What is Tongue/Lip-Tie?

A tongue-tie, medically known as ankyloglossia, occurs when the lingual frenulum—the band of tissue underneath the tongue—restricts the tongue’s movement and function.

A lip-tie refers to the tissue that connects the lip to the gums. Everyone has these tissues, and simply seeing or feeling a prominent frenulum does not necessarily mean there is a problem.

What matters most is how your baby is functioning.

When we are concerned about a possible oral restriction, we look at much more than what the tissue looks like. We consider how your baby moves their tongue and lips, creates and maintains suction, manages milk flow, transfers milk, and coordinates feeding.

This is why I prefer to look at the whole picture rather than focusing on whether a frenulum simply “looks tight.”

Some babies have very noticeable oral tissues and feed beautifully, while others may have a less obvious restriction that significantly affects their ability to feed comfortably and effectively.

During a lactation consultation, I can assess your baby’s feeding and oral function, explain what I am observing, and help determine whether additional evaluation by another member of your baby’s care team may be appropriate.

We treat function—not just what we see when we look inside your baby’s mouth.

Could Tethered Oral Tissues Be Affecting My Baby’s Feeding?

Tongue-tie, sometimes referred to as a tethered oral tissue (TOT), can affect feeding for some babies—but simply having a visible frenulum does not necessarily mean there is a feeding problem or that a procedure is needed.

What matters most is function: how your baby uses their tongue, lips, jaw, and entire body during feeding.

Signs That May Mean Your Baby Needs a Feeding Assessment

Your baby may:

• Have difficulty latching or maintaining a latch

• Have a shallow latch that causes nipple pain or damage

• Frequently click, slip, or lose suction during breast or bottle feeding

• Cough, sputter, choke, or struggle to coordinate sucking, swallowing, and breathing

• Feed for very long periods or seem hungry again soon after a feeding

• Become tired, frustrated, or restless during feeds

• Have difficulty transferring milk effectively

• Have slow or concerning weight gain

• Require supplementation because they are not transferring enough milk at the breast

• Have difficulty managing bottle flow or creating a consistent seal on the bottle

A Breastfeeding Parent May Experience:

• Persistent nipple pain during or after feeding

• Cracked, damaged, or misshapen nipples

• A nipple that appears creased, flattened, or “lipstick shaped” after feeding

• Recurrent plugged ducts, engorgement, or mastitis

• Difficulty maintaining milk supply—or sometimes an oversupply related to frequent milk removal

• Long, exhausting, or very frequent feeding sessions

• Frustration, worry, or discouragement surrounding feeding

These symptoms do not automatically mean your baby has a tongue-tie. Many feeding challenges can have similar signs, which is why a thorough feeding and oral-function assessment is so important.

What Happens During an Assessment?

As an IBCLC, my role is to evaluate breastfeeding and feeding function, help identify what may be contributing to your challenges, and collaborate with or refer you to the appropriate healthcare provider when additional evaluation is needed.

During our consultation, we’ll start by talking through your pregnancy, birth, feeding history, milk supply, weight gain, and the concerns you’re noticing at home.

Then, depending on how your baby is feeding, I may:

• Observe a breastfeeding and/or bottle-feeding session

• Evaluate your baby’s latch and positioning

• Watch how your baby uses their jaw, tongue, and lips during feeding

• Assess sucking, swallowing, and breathing coordination

• Evaluate milk transfer when appropriate

• Perform a gentle oral-function assessment, including tongue movement, suck function, and the structures inside your baby’s mouth

• Talk you through what I am observing so you understand what we are seeing together

The goal is not simply to look for a “tie.” The goal is to understand why feeding is difficult and what we can do to make it better.

What If I’m Concerned About a Tongue-Tie?

We start with feeding.

Sometimes changes to positioning, latch, milk flow, bottle technique, or other feeding strategies can make a significant difference. Every baby and feeding relationship is different, so your care plan will be individualized to your family.

If your baby continues to have significant functional feeding challenges and I have concerns about restricted tongue movement, we can discuss a referral to an appropriately trained medical or dental provider who can evaluate your baby and determine whether a frenotomy or other treatment should be considered.

A referral does not automatically mean your baby needs a procedure.

If a release is recommended and you choose to proceed, I can continue supporting you before and after the procedure with feeding assessment, suck and oral-motor support that is appropriate within my scope of practice, and an individualized feeding plan.

If a Procedure Is Recommended

A frenotomy is a procedure used to release a restrictive lingual frenulum, or tongue-tie. The decision to proceed should be based on your baby’s symptoms, oral function, feeding assessment, response to conservative feeding support, and evaluation by a qualified healthcare provider.

Depending on your baby’s individual needs, your care team may include additional professionals. I can help you determine which referrals make sense for your baby rather than giving every family the same checklist.

Follow-up feeding support is especially important. If your baby has a procedure, I typically recommend reassessing feeding shortly afterward so we can evaluate comfort, latch, milk transfer, and how your baby is adapting to their new range of movement.

Our goal isn’t simply a successful procedure.

Our goal is a baby who feeds better and a family who feels supported.

Who May Be Part of Your Baby’s Care Team?

Feeding challenges are rarely about just one piece of the puzzle. We believe in looking at the whole baby and collaborating with other skilled providers when appropriate.

Your baby’s care team may include:

• Your Lactation Consultant — that’s me! I evaluate feeding function, latch, milk transfer, oral function, and the way your baby uses their tongue, lips, and jaw during feeding. I help you understand what I am observing, create an individualized feeding plan, and make referrals when additional evaluation would be helpful.

• An Infant Bodyworker — strongly recommended when oral restriction is suspected. Babies can carry tension or asymmetry throughout their bodies that may affect positioning, range of motion, latch, and feeding function. An appropriately trained infant bodyworker can provide another valuable perspective and help us determine what may be related to tension and what may be related to a suspected oral restriction. Depending on your baby’s needs, this may include a pediatric physical therapist, occupational therapist, chiropractor with specialized infant training, craniosacral therapist, or osteopathic provider.

• Your Baby’s Pediatric Healthcare Provider — an important part of evaluating your baby’s overall health, growth, development, and any medical concerns that could be contributing to feeding difficulties.

• A Qualified Release Provider — such as a dentist, physician, or ENT who is appropriately trained and experienced in evaluating infant oral restrictions and determining whether a frenotomy or other treatment should be considered.

How Long Does it Take?

As much as I wish I could snap my fingers and make feeding immediately feel easy and “normal,” healing and learning new feeding patterns take time.

Some babies show changes quickly after a revision, while others need more time and support. Remember, your baby has been using their tongue, jaw, and body in a certain way since before they were born. Even after a restriction is released, they may naturally return to the movements and feeding patterns that feel familiar to them.

This is why continued lactation support, oral-motor work when appropriate, and collaboration with your baby’s care team can be such an important part of the process.

You may notice improvements along the way, but progress is not always linear. There may be great feeds followed by harder feeds—and that does not necessarily mean something is going wrong.

Rather than expecting everything to change overnight, we focus on gradual improvements in function, comfort, milk transfer, and feeding skills over time.

Every baby’s timeline is different. Some families notice meaningful changes within the first several weeks, while others continue to see improvements over the following months.

The revision itself is one step in the journey—not the finish line. My goal is to continue supporting you and your baby as they heal, learn new movement patterns, and develop more comfortable and effective feeding skills.