This page is a great resource for any mama who has been told that her baby may have an oral tie... 

Or maybe you have been told by a pediatrician or other professional that your baby doesn't have a tie, but your gut is telling you that something just isn't right. 

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Tongue Tie Self-Assessment

Evaluation:

Parents should put the baby’s head in your lap with legs facing away sitting bumped up against a chair with a pillow on the other chair to support the legs (two people is ideal)

Proper positioning is important. This is the most common error made by medical professionals looking for tongue-tie or lip-tie. The provider and the parent should face each other, knees touching. The baby is laid on the lap of this makeshift table, baby's head towards the examiner. You cannot adequately evaluate a baby's mouth when they are sitting in a parent's lap in an upright position. A pillow on a chair can substitute for the second parent when only one parent is available for the evaluation.

The goal of the examination is to try and determine the degree of tension of the frenulum of the lip and tongue on the surrounding tissue.

The assessment is accomplished by pulling on the upper lip and lifting up the tongue with two fingers and observing how the baby reacts. In the event that it appears to be awkward to them, they regularly wriggle. In the event that the frenulum is tight, it will frequently turn white or blanch. Take a look at where the frenulum is connecting to the gum line or tongue.

This technique is also the preferred technique for obtaining pictures of the lip or tongue. 

>>>This video illustrates the examining procedure (credit is not mine).

Tongue ties (ankyloglossia) are caused by an unusually tight band of tissue anchoring the tongue to the floor of the mouth. This restricts the tongue’s normal function, which can cause breastfeeding issues in infants, as well as speech, dental, and airway issues later on.

Tongue ties are more common than most people think—in fact, they’re the most common problem I see in my postpartum/at home lactation visits. Doctors and lactation consultants have known about anterior tongue ties for years (the kind of tie that extends further toward the tip of the tongue), but are often less educated about posterior ties—the kind closer to the base of the tongue. The resulting underdiagnosis of posterior ties means many mothers and babies continue to suffer and experience a frustrating breastfeeding relationship.

Because anterior tongue ties are more obvious, almost no one will question an anterior tie. A posterior tie, however, can sometimes be almost invisible.

I’ve had clients come to me who have already been told definitively by their pediatrician or another lactation consultant that their child doesn’t have a tongue tie, only to discover that a very tight posterior tie is causing their breastfeeding issues.

Even if a baby has a normal-appearing tongue, with the frenulum in the expected place—or even no frenulum at all—if they or the mother are experiencing the below symptoms, they can still have a posterior tie.

Here are the things to look for. Please remember that a baby with a tongue tie may only have one of these signs, but they may also have many of these signs.

1. Breastfeeding hurts.

Breastfeeding is not supposed to hurt. If it does, then something is wrong. Sometimes it’s simply a latch issue—but babies that have consistent difficulty latching correctly are often experiencing this because of a tongue- and/or lip tie. Tongue ties and lip ties often go hand in hand. If your baby cannot flange their upper lip over the breast, this is a sign of a lip tie—and an indicator that a tongue tie is likely also present.

2. Cracked, bleeding nipples.

Often, when a baby has a tongue tie, the tongue is unable to draw the breast tissue into the baby’s soft palate, causing nipple damage from rubbing on the hard palate. Good positioning and using the ‘breast sandwich’ technique can help with this some of the time.

3. Misshapen nipples.

Often, after a feed, the mother’s nipples will look like the tip of a lipstick bullet, or have a crease on the end.

4. Frustration at the breast.

A tongue-tied baby often gets frustrated at the breast and may break the latch frequently, because they are unable to transfer milk efficiently.

5. Clicking and/or gulping sounds while nursing.

A tongue-tied baby is often unable to form a proper seal around the breast, which results in clicking sounds as suction breaks repeatedly. The gulping is from the tongue’s inability to swallow appropriately as the tongue is tethered. Both of these function issues will often cause the babe to take on a lot of air and be gassy and fussy.

6. Too much suction.

When the tongue is dysfunctional as a result of a tongue tie, a baby will often attempt to compensate for this by sucking harder. This excess vacuum can be exhausting for the baby, and uncomfortable for the mother. A normal “suck” is more like a wave motion of the tongue than a suck.

7. A sensitive gag reflex.

When the tongue is tethered too tightly to the floor of the mouth, the baby’s palate doesn’t receive a normal amount of stimulation, which can result in an overly sensitive gag reflex.

8. Uncoordinated sucking motion.

When you put your finger in a tongue-tied baby’s mouth, often the sucking motion will be uncoordinated and uneven, and they may break suction often. This can be frustrating for the baby, resulting in fussiness at the breast, and it can also be very exhausting, tiring the baby out before getting a full feed.

9. Poor weight gain.

If mom doesn’t have a strong milk letdown, a tongue-tied baby can struggle to gain weight. If mom has a good letdown, sometimes a baby with a tongue-tie can still thrive and gain weight well—but may experience other non-weight-related symptoms (more info on that below.

10. Digestive problems.

Because of the difficulty a tongue-tied baby has forming and maintaining a proper seal around the breast (see #5 and #8), they tend to swallow a lot of extra air, which can result in gassiness, excessive spit-up, and reflux-like symptoms.

11. Irritability or colic.

This is often related to #10, or caused by baby simply being hungry because they can’t get a full feed. Even in the absence of obvious gassiness, stomach discomfort from excess air intake can manifest itself as colic or general irritability.

12. Recessed chin or dimples.

An unrevised tongue tie can cause a recessed chin, though some babies will have this without a tongue tie simply due to genetics.

13. High, narrow palate.

A fully functional tongue rests against the roof of the mouth when the mouth is closed, which helps the palate develop the proper shape. A tongue tie can prevent the tongue from resting against the palate, which can cause it to develop a high and/or narrow shape.

To breastfeed efficiently, baby needs to be able to compress the breast tissue against the roof of the mouth, and a high palate can interfere with this.

14. Reoccurring Clogged Ducts or Mastitis.

A dysfunctional tongue will have the overall result of preventing the baby from transferring milk well, and properly draining the breast. This can result in mastitis, as clogged ducts in the breast can lead to painful and potentially dangerous infections.

If any of the above symptoms—even just one—sound familiar to you, please see an IBCLC (Internationally Board Certified Lactation Consultant), or a pediatrician who is familiar with posterior tongue ties. Not all pediatricians or lactation consultants will be familiar enough with posterior ties to recognize or diagnose them.

All anterior ties also have a posterior component, so it’s crucial that you find a provider that knows how to laser or clip the tie completely. If the provider doesn’t revise the tongue far enough back, it will be an incomplete revision which often will not improve symptoms.

Why We Revise Tongue-Ties

Sometimes mothers and medical practitioners are hesitant to revise a tongue tie because of the discomfort it may cause the baby, or because breastfeeding is going well enough. Here are some important things to consider if you’re on the fence:

Milk production, at the very beginning, is hormonally-driven. Hormones present in your system stimulate the production of milk, regardless of whether or not baby is nursing, and these hormones continue to affect production to some extent for the next several weeks. Around 10-16 weeks, production begins to work almost solely on supply and demand. This means that if the baby is not transferring milk efficiently, milk supply will almost certainly begin to dip. It takes an incredible amount of work to maintain supply when a baby is inefficient at draining the breast at each feeding.

Even if a tongue-tied baby has been breastfeeding well and gaining weight during the first several weeks—usually because Mom has an exceptionally good letdown reflex—supply will often drop at the 10-16 week mark once hormones aren’t playing as big a role. Coincidentally, this is around the time a lot of mothers go back to work or start menstruating again, and so often the real issue (the tongue tie) is masked by other factors.

Other complications that can arise from an unrevised tongue tie (even if breastfeeding is going well):

• Difficulty swallowing solid foods when they are introduced to the diet. Gagging, choking, and tongue-thrusting motions are common with tongue-tied babies attempting to eat solids.
• Dental issues are very common with tongue-tied children, though these usually aren’t obvious until much later. A tongue or lip tie can cause the spreading of the upper teeth and prevent the jaw from developing correctly, resulting in the need for orthodontic work later in life. The underdeveloped jaw often will be weak/recessed, and not provide enough room for the adult teeth, causing crowding and recurrent decay issues.
• Speech problems are common among children with unrevised tongue ties, as their tongues are unable to achieve the full range of motion necessary to create the proper sounds.
• Back pain. Believe it or not, a tightly tethered tongue can cause tightness in the muscles of the jaw, face, and neck, which creates a kind of domino effect throughout the body (remember, everything is connected), resulting in poor posture and lifelong back pain.
• Sleep problems. The underdevelopment of the jaw can compromise the airway, resulting in sleep apnea and other disorders that can affect your child’s sleep throughout their life.

There are many reasons to address a baby’s tongue tie, even if breastfeeding is going well. If you’re struggling to breastfeed, if baby is having a hard time gaining weight, or if you’re experiencing any of the above symptoms, please see a specialist that can properly diagnose both an anterior and a posterior tongue tie. The results of a proper tongue-tie revision can be truly life-changing.

To find a qualified provider near you, please visit your state’s Facebook Tongue Tie group or even better…a local mama Facebook group so that mama’s in your area can dish the good and the bad before you book in with someone.

At this time I am currently able to accept many forms of insurance which would make your telehealth visit with me completely free once approved. To check your insurance just use the link here.

If you have been told that your baby doesn’t have a tongue tie, but your gut is saying, “Something just isn’t right…” get reevaluated by another expert! Many many many pediatricians and IBCLC’s are not qualified to be evaluating for tongue/oral ties and therefore babies are left without revisions that will be beneficial to both them and you!

In the meantime, if you need to wait to be seen and revised, some families have found that bodywork including chiropractic, massage, and craniosacral therapy (CST) have helped release tension in the nursling and ease breastfeeding pain associated with tongue ties and lip ties.

Some families will opt to just receive bodywork and not have the tie released at all. This is a personal decision that only you can make with the help of your trusted provider.

Who can diagnose a tongue tie? 

Tongue tie is typically diagnosed during a physical exam. Tongue ties are sometimes diagnosed during a baby’s routine newborn check, but it’s not always easy to spot. It may not become apparent until later when problems have arisen. Once a tongue tie is suspected, it’s important to find someone who is knowledgeable about both tongue ties and how they interact with breastfeeding. This may be a pediatrician, dentist, oral surgeon, or otolaryngologist (ENT). An IBCLC cannot diagnose a tongue tie, but they can evaluate and refer to another healthcare provider for a diagnosis.

How does a tongue-tie revision work?

Tongue ties are revised (corrected) surgically. Also called a frenotomy, the procedure is usually done by an otolaryngologist (ENT) or pediatric dentist but is also done by some pediatricians. The provider will usually do a physical evaluation of the tongue and mouth and may also do a functional evaluation to see how the baby nurses. The provider may also suggest seeing an IBCLC for a more thorough functional evaluation before or after the procedure to ensure that there are not other possible breastfeeding issues.

Here are a couple of videos of an actual laser tongue tie release:

Video 1

Video 2

At-Home Exercises Are Important!

Something that many providers forget to tell parents or don’t elaborate on enough is the Post Frenectomy Exercises After Tongue-Tie and Lip-Tie Release. These are SUPER important so that the tissue does not re-adhere and cause issues in the future. Here is a great video to follow if your provider didn’t go into much discussion about the importance of the exercises or show you how to do them.

Here is a second resource that is amazing.

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