Infant Tongue Tie

What is a tongue-tie (ankyloglossia)?

The strand of tissue shaped like a cord (lingual frenulum), that attaches the tongue to the floor of the mouth, can sometimes be too short, causing a restriction in movement and strength of the tongue. Although most of the time the tight frenulum is easy to see and identify, sometimes the tight cord is underneath the skin causing a submucosal or posterior tongue-tie.   This restriction can result in a poor latch, nipple pain, and other complication with breastfeeding. Aside from nursing, a tied tongue has been linked to other issues during the child’s development from infancy to adulthood.  


What is a lip tie?

A lip tie is when the cord (labial frenulum) that attaches the lip to the gum area of the mouth causes a restriction in the range of motion and strength of the lips.  This restriction can result in a poor seal while bottle or breastfeeding, causing more air to be swallowed by the baby.  Babies with a lip tie may have more reflux and be gassier or “colicky”. Just like an untreated tongue-tie, a lip tie has also been shown to impact the development of the child from infancy to adulthood.

Although a long list of issues can be attributed to lip and tongue tie, here are some common ones to look for:

Baby’s Signs:

  • Shallow latch at breast or bottle
  • Falls asleep while eating
  • Slides or pops on and off the nipple
  • Clicking sound while nursing
  • Reflux/gassiness/spitting up
  • Hiccups
  • Overly frustrated/colicky baby
  • Congestion
  • Snoring
  • Feeding feels like a full-time job (frequent feeding every 1-2hrs or more)
  • Poor weight gain
  • Milk dribbles out of the mouth while nursing/bottle feeding

Mom’s Signs:

  • Pain during latching or nursing
  • Flattened/lipstick shaped nipples after feeding
  • Blistered/sore nipples requiring nipple shield
  • Nipple damage
  • Poor/ incomplete breast drainage
  • Blocked ducts or mastitis
  • Nipple thrush
  • Decreased milk production

Developmental Effects (Signs and Symptoms)

A restricted tongue and lip can not only impact nursing, but it can also affect growth and development of the child from infancy to adulthood.  The tongue and its surrounding muscles lay the architecture for the rest of our dentition.  With proper tongue posture or positioning, the tongue acts as a scaffold for the development of the oral cavity and the skull as a whole. Some warning signs and symptoms to look for in your child which may indicate a problem in their growth and development are:

  • Crowded or spaced dentition
  • Mouth breathing day or night
  • Malocclusions (incorrect bite)
  • Bedwetting/sweating
  • Teeth grinding
  • Speech impediments
  • Oral aversions to certain textures
  • “Picky” eating
  • Arrested growth and development
  • ADD/ADHD
  • Poor sleep quality
  • Torticollis (stiffness in neck—the child may have a preference of turning to one side over another)

How is a tie diagnosed?

Assessing function during the assessment process is critical to diagnosing frenulum restrictions.  While some ties may be very obvious, other ties may not be as visible and yet cause the same problems for mom and baby. Some babies can also have a posterior (submucosal) tongue tie and/or buccal (cheek) ties, which may be easier to miss.  

What to expect at baby's visit

The first visit with Dr. Jafari/Dr. Persaud will be a consultation with the possibility of same-day treatment.  The consult begins with looking at signs and symptoms associated with a tie through the paperwork provided. Then, the frenulums are evaluated through a functional assessment. Next, the doctor will do a structural assessment using a knee-to-knee exam.  If treatment is to be recommended, our Occupational Therapist who is certified in TummyTime! Method will perform bodywork for about 30 minutes to release some fascial tension.  The release is then performed by the doctor using a quick and non-invasive procedure. Once finished, our lactation consultant will help with the initial latch to the breast or bottle to ensure a deep latch is achieved.

State-of-the-Art CO2 LightScalpel Laser

The LightScalpel CO2 laser proves to be an efficient and safe method in performing frenectomies.  Compared to other lasers, it evaporates the tissue and provides instant hemostasis, allowing a clean field for the procedure.  This also allows for precise and reproducible results.

A Multidisciplinary Team Approach

A multidisciplinary approach is imperative in the success of a tongue and lip tie revision.  Without the intervention of bodywork and lactation therapy, there is a significant risk of re-attachment.  Our team consists of a Board Certified Lactation Consultant (IBCLC) and an Occupational Therapist (OT).  

Connect With Us

We’d love to meet you. Call (678) 355-8980 or request an appointment online to set up your first visit. We’ll be in touch soon.