Tongue Tie & Breastfeeding: A Guide to the Best Approach

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Did you know it requires the coordination & proper function of 6 cranial nerves, and 26 muscles for a child to use their mouth correctly in order to feed?! In fact, the tongue alone is made up of 8 different muscles.

The benefits of breastfeeding for achieving long term health have been widely researched and documented. However the road to successful breastfeeding is not always easy and can be littered with lots of misinformation.

The Board Certified Lactation Consultants at Milk Diva believe in an integrative and collaborative approach in order to achieve long-term, optimal oral function.

Let’s begin to untie the knotted topic of tongue & lip ties, also known as oral restrictions or ankyloglossia .

Let’s start off with a few facts:

Tongue or lip ties cannot be diagnosed with merely a picture or a quick look.

One of the biggest misunderstandings about frenectomies — the procedure that is done to release the tie,– is that the procedure alone is enough to “fix” a baby with a tongue or lip tie. For optimal outcomes, a team approach is critical.

If I see a piece of tissue under my baby’s tongue does that mean they have a tongue tie?

Most people have a thin piece of tissue under their tongue or above their gum line called a frenulum. A tongue or lip tie occurs when the frenulum is restricted or tight and interferes with effective function.


When breastfeeding, a restricted frenulum–also known as tongue or lip tie–can cause symptoms for both the mother and the baby.

Some of the symptoms for the parent are:

  • Painful nursing
  • Creased or flattened nipples
  • Nipple Damage
  • Incomplete breast drainage
  • Recurrent plugged ducts or mastitis
  • The Inability to nurse without a nipple shield
  • Decreased milk supply

Some of the symptoms for the Baby are:
  • Poor latch
  • Poor weight gain
  • Clicking or smacking noises when eating
  • Dribbling milk out of mouth
  • Inability to hold a pacifier
  • Mouth breathing
  • Problems with bottle feeding

One of the biggest misunderstandings about frenectomies — the procedure that is done to release the tie,– is that the procedure alone is enough to “fix” a baby with a tongue or lip tie. For optimal outcomes, a team approach is critical.

It may come as a surprise, but tongue tie education is not part of the standard curriculum for Lactation Consultants, Dentists, Pediatricians, ENT’s, Occupational Therapists or Speech Language Pathologists. The best way to find out if a baby has a tongue or lip tie is to have the baby evaluated by a provider who has specialized training in oral restrictions.


A full Functional AND structural oral assessment is required to diagnose an oral restriction. A Functional assessment for a baby can be performed by a specially trained IBCLC, or Speech Language Pathologist. A structural assessment can be performed by a specially trained Dentist, an Ear, Nose and Throat doctor, or Pediatrician.

You might be curious if there are any risks related to not releasing a lip or tongue tie…..

When the tissue is too tight, the tongue’s movement is limited, which can cause multiple adverse issues, including:

  • Difficulty breastfeeding
  • Difficulty taking solid foods
  • Potential speech impediments
  • Chronic headaches
  • Neck pain
  • Orthodontic issues
  • Sleep apnea or other airway issues

Considering that a child’s long term health can be negatively impacted by oral restrictions, it is vital to consider the risks of not releasing the restrictions.

A frenectomy for an infant is a short procedure, lasting less than a few minutes, which removes the restricted tissue. Procedures performed with a carbon dioxide laser offer the quickest, most complete results with the least amount of pain compared to scissors or traditional diode lasers.

One of the biggest misunderstandings about frenectomies is that the actual procedure is all that is needed to “fix” a baby with tongue tie. The goal when treating ties is to restore optimal oral function. In addition to the frenectomy, the parents and infant may need the help of multiple specialists to prepare for the procedure and to work with afterward in order to fully achieve optimal function and comfortable breastfeeding.

As expert leader in the field of diagnosing and treating tongue ties, Dr. Matthew Rowe explains,

The Tongue is a complex muscle made up of multiple muscles…and a frenectomy procedure is similar to running a marathon. In order to excel at the marathon you need to train for it. For best results it is very important to ensure that flexibility, coordination, and endurance of the mouth are established BEFORE starting the marathon or in our case before a frenectomy is performed.

This ‘Pre-work’ or training, when coupled with continued oral training after the frenectomy, provides consistent predictable results when compared to frenectomies performed without these complementary therapies.”

How Do I Find the Right Help?

Finding the right help is important. There are many types of providers that fall under each broad category, but the MOST important quality to look for, no matter which type of provider, is that they are specifically trained in the problems and solutions related to ties and oral dysfunction – this means they have gained EXTRA education in these areas. Do not assume that all providers automatically know about ties and oral dysfunction. ASK if they have had specialized training before booking an appointment. A good place to start is with a specially trained IBCLC, Consultant, Speech Therapist or Occupational Therapist. Any one of these professionals can identify ties and help you find the best bodyworkers and release providers for your baby.

The IBCLC’s at Milk Diva have all had hands-on, in-person advanced training in working with infants with oral restrictions, totaling more than 200 hours combined, including the esteemed Masterclass for Oral Habilitation™ course and Tethered Oral Tissues Specialty Training. In addition they have had thousands of hours of experience working with babies with tongue and lip ties. The advanced practice lactation consultants at Milk Diva are ready to equip and help families navigate through all the stages of infant feeding and oral habilitation.

If you are a parent seeking to secure a thorough, collaborative oral evaluation and plan of care to ensure optimal breastfeeding, and long term oral health, please contact us today by calling 512-846-6455, visiting us or sending an email to

If you have more specific questions and would like expert advice from an IBCLC for your individual breastfeeding questions, check us out!


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