The Short Version

A tongue tie (ankyloglossia) happens when the strip of tissue connecting the tongue to the floor of the mouth, called the lingual frenulum, is shorter, thicker, or tighter than typical. That can limit how far the tongue moves. A lip tie works the same way but involves the tissue connecting the upper lip to the gum.

When these ties are significant, they can interfere with breastfeeding, bottle feeding, and down the road, speech and eating. The conversation around ties has gotten messy, though. Some providers feel ties are widely under-diagnosed. Others worry about a trend toward over-diagnosis and procedures that are not needed.

Your job as a parent is not to take a side in that debate. It is to understand the facts well enough to make a good decision for your baby.

What Tongue Ties and Lip Ties Actually Are

Every baby has a lingual frenulum under the tongue and a labial frenulum under the upper lip. That is normal anatomy. A tie only becomes an issue when that tissue actually restricts function in a meaningful way.

Types of Tongue Tie

Tongue ties are sometimes classified using the Coryllos system:

  • Type 1: The frenulum attaches right at the tongue tip, sometimes giving the tongue a heart-shaped look. This one is the most obvious and easiest to spot.
  • Type 2: The frenulum attaches just behind the tongue tip.
  • Type 3: The frenulum attaches at the mid-tongue. These are harder to see but can still limit movement.
  • Type 4 (posterior tongue tie): The frenulum sits under the mucous membrane and may not be visible at all. Diagnosis here is the most debated because it relies on feel rather than sight.

Lip Ties

Upper lip ties follow a similar spectrum. A significant lip tie can stop the upper lip from flanging outward during feeding, which compromises the seal around the breast or bottle.

How Ties Can Affect Feeding

When a tongue or lip tie is functionally significant, both baby and nursing parent can run into problems:

For the baby:

  • Difficulty latching or holding a latch
  • Clicking sounds during feeding
  • Excessive gas or colic symptoms from swallowing air due to a poor seal
  • Slow weight gain or failure to thrive
  • Falling asleep quickly at the breast because working harder to feed is exhausting
  • Milk dribbling from the sides of the mouth
  • Difficulty with bottle feeding too, since ties are not just a breastfeeding issue

For the nursing parent:

  • Persistent nipple pain even after latch correction attempts
  • Damaged, cracked, or blistered nipples
  • Plugged ducts or recurrent mastitis
  • Incomplete breast drainage leading to supply issues
  • A flattened or misshapen nipple after feeding, often described as looking like a new lipstick

The presence of a tie does not automatically mean it is causing a problem. Plenty of babies have visible frenula that do not restrict function at all. The question that matters is whether there is a functional impact.

The Assessment Process

If you suspect a tie might be contributing to feeding difficulties, here is how evaluation typically plays out:

Step 1: See a Lactation Consultant

Before zeroing in on ties, it is worth getting a comprehensive feeding evaluation with an IBCLC (International Board Certified Lactation Consultant). Plenty of latch issues have nothing to do with ties and can be resolved with positioning changes, pacing adjustments, or addressing other factors like a fast or slow letdown, oversupply, or bottle preference.

An experienced IBCLC can:

  • Observe a full feeding
  • Assess your baby's latch, suck pattern, and oral motor function
  • Perform a functional assessment of tongue and lip mobility
  • Do a weighted feed to measure milk transfer
  • Rule out other causes of feeding difficulty

Step 2: Get an Expert Assessment

If a tie is suspected, you will want an evaluation from someone experienced in diagnosing oral restrictions. That might be:

  • A pediatric dentist
  • An ENT (ear, nose, and throat doctor)
  • A pediatrician with specific training in oral assessment
  • An oral myofunctional therapist

The assessment should include both a visual examination and a functional evaluation, meaning actually feeling the frenulum and testing range of motion. A diagnosis based on looks alone, or on a photo, is not enough.

Step 3: Consider Getting a Second Opinion

This is one area where a second opinion is genuinely useful. If one provider recommends a release and you are unsure, seeing another qualified provider is entirely reasonable.

Treatment Options

If a functionally significant tie is identified, there are several approaches to consider:

Frenotomy (Tongue Tie Release)

A frenotomy is a quick procedure where the frenulum is clipped or cut. In infants, this is typically done with sterile scissors or a laser.

Scissor frenotomy:

  • Takes seconds
  • Usually done in office, often by a pediatric dentist or ENT
  • Minimal bleeding
  • Baby can nurse immediately after

Laser frenotomy:

  • Uses a laser to release the tissue
  • Also done in office
  • Proponents argue it is more precise and may have a lower reattachment rate
  • Typically more expensive

What the research says: A 2017 Cochrane review found limited evidence that frenotomy improves breastfeeding in babies with tongue tie. Most of the studies included were small, and researchers noted the available evidence was not strong enough to draw firm conclusions either way. That said, several individual studies have shown improvement in breastfeeding and a reduction in maternal pain after the procedure.

Bodywork (Craniosacral Therapy, Chiropractic, Myofascial Release)

Some practitioners recommend bodywork before or after, or instead of, a release procedure. The theory is that tension patterns in the jaw, neck, and body can contribute to restricted oral function, and releasing those patterns can improve feeding.

What the research says: Clinical evidence for bodywork as a treatment for feeding difficulties related to oral ties is very limited. Many parents and practitioners do report subjective improvement, though, and the interventions are generally considered low-risk.

Wait and See

Not every identified tie needs immediate treatment. Some providers recommend monitoring, especially if:

  • The baby is gaining weight well
  • The nursing parent is not in significant pain
  • Feeding is functional, even if not perfect
  • The baby is older and may be close to starting solids

Ties can sometimes stretch or become less restrictive as the baby grows. On the other hand, waiting can mean prolonged discomfort for the nursing parent and potential supply issues if the baby is not effectively draining the breast.

The Over-Diagnosis Debate

This is the part of the conversation that makes everyone a little uncomfortable, but it needs to be said.

Concerns about over-diagnosis include:

  • The rate of diagnosed tongue ties has increased dramatically in recent years, and some researchers question whether this reflects better identification or over-identification
  • Posterior tongue ties (Type 3 and 4) are assessed subjectively, and diagnosis can vary significantly between providers
  • Some providers who diagnose ties are also the ones who perform, and profit from, the release procedure, creating a potential conflict of interest
  • A procedure that is unnecessary carries risk, pain, infection, feeding disruption, reattachment, without benefit

Concerns about under-diagnosis include:

  • Tongue ties have historically been dismissed or missed, leading to breastfeeding failure, speech difficulties, and other issues that could have been addressed
  • Some pediatricians have minimal training in assessing oral function
  • Parents are sometimes told to "just push through" pain that is being caused by a structural issue

The balanced take: Both over-diagnosis and under-diagnosis are real. The answer is not to dismiss ties or to release every frenulum in sight. It is thorough, functional assessment by qualified providers, ideally including both a lactation consultant and a medical provider experienced in oral restrictions.

Questions to Ask Before Proceeding

If a release is recommended, consider asking:

  • What specific functional issues are you seeing that indicate a release would help?
  • Have we tried all other interventions first, like latch correction, positioning, bodywork?
  • What type of release do you recommend and why?
  • What is the expected recovery process?
  • What are the risks, including reattachment?
  • Do you recommend any pre-release or post-release exercises?
  • What results should I expect, and on what timeline?
  • What if it does not improve things?

Finding the Right Help on BAABY

Navigating tongue ties and latch issues is one of those situations where having the right team makes all the difference. Start with a lactation consultant who can do a comprehensive feeding evaluation. BAABY's directory can help you find an experienced IBCLC in your area who can assess whether a tie might be part of the picture and connect you with the right specialists if further evaluation is needed.