Tongue Ties: What They Are, What They're Not, and What to Do 👅

A genuinely confusing topic made clear — including the controversy you deserve to know about.

Tongue tie is one of those diagnoses that can feel like a revelation — finally, an explanation for why breastfeeding is so hard — and then, sometimes, like a rabbit hole with no clear exit. If you've been told your baby might have a tongue tie, or if you're breastfeeding and struggling and wondering if this might be why, here's what you actually need to know.

What a tongue tie actually is

A tongue tie — medically called ankyloglossia — is a condition where the frenulum, the small band of tissue connecting the underside of the tongue to the floor of the mouth, is shorter, thicker, or more tightly attached than usual. This restricts the tongue's range of motion — specifically the ability to lift, extend, and lateralize the tongue freely.

A lip tie is a similar condition affecting the frenulum between the upper lip and the gum — a tight attachment that limits how far the lip can flange outward. Lip ties are often discussed alongside tongue ties in the context of breastfeeding difficulties.

How tongue ties affect breastfeeding 🤱

Effective breastfeeding requires the baby to extend their tongue over their lower gum, create a wide latch that includes a significant amount of breast tissue (not just the nipple), and use a rhythmic wave-like tongue motion to draw milk. A restricted tongue can limit all of these movements, leading to:

• Painful latch — the baby compensates by clamping rather than cupping
• Nipple damage — compression, creasing, or lipstick-shaped nipples after feeds
• Poor milk transfer — the baby works hard but doesn't drain the breast efficiently
• Frequent feeding — the baby is hungry because feeds are inefficient
• Poor weight gain in the baby
• Maternal engorgement, blocked ducts, or mastitis from incomplete drainage
• Clicking sound during feeding — from the tongue breaking suction repeatedly
• Baby frustration at the breast — coming on and off, crying

The diagnosis question ⚠️

Here is where the tongue tie conversation gets complicated, and where you deserve full honesty: tongue tie diagnosis and treatment is a genuinely contested area of medicine right now. There has been a significant increase in tongue tie diagnoses and surgical releases (frenotomies) over the last decade — an increase that many clinicians believe reflects improved awareness and some believe reflects over-diagnosis.

The research on tongue tie treatment is mixed. Studies on posterior tongue ties — the deeper, less visible form that has become more commonly diagnosed — show less consistent benefit from release than studies on anterior ties (the more visible, classical form). And the procedure, while generally low-risk, is not without complications — including reattachment, scarring, and in some cases worsening of symptoms if the underlying breastfeeding mechanics aren't also addressed.

This does not mean tongue ties aren't real or that treatment doesn't help — for many families, release of a true functional tie is genuinely transformative for breastfeeding. It means you deserve to approach this diagnosis with clear eyes and some questions.

Questions worth asking before a frenotomy 💛

• "Is this a functional tie — is the restriction actually affecting how my baby feeds — or purely an anatomical finding?"
• "Have we worked with an International Board Certified Lactation Consultant (IBCLC) to optimize latch and positioning before considering release?"
• "What specific improvements would we expect to see after the procedure, and in what timeframe?"
• "What happens if we wait and monitor — will this resolve on its own or get worse?"
• "Is bodywork (craniosacral therapy, infant chiropractic) recommended alongside or before the procedure in your practice?"

The lactation consultant first approach 🩺

The most evidence-consistent recommendation in the literature is this: work with an International Board Certified Lactation Consultant (IBCLC) before and alongside any tongue tie evaluation. Many breastfeeding problems attributed to tongue tie can be significantly improved with latch optimization, positioning changes, and oral motor exercises — without any procedure. An IBCLC can also help you evaluate whether the tie is functionally significant and refer you to a trusted provider if release is genuinely indicated.

What the procedure involves 🔪

If a frenotomy is recommended, the procedure involves a small snip or laser release of the frenulum — typically performed by a pediatric dentist, ENT, or trained pediatrician. In newborns, it is usually very quick (under a minute), causes minimal bleeding, and babies can feed immediately afterward. In older infants, a brief local anesthetic may be used. Post-procedure, stretching exercises are typically recommended to prevent reattachment as the tissue heals.

Trust your instincts. Get a second opinion if something doesn't feel right. And find an IBCLC — they are your best ally in this conversation. 🌱