What is a tongue tie?Â
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 alone doesn't tell us whether it's 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. Â
What does an IBCLC assess?Â
An IBCLC trained in oral function is looking at much more than whether there is a visible frenulum. They want to look at the whole picture. Â
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This includes:Â
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Your pregnancy, birth and feeding historyÂ
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Your breastfeeding goalsÂ
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Weight gain and growthÂ
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Wet and dirty nappiesÂ
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How your baby behaves during feedsÂ
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Breastfeeding or bottle feeding techniqueÂ
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Milk transfer during a feedÂ
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Your comfort and any nipple painÂ
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Your milk supplyÂ
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Your baby's oral anatomy and, more importantly, how their tongue functionsÂ
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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.Â
Signs that may suggest further assessment is needed:Â
No single sign confirms a tongue tie, but a combination of symptoms may indicate that your baby's tongue function should be assessed. These can include:Â
During breastfeeding:Â
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Difficulty achieving or maintaining a deep latchÂ
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Painful breastfeedingÂ
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Frequent slipping off the breastÂ
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Clicking sounds during feedsÂ
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Long or very frequent feedsÂ
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Poor milk transferÂ
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Falling asleep quickly at the breast but remaining hungryÂ
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Poor weight gain despite frequent feedingÂ
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Persistent nipple damageÂ
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During bottle feeding:Â
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Clicking while feedingÂ
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Difficulty maintaining the teat in the mouthÂ
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Milk leaking from the corners of the mouthÂ
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Taking a long time to finish bottlesÂ
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Becoming tired during feedsÂ
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Things you might notice when looking at your baby's mouth:Â
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An open mouth posture at restÂ
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A tongue that sits low in the mouthÂ
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Difficulty lifting the tongue towards the roof of the mouth, even during cryingÂ
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A heart-shaped tongue tip when the tongue is extendedÂ
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Milk coating the tongue hours after feeds (although this can have other causes too)Â
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Limited tongue movement from side to side or forwardsÂ
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It's important to remember that these signs can also occur for other reasons, which is why assessment is so important.Â
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Why does tongue function matter? Â
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.Â
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This can lead to:Â
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Poor milk transferÂ
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Long or frequent feedsÂ
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Reduced stimulation of your milk supplyÂ
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Ongoing nipple pain or damageÂ
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Slow weight gain in some babiesÂ
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Again, these symptoms don't automatically mean a tongue tie is the cause, but they do warrant a thorough assessment.Â
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Why early assessment matters:Â
Feeding challenges can have many different causes. Sometimes a tongue tie is contributing, but sometimes it's simply positioning and attachment isn't right. Occasionally it's related to milk supply, oral tension, prematurity, birth interventions, or another underlying factor which is why it's important to get a thorough assessment. Â
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.
