Does My Baby Have a Tongue-Tie?

If your baby is having trouble with breastfeeding or bottle feeding, it can be overwhelming to try to troubleshoot the issue. Is it the latch on the bottle or at the breast? The positioning while feeding? The flow from the bottle or nipple? The possibilities for parents to consider feel endless—especially on little sleep.

For some babies, a tongue-tie could be to blame. A tongue-tie occurs when the tissue that connects the tongue to the floor of the mouth (called frenulum tissue) is positioned too far forward under the tongue or is too thick or tight. This can restrict the tongue’s range of motion. A tongue-tie can negatively affect nursing, bottle feeding, eating solids, speech and even sleep as a baby grows. And they’re common: Estimates vary, but as many as 1 in 10 newborns are born with a tongue-tie.

Sometimes having a procedure to release the tie is recommended, but in other cases, there are less invasive strategies you can try. Lisa Queen, MA, a UNC Health pediatric speech-language pathologist, explains.

Signs Your Baby Could Have a Tongue-Tie

There are signs in both baby and mom that could indicate a tongue-tie. In babies, watch for any of the following:

  • Inability to latch
  • Sliding on and off the nipple while feeding; inability to sustain a latch
  • Noises while feeding, such as lip smacking or tongue clicking
  • Poor weight gain
  • Falling asleep at the breast quickly without completing a feeding
  • Hunger shortly after feedings
  • Gagging while breastfeeding
  • If bottle feeding, struggling to complete a feed in 30 minutes
  • Thick tissue tying the tongue to the floor of the mouth

These are the signs to watch for in moms:

  • Pain while breastfeeding that lasts longer than 30 seconds at a time or persists for longer than two weeks
  • Drop in milk supply
  • Cracked, damaged or sore nipples
  • Misshapen nipples or white creases on the tips

Of course, many of these issues are common to breastfeeding or could indicate other conditions. If you notice any of these signs or symptoms, reach out to your pediatrician, a lactation consultant or a speech-language pathologist who specializes in infants. Your provider will help you determine what’s going on.

Diagnosing Tongue-Tie in a Baby

Everyone has frenulum tissue, so determining whether a baby truly has a tongue-tie can be subjective. Queen looks at several factors, including whether the tongue can complete the wavelike motion that transfers milk from the front of the mouth to the back.

“When we evaluate potential tongue-ties, we are trying to figure out how much it’s going to restrict the tongue’s range of motion,” Queen says. “You have to look at the anatomy, the function of that anatomy and the symptoms the mother is experiencing while breastfeeding.”

Queen uses a tongue-tie screening and assessment standard developed by Alison Hazelbaker, PhD, to evaluate the severity of the tie. This tool gives guidelines to place the tie in one of four categories based on where the frenulum tissue is anchored on the tongue, how pliable and thick the tissue is, and how well the tongue can move.

The most severe is the type 1 tongue-tie, also known as an anterior tie. The tissue starts at the tip of the tongue and connects the whole tongue to the floor of the mouth, restricting movement significantly. Type 2 is considered severe but less restrictive than type 1, and so on. In types 3 and 4, also called posterior ties, the tissue begins much farther back on the tongue, allowing it to move more. However, these can also be problematic, Queen says.

How to Treat Tongue-Tie

If the tie is severe, your provider may recommend a surgery called a frenectomy to release it. If the tie is posterior, there are probably noninvasive techniques you can try first.

For example, lactation consultants can help you improve your baby’s latch and positioning to make breastfeeding less painful and more effective. They can offer advice on pumping, the use of nipple shields and formula feeding.

A chiropractor who is trained in treating newborns can help perform infant massage, also known as craniosacral therapy or bodywork. Far different from a typical adult chiropractic appointment, the chiropractor uses gentle pressure to help loosen up the baby’s neck, head and sacrum bone at the base of the spine. This can help improve mobility of the tongue.

“My goal is to assess the patient and quickly connect the family with the professionals they need so they can have answers in a matter of weeks,” Queen says. “Time is of the essence because babies have motor memory, and we want them to learn how to complete the wavelike motion more effectively.”

Sometimes seeing a lactation consultant or a chiropractor helps get the tongue moving enough that a release is not necessary. If you choose to have the procedure, those nonsurgical services are sometimes recommended before and after, to keep the mouth loose.

A frenectomy can be done by an otolaryngologist or a pediatric dentist. Otolaryngologists—also known as ear, nose and throat doctors, or ENTs—will use scissors to cut the frenulum tissue and release the tie, while most pediatric dentists use a laser. Frenectomies can also be performed on lip-ties, when the skin of the upper lip is connected to the gums in a way that makes feeding difficult.

No matter where you go, frenectomies can be painful, but they are quick. They usually take less than five minutes and are performed in-office. Anesthesia is generally not used because of safety concerns.

“Whether you see an ENT doctor or a dentist, we want to make sure you receive proper after-care,” Queen says.

The wound heals rapidly in the first two weeks, but it can take up to a month to heal fully. After-care involves performing gentle stretches in your baby’s mouth every few hours (even through the night) for that length of time to keep the frenulum tissue from reattaching or scarring. Queen says that whether or not a family chooses frenectomy, it’s important to have a pediatric speech-language pathologist on your care team to ensure your baby’s oral motor skills develop properly.

“We unfortunately don’t have a crystal ball and can’t guarantee that a frenectomy will completely resolve the feeding issues,” Queen says. “My job is to educate families on the pros and cons and help families make the right decision for them.”

Looking for a provider who can help assess feeding problems? Find one near you.