions without being provided all of their options.
+ I don’t see a tie when I look in my baby’s mouth?
Tongue-tie is a functional diagnosis, and what the mouth looks like visually is not as important as how the tongue can move. The only way to know how the tongue can move is to do a functional assessment. Without that functional assessment, what the tongue looks like may be irrelevant.
+ I’ve already seen other lactation consultants who said this isn’t the issue?
Here we go again. If they said that wasn’t the issue, what did they say the issue was, and has their planned helped you at all?
Unfortunately, not all lactation consultants are created equal, and tongue-ties are a higher level issue requiring extra training and education to properly manage and assist with these breastfeeding challenges. If you are still experiencing problems, you aren’t imagining things, you need to get the help from someone better trained to assist you.
+ If not all lactation consultants can help with tongue-ties, and not all medical providers have the right training, how on earth do I find the resources I need?
When it comes to lactation consultants you want to look for someone with experience. There are a lot of lactation certifications you can obtain with 1-2 weeks of course work, no prerequisite education, and no actual hands-on training. You want to look for someone with:
Significant experience- at least 2-3 year in my opinion.
Someone with specific tongue-tie training: ask them how they got their experience and training to be able to support you. Basic training is not sufficient in this area, you are looking for someone with continuing education on tongue-tie or hands-on training from skilled providers.
Note: This website does provide on ongoing list of IBCLC’s who have completed a higher level continuing education course on tongue-ties including training on how to help babies learn to eat more effectively before and after a revision process.
This is not the only course available, and many lactation consultants not on this list are capable of providing the skilled care necessary. This course, however, is highly regarded as providing great training, and is a great resource list to identify someone to assist you.
When it comes to finding skilled revision providers, I recommend connecting with your local tongue-tie or national tongue-tie social media groups for nuanced feedback and review of providers.
+ Is there a way to see for myself as the parent if my baby is likely impacted by a tongue-tie?
Yes! There is actually a fantastic IBCLC who created a parent-focused oral assessment that allows you to personally assess how your baby is able to use their tongue and oral muscles. You can actually download this assessment on her website for free to complete yourself.
This is a fantastic tool, and is one I use in my own practice for virtual consultations to help assess how a baby is doing.
If you are not sure if you need lactation care you can always download that tool and start there. If it flags any issues, you can be confident that skilled lactation care is the right option for you!
+ What are some great resources available online for me to learn more about tongue-ties?
While no one can (or should) diagnose your baby in online social media groups, these groups can serve as great conduits of information for parents. They often provide recommendations and reviews of providers in your local area that may be good fits for your family’s needs. The decisions for how to handle a possible tongue-tie can only be made by your family, and connecting with other parents and professionals who understand can make the process much easier.
Facebook: Tongue Tie Babies Support Group
Facebook: New England Tongue and Lip Tie Support Group
