The Tongue Tie Conundrum

It seems everyone has some kind of oral tether these days. That some connective tissue in their mouth is restricting their ability to function. With tongue tie centers popping up all over, it’s no surprise there are many professionals readily available to diagnose and receive payment to fix these structural problems. However, I am finding that parents are feeling pressured to get tongue ties, lip ties, and buccal ties released only to find that it does not solve their problem. Or worse, there is no problem but they are told their child’s ability to speak clearly years down the road relies on a procedure now.

For this I would like to share some other factors that can impact your baby’s tongue, reduce the fear of future problems, and provide some insight so that you feel confident when faced with the tongue tie diagnosis.

First and foremost, there is a wide range of normal when it comes to body parts for people (including baby mouths). That means that just looking at a mouth is not typically enough to confidently diagnose and recommend a course of action. It also means that some babies can move their tongues farther than others, but both can be considered normal. A full feeding evaluation with someone who understands how the whole body is involved in feeding is ideal if you are having any issues or suspecting a tongue tie (examples might be an IBCLC, SLP, etc.).

This is because, a commonly ignored but important fact is that the mouth is impacted by the whole body. So if there is tightness in the body (say the neck, torso, or hips) it impacts how wide a baby can latch as well as how the tongue functions.

A second surprising factor is the flow rate of the milk. It’s not uncommon for mothers who experience nipple pain around day three, to have had no prior latch problems the first couple of days after birth. This may be due to the challenge of latching on to a very engorged breast but it can also be baby's way of protecting their airway through clamping downward, sliding down to a shallow latch, or moving their tongue back if the flow of milk is a bit too fast for them.

These are just a few examples that require an experienced eye for nuance. Here is a list of potential factors that an advanced infant feeding specialist might be trying to rule out, and knowing them helps you consider who the best person to help your baby is:

● Body tension

● Milk flow too fast for baby

● Poor swallow coordination

● Inability to shape the tongue optimally

● Low tone

● Reflux

But what if your baby is eating well? What if they are growing, generally happy, mostly comfortable, thriving even? What if there is no current problem, but you are told your baby has a tongue tie and may have speech or articulation issues later down the road? The truth is, there is no way (aside from obvious anatomical issues) that we can predict who will have future articulation problems based on what your infant’s tongue looks like alone. Because there are normal differences in how we make sounds with our mouths. Adults use varied oral postures to produce clear speech sounds. So, if they sound normal, is there a problem?

Lastly, I would like to state that yes, I do believe that there are cases of true tongue ties and that breastfeeding pain can in some instances be improved with intervention. Also yes, I do believe there are times when tongue range of motion negatively impacts the production of clear speech as well as our ability to clear food residue from our teeth. It just seems as if it has become so popular we are overdoing it without considering the big picture.

All things considered, if you find that tongue tie intervention via frenotomy is an appropriate intervention for your baby, here are a few things to consider:

1. Scissors are more likely covered by insurance while laser intervention is often not

2. Post frenotomy “stretches” are common but are lacking evidence to support them (according to the ABM) and for some babies may contribute to more negative outcomes and increases oral aversion

3. If your baby has low tone, respiratory issues, other structural factors, or medical conditions (diagnosed or not), then this “simple” procedure may be dangerous. So it’s best to consult with an ENT or pediatric dentist with experience in special populations if you suspect any of these

4. When it’s as straight forward as only a tongue tie, usually improvement is observed right

away

If you want to learn more about the current stats risks and benefits of oral tether interventions,

check out this episode on the How to Feed Your Baby Podcast!

Written by:

Barbara Nelson, SLP, IBCLC

Feedingbyjanuary.com

Referenced: Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in

Breastfeeding Dyads

Barbara Nelson is an International Board Certified Lactation Consultant and CCC-SLP with over a decade of clinical experience supporting infant feeding and early development. She combines evidence-based guidance with a compassionate, realistic approach that meets families where they are. As a mom herself, Barbara understands the emotional and practical challenges of the newborn phase. Her work is dedicated to helping parents feel confident, informed, and supported as they care for their babies in real life.