What is a tongue tie?Β
A tongue tie occurs when the lingual frenulum (the small piece of tissue connecting the underside of the tongue to the floor of the mouth) is shorter, tighter, or positioned in a way that may restrict tongue movement. However, the presence of a frenulum aloneΒ doesn'tΒ tell us whetherΒ it'sΒ causing a problem. Many babies have visible frenula and breastfeed beautifully with no other concerns. Others may have very subtle looking anatomy but significant restrictions in tongue movement that affect feeding. This is why assessment of function is so important rather than diagnosing off a visual alone.Β Β
What does an IBCLC assess?Β
An IBCLC trained in oral function is looking at much more than whether there is aΒ visibleΒ frenulum. They want toΒ look atΒ the whole picture.Β Β
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This includes:Β
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Your pregnancy, birth and feeding historyΒ
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Your breastfeeding goalsΒ
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Weight gain and growthΒ
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Wet and dirty nappiesΒ
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How your baby behaves during feedsΒ
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Breastfeeding or bottle feeding techniqueΒ
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Milk transfer during a feedΒ
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Your comfort and any nipple painΒ
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Your milk supplyΒ
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Your baby's oral anatomy and, more importantly, how their tongue functionsΒ
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A tongue tie assessment is never just a quick look inside the mouth, it should always be combined with a full feeding assessment.Β
Signs that may suggest further assessment is needed:Β
No single sign confirms a tongue tie, but a combination of symptoms mayΒ indicateΒ that your baby's tongue function should be assessed. These can include:Β
During breastfeeding:Β
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Difficulty achieving or maintaining a deep latchΒ
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Painful breastfeedingΒ
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Frequent slipping off the breastΒ
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Clicking sounds during feedsΒ
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Long or very frequent feedsΒ
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Poor milk transferΒ
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Falling asleep quickly at the breast but remaining hungryΒ
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Poor weight gain despite frequent feedingΒ
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Persistent nipple damageΒ
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During bottle feeding:Β
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Clicking while feedingΒ
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Difficulty maintaining the teat in the mouthΒ
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Milk leaking from the corners of the mouthΒ
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Taking a long time to finish bottlesΒ
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Becoming tired during feedsΒ
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Things you might notice when looking at your baby's mouth:Β
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An open mouth posture at restΒ
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A tongue that sits low in the mouthΒ
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Difficulty lifting the tongue towards the roof of the mouth, even during cryingΒ
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A heart-shaped tongue tip when the tongue is extendedΒ
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Milk coating the tongue hours after feeds (although this can have other causes too)Β
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Limited tongue movement from side to side or forwardsΒ
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It'sΒ important to remember that these signs can also occur for other reasons, which is why assessment is so important.Β
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Why does tongue function matter?Β Β
The tongue plays a huge role in feeding. To breastfeed effectively, your baby needs to lift, extend and cup their tongue around the breast while creating rhythmic movements that remove milk. If tongue movement is restricted, babies may struggle to generate enough suction to maintain latch or remove milk efficiently.Β
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This can lead to:Β
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Poor milk transferΒ
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Long or frequent feedsΒ
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Reduced stimulation of your milk supplyΒ
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Ongoing nipple pain or damageΒ
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Slow weight gain in some babiesΒ
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Again, these symptomsΒ don'tΒ automatically mean a tongue tie is the cause, but they doΒ warrantΒ a thorough assessment.Β
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Why early assessment matters:Β
Feeding challenges can have many different causes. Sometimes a tongue tie is contributing, but sometimesΒ it'sΒ simply positioning and attachmentΒ isn'tΒ right. OccasionallyΒ it'sΒ related to milk supply, oral tension, prematurity, birth interventions, or another underlying factor which is whyΒ it'sΒ important to get a thorough assessment.Β Β
If feeding isn't feeling comfortable or your baby seems to be struggling, trust your instincts. Seek support from an IBCLC who will be able to help you move forward and direct you further if needing diagnosis and intervention.
