What’s A Tongue Tie?
Topics
Understanding Ankyloglossia (Tongue-Tie): Types, Treatment, and Support
Types of Oral Restrictions
Breastfeeding Problems Caused by Tongue-Tie
How Lactation Consultants Help With Tongue Tie
Craniosacral Therapy for Babies With Tongue-Tie
Myofascial Release, Infant Massage, and Other Holistic Therapies
What is a Frenotomy (Tongue-Tie Release)?
Importance of Pre- and Post-Frenotomy Exercises
Mental Health and Breastfeeding Stress
Allay Can Help With In-Home Support
Understanding Ankyloglossia (Tongue-Tie): Types, Treatment, and Support
Ankyloglossia, commonly known as tongue-tie, is a condition present at birth where a short, tight, or thick lingual frenulum restricts the tongue's range of motion. This can interfere with a baby's ability to breastfeed effectively, leading to challenges in feeding, weight gain, and maternal comfort. Ankyloglossia affects approximately 4% to 11% of newborns (Brzęcka, 2019).
Types of Oral Restrictions
Tongue-tie and related oral ties come in various forms, and it's important for parents and healthcare providers to understand the different types:
Anterior Tongue-Tie: The most visible type, where the frenulum connects near the tip of the tongue to the floor of the mouth, clearly restricting tongue mobility.
Posterior Tongue-Tie: The frenulum is deeper under the tongue and less visible, often requiring a trained provider to detect. It can still significantly limit movement.
Submucosal Tongue-Tie: Hidden beneath the mucous membrane, making it even more difficult to detect without a skilled oral exam.
Lip Tie: A tight or thick frenulum connects the upper or lower lip to the gum, interfering with flanging and sealing during breastfeeding.
Buccal Tie: Tension between the cheeks and gums that can contribute to oral tension and difficulty latching.
Breastfeeding Problems Caused by Tongue-Tie
Understanding the signs of tongue-tie early can help improve infant feeding success and reduce stress for both baby and parent. Common challenges include:
Shallow latch and poor milk transfer
Nipple pain, blisters, or cracking
Noisy or inefficient suckling, such as clicking or gulping
Frequent unlatching and signs of frustration
Gassiness, reflux, or excessive spit-up
Restricted tongue movement affects not only the latch but the baby’s ability to coordinate sucking, swallowing, and breathing. Over time, this can lead to issues with weight gain, early weaning, and a stress experienced for both the parent and the baby.
According to the Journal of Human Lactation, timely treatment of tongue-tie—such as a frenotomy—can improve feeding outcomes and reduce nipple pain (O'Callahan et al., 2013). While a frenotomy can significantly improve breastfeeding challenges, it may not resolve all feeding issues on its own. Doing the recommended tongue-tie release stretches and oral exercises before and after a frenotomy is essential for improving latch and preventing reattachment.
Untreated tongue-tie may lead to long-term complications that go beyond breastfeeding. These can include speech delays, articulation difficulties, mouth breathing, snoring, and disrupted sleep due to airway restriction. Children with tongue-tie may also experience difficulty with chewing and swallowing solid foods, picky eating, increased risk of dental issues, and challenges with oral hygiene. Early evaluation and intervention can help prevent these issues and support healthy oral and speech development.
How Lactation Consultants Help With Tongue Tie
Lactation consultants (IBCLCs) are essential for identifying and managing feeding issues related to tongue-tie. While they don't diagnose, they provide comprehensive oral and feeding assessments. Their support includes:
Conducting oral function evaluations to detect possible restrictions
Observing feeding and troubleshooting latch problems
Recommending positions that optimize latch depth
Referring families to trusted pediatric dentists, ENTs, or orofacial myofunctional therapists
Supporting pre- and post-frenotomy release oral exercises for improved outcomes
Using evidence-based strategies—such as oral motor exercises, optimal positioning for latch, and guided pre- and post-frenotomy care—IBCLCs help reduce parental stress, build confidence, and empower families navigating tongue-tie challenges in their breastfeeding journey.
A 2017 review study emphasized the critical role of IBCLCs in early identification and referral for tongue-tie, demonstrating improved feeding outcomes when IBCLCs were involved in care (O'Shea et al., 2017).
Craniosacral Therapy for Babies With Tongue-Tie
Craniosacral therapy (CST) is a gentle, hands-on approach that releases tension in the cranial and fascial system. For babies with tongue-tie, CST supports:
Relaxation of tight jaw, face, neck, and shoulder muscles
Increased tongue mobility
Reduced strain on the feeding muscles
Improved nervous system regulation and feeding cues
CST can be effective in resolving or mitigating biomechanically based sucking issues, emphasizes the importance of a comprehensive approach, while combining CST with other interventions for optimal results (Genna, 2017).
Myofascial Release, Infant Massage, and Other Holistic Therapies
In addition to CST, various body-based therapies can help babies with oral restrictions:
Myofascial Release for Tongue-Tie
Myofascial release (MFR) focuses on releasing tension in the fascia—the connective tissue that surrounds muscles and organs. In tongue-tied infants, MFR:
Increases oral motor function and tongue elevation
Reduces compensatory muscle patterns developed from restricted motion
Supports post-frenotomy recovery by allowing optimal movement of the tongue and surrounding muscles
A study from Laryngoscope Investigative Otolaryngology journal found that combining surgical intervention of the frenulum with myofunctional therapy, including MFR, led to significant improvements in tongue mobility and associated functions (Zaghi et al, 2019).
Infant Massage and Tongue-Tie
Infant massage involves gentle, rhythmic movements that help relieve muscle tension, stimulate the vagus nerve, and promote parent-infant bonding. In cases of tongue-tie, infant massage is especially useful for:
Reducing tension in the jaw, neck, and shoulders that may be compensating for poor tongue mobility
Promoting relaxation during pre- and post-frenotomy care
Enhancing oral-motor function by improving general muscular coordination
Infant massage can promote neuromuscular relaxation and physiological stability, which are essential for effective feeding. These benefits may be particularly relevant for infants with oral dysfunctions, including those with tongue-tie (Mrljak et al, 2022).
Pediatric Chiropractic Care for Tongue-Tie
Pediatric chiropractic adjustments can help infants compensate less for oral restrictions by restoring optimal cervical and cranial alignment. Specifically, chiropractic care may help:
Release tension in the neck and upper back that may contribute to head-turning preference or tightness
Improve alignment in the jaw and cranial bones, enhancing the baby’s ability to open their mouth and latch deeply
Reduce strain on compensatory muscles that develop when tongue function is limited
A study from The Journal of Chiropractic Medicine suggest that the presence of neuromusculoskeletal dysfunction can impact an infant's ability to suckle effectively, and chiropractic adjustments may help improve the infant's suckling efficiency by addressing these underlying issues. (Holleman et al., 2011)
What is a Frenotomy (Tongue-Tie Release)?
A frenotomy is a quick procedure that involves cutting or using a laser to release a restrictive frenulum (tongue, lip, or cheek tie). It is considered safe, especially when performed by an experienced provider.
The Standard of Care:
Thorough Assessment: A comprehensive evaluation is essential for identifying feeding difficulties related to tongue-tie. While IBCLCs cannot diagnose tongue-tie, they play a crucial role in assessing breastfeeding challenges such as latch issues, nipple pain, and milk transfer difficulties. Tools like the Bristol Tongue Assessment Tool (BTAT) and Tongue Assessment Tool for Babies (TABBY) are widely used to help identify feeding restrictions associated with tongue-tie, ensuring that families are referred to a qualified healthcare provider for diagnosis and treatment.
A study published in the International Breastfeeding Journal (2019) underscores the value of these assessment tools in improving the identification and management of tongue-tie, leading to better feeding outcomes (Ingram et al., 2019).
Finding A Provider: It’s vital to work with a provider experienced in diagnosing and treating all types of tongue-tie, including anterior, posterior, and submucosal ties. Providers should have expertise in frenotomy procedures, whether using scissors or laser.
Procedure: Frenotomy is a quick, in-office procedure that releases the restrictive tissue to improve tongue mobility. Using sterile scissors or a laser, the procedure typically takes only seconds and is minimally invasive with a white, diamond shaped lesion left behind.
Aftercare: Proper aftercare includes feeding support, oral exercises, and bodywork to prevent reattachment and promote healing. Feeding support ensures proper latch, while oral exercises and bodywork help maintain full range of motion and address any residual tension.
Importance of Post-Release Care: An incomplete frenotomy or improper post-release exercises can lead to reattachment, scarring, or ongoing feeding issues. Post-release care, especially when guided by a lactation consultant, ensures exercises are done correctly and helps reduce stress around the process, while also preventing complications and supporting healthy feeding.
Importance of Pre- and Post-Frenotomy Exercises
Before a frenotomy, babies often benefit from bodywork and oral exercises to:
Improve oral motor coordination: Strengthening the coordination of the tongue, lips, and jaw muscles helps prepare the baby for more efficient feeding post-release.
Increase readiness for the release: Preparing the baby’s mouth and muscles through bodywork, like craniosacral therapy or myofascial release, can make the frenotomy procedure smoother and reduce discomfort during and after the release.
Reduce muscle tension and compensations: Babies with tongue-tie often develop compensatory patterns, such as tight neck muscles or jaw tension, to compensate for the restriction. Bodywork helps relax these areas, promoting balanced muscle function and preventing the buildup of tightness and stress in the baby.
Get baby accustomed to oral exercises: You can begin oral exercises before the frenotomy to help the baby get used to having fingers in their mouth. This familiarization can reduce resistance to post-release exercises, making the transition easier for both the baby and the parents.
After a frenotomy, ongoing therapy is crucial to:
Prevent reattachment of the frenulum: Post-release exercises and bodywork, such as gentle stretches and massage, help keep the tongue's range of motion intact and prevent the frenulum from healing back in a restrictive position.
Strengthen new movement patterns: As the baby gains better tongue mobility, specific exercises can strengthen the new movement patterns to ensure long-term feeding success and avoid the return of compensatory behaviors.
Optimize breastfeeding or bottle-feeding function: Ongoing support helps the baby adjust to the newly released tongue, improving latch, milk transfer, and overall feeding efficiency, whether breastfeeding or bottle-feeding.
Sample Pre/Post Exercises:
Tongue lifts and stretches: Help maintain the released tissue and improve tongue mobility by gently lifting the tongue toward the roof of the mouth.
Lateral tongue sweeps: Encourage side-to-side movement of the tongue to build strength and coordination for feeding and speech development.
Lip flanges: Stretch and roll out the upper lip to improve latch, especially for babies who tuck their lips inward during feeding.
Gentle facial massage: Relieves muscle tension in the cheeks and jaw, enhances circulation, and supports overall relaxation for better feeding.
Lactation consultants trained in oral exercises provide gentle, baby-led guidance to parents, ensuring each exercise is done safely and comfortably to support healing and long-term feeding success.
Mental Health and Breastfeeding Stress
Feeding difficulties, such as those caused by tongue-tie, can significantly impact maternal mental health. A study published in the Journal of Advanced Nursing found that mothers who ceased breastfeeding due to physical difficulties or pain exhibited higher levels of depressive symptoms, as measured by the Edinburgh Postnatal Depression Scale. This suggests that challenges in breastfeeding, particularly those stemming from physical issues like tongue-tie, may increase the risk of postpartum depression (Brown et al., 2015).
How Stress Affects Milk Supply:
Breastfeeding isn’t just about latch and position—it’s deeply influenced by hormones, emotions, and your environment. When you're under chronic stress, your body produces higher levels of cortisol, the "stress hormone." While cortisol is helpful in small amounts, too much of it can interfere with oxytocin and prolactin, two hormones that are absolutely essential for breastfeeding.
Oxytocin is responsible for the let-down reflex, the release of milk during feeding.
Prolactin supports ongoing milk production.
When these hormones are suppressed, it can lead to:
Low milk supply – Very high levels of stress impacts your body’s ability to make enough milk.
Incomplete breast emptying – Due to tongue-tie and an improper latch, your baby may be unable to effectively transfer milk or fully empty the breasts. This can lead to issues such as clogged ducts, mastitis, and reduced milk supply over time.
Feeding frustration – When feeding is difficult or painful, both parent and baby can become overwhelmed, making the process even more challenging.
This is where lactation consultants can make a huge difference. They're not just focused on breastfeeding techniques; they support your whole experience. Here’s how:
They help create a reassuring feeding environment to support hormone release and emotional well-being.
They recognize when extra support is needed, offering referrals to postpartum therapists who specialize in perinatal mental health.
They connect you with local support groups so you never feel alone in your journey.
If you're feeling stressed or unsure about your feeding experience, know that you’re not alone—and help is available. Lactation consultants are here to support both your baby's nutrition and your mental health, every step of the way.
Allay Can Help With In-Home Lactation Support
If you're facing challenges related to tongue-tie, lip tie, or feeding difficulties, Allay’s team of lactation consultants is here to help. We specialize in home-based care that includes:
Poor latch or breastfeeding positioning
Low milk supply or oversupply
Sore nipples or nipple pain
Engorgement
Plugged ducts or mastitis
Tongue-tie or lip-tie concerns
Poor weight gain
Baby colic, fussiness, reflux
Breastfeeding challenges after a cesarean birth
Weaning support and transitioning to bottle feeding
Pumping and bottle feeding guidance
Returning to work while breastfeeding
Whether you're looking for holistic treatments for tongue tie, personalized therapy, or a trusted lactation consultant in San Francisco, Allay provides warm, compassionate care that meets you where you are. We accept insurance through The Lactation Network, click here to see if your insurance is covered for lactation consultant services.
We proudly offer home visits within a 30-mile radius of San Francisco, including but not limited to: San Francisco, Oakland, Berkeley, Daly City, San Mateo, South San Francisco, Millbrae, Burlingame, Hillsborough, Palo Alto, Mountain View, Sunnyvale, Cupertino, Santa Clara, San Jose.
Contact Allay today to schedule your home visit with a compassionate lactation consultant who is here to support you.
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