A Note on Tongue Tie
If you have an infant and you’re in any social media spaces, you’ve likely heard the term “tongue tie.” Spend just a few minutes browsing parenting groups on Facebook, and you’ll come across accounts of parents being told their babies “only have a slight tie,” or that “ties don’t affect breastfeeding/ bottle feeding/ reflux/etc…” I’ve had clients tell me their pediatrician dismissed their concerns and told them tongue tie is a fad diagnosis. I actually had to educate our family doctor on tongue ties and breastfeeding when my third child was born with a complete tongue tie and my nipples were scabbed and bleeding at 3 days postpartum.
Doctors don’t get much breastfeeding education unless they pursue it on their own. Some do very well on staying up-to-date with current research and recommendations, and others are wonderful at consulting with other care providers when a patient presents with breastfeeding issues. And that’s exactly what doctors should be doing — referring patients out when something, like tongue tie, is out of their scope of practice.
As an IBCLC, I cannot diagnose a tongue tie. But as a care provider who specializes in lactation and has education and personal experience in dealing with tongue ties, I can assess babies’ oral function and tongue mobility, and refer to pediatric dentists who are able to diagnose and release tongue ties (performing a frenotomy).
Not all ties are obvious, which is why so many go undiagnosed. Many providers are not trained in evaluating tongue mobility. If your care provider said your baby does not have a tongue tie without ever lifting baby’s tongue, then they did not properly check for tongue restriction.
Of course, tongue ties must be assessed functionally. You must look at the full picture:
Is baby gaining weight appropriately?
Does the lactating parent have pain, cracks or bleeding from nursing?
Are nipples flattened or shaped like a new lipstick when baby unlatches?
Does baby seem to have reflux or spit up a lot?
Is baby transferring milk well?
Does milk spill out of the corners of baby’s mouth while nursing or bottle feeding?
Is baby excessively gassy or colicky?
Does baby make clicking sounds while nursing or bottle feeding?
Does baby have trouble holding a rounded pacifier in their mouth?
Does baby feed for a long time and never seem satisfied?
Was baby previously gaining weight well, but after a few months, milk supply dropped and now baby is falling off their curve?
A tongue tie release, or frenotomy, is a medical procedure and not something to be discounted or brushed off. There are risks with any procedure, and you should weigh the risks and benefits with your care provider.
Dr. Bobby Ghaheri is an amazing resource for the most up-to-date information on tongue ties and I often send clients to his website for information and visuals for stretches and exercises.
Another fabulous resource for parents and care providers alike is the book Tongue Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More by Richard Baxter, DMD, MS. It’s available on Audible for those of you who prefer audiobooks (and a great option for new parents who have their hands full enough without trying to hold onto a book!). Here it is on Amazon, too ( I don’t get any compensation from sales).
What has been your experience with tongue ties? I was so nervous to have my baby’s ties first clipped by ENT and then fully released with a laser by a pediatric dentist, but every time I see him happily eating foods, and nursing without issues and being silly sticking his little heart-shaped tongue out, I am so grateful that I went through with the procedures.
If you’re having nursing issues, or you suspect something isn’t right, please reach out.