Infant Tongue & Lip Ties

Play Video

Diagnosing & Treating Tongue & Lip Ties in Infants

During a gentle exam, Dr. Green will check your baby’s tongue for adequate range of motion. If your baby has a tongue-tie, he or she may have trouble lifting or moving their tongue. Some babies can’t lift the tip, while others can’t lift the back of their tongue. A heart shaped tongue can also be a sign of a tongue tie.
Infant Tongue Ties
According to the most recent research, 4-11% of infants are born with a tongue tie that is severe enough to adversely affect breastfeeding.
Most of the time, tongue tied babies are fussy and cry a lot which leads to sleep deprivation and extra stress for everyone in the family. Parents of tongue tied babies – especially Moms – can usually sense their child is suffering, but often can’t put their finger on exactly what the problem is.

 The medical term for tongue tie is ankyloglossia. It’s a fancy word that describes a simple concept. Picture your baby with his or her mouth wide open, tongue curled back so you can see the bottom of the tongue. There’s a “cord” running down the center of the bottom of the tongue. That’s a ligament that attaches the tongue to the bottom of the mouth. It’s called a lingual frenum or frenulum. When the frenulum is too short and/or too thick, it “ties” the tongue to the floor of the mouth. This restricts tongue motion, impairs tongue mobility and can cause a host of functional and developmental problems for the tongue tied baby. A simple analogy is a baby being born with webbed fingers or toes– this child will have to learn to use their body differently to make up for the lack of normal function and may have lifelong repercussions.

A tongue-tie can make it difficult for a baby to breastfeed properly. To breastfeed, a baby needs to open their mouth wide and use their tongue to scoop the breast into their mouth. Then, the tongue needs to move in a wave-like motion to remove milk from the breast. If the baby has a tongue-tie, these simple oral functions become difficult if not impossible to perform.
Tongue tied babies have a hard time latching to the breast properly. An improper latch can cause chomping, gumming, popping on and off of the breast and clicking as the baby tries to feed. It can also cause nipple pain and trauma for Mom. If Mom and baby continue to struggle with nursing over time, they can experience decreased milk intake, a decline in milk supply, and premature weaning. Tongue ties can also impact bottle feeding. Left untreated, a tongue tie can make eating solid foods more difficult and impair speech.
Diagnosing Infant Tongue Ties
During a gentle exam, Dr. Green will check your baby’s tongue for adequate range of motion. If your baby has a tongue-tie, he or she may have trouble lifting or moving their tongue. Some babies can’t lift the tip, while others can’t lift the back of their tongue. A heart shaped tongue can also be a sign of a tongue tie.
Infant Lip Ties
Picture yourself gently lifting a baby’s upper lip and pulling it away from the gums and teeth. The little “cord” you see that connects the lip to the upper gums is called a lip frenum.
Lip ties occur when the lip frenum is too thick or too tight. Babies need a long and flexible lip frenum so they can flare the upper lip out and form a seal on the breast or bottle. A good seal creates a healthy latch which prevents “leaking” and reduces excess air intake during feeding.
Just as tongue ties restrict the tongue, lip ties can adversely affect the motion and mobility of the upper lip. Similar to tongue ties, lip ties can lead to problems with breastfeeding and/or bottle feeding in the short term. If the condition isn’t addressed, it can lead to problems with solid foods and speech in the long term.
Sometimes, babies have lip ties that become more noticeable as their front teeth grow in. This can cause a big gap between the front teeth and the lip tie. Parents may notice babies having trouble clearing food off a spoon, biting into food or keeping their lips closed.
Diagnosing Infant Lip Ties
Dr. Green will look at your baby’s upper lip to see if the frenulum is too taut or thick. If she observes tight or restricted tissue, it may indicate a lip tie which is making it difficult for your baby to properly latch onto the breast or bottle during feeding.
She may also perform a “lip flip” test. During this simple and easy exam, Dr. Green will use her finger to gently turn the baby’s upper lip upward and check for any tension or restriction.
Treating Infant Tongue & Lip Ties
A frenectomy or frenuloplasty is a simple in-office procedure that releases or “frees up” the frenum. Combined with proper aftercare, a frenectomy gives the tongue (or lip) the motion and mobility it needs for proper breastfeeding. That leads to improved milk transfer and more comfortable breastfeeding for Mom and baby. Dr. Green understands that having your baby undergo a surgical procedure can be scary.
She performs frenectomy procedures in our private baby rooms and uses a CO2 LightScalpel Laser which makes the procedure precise, quick, and safe. She often gives babies Sweet-Ease sugar water and/or topical numbing gel before the procedure to make it gentler. The procedure usually takes less than 20 seconds and bleeding is very rare. Immediately after the procedure, we’ll bring you to our private, serene feeding room where you and your baby can regroup, relax and nurse before heading home.
Next, Dr. Green will guide you through some simple aftercare exercises that will help prevent re-attachment of the ligament that was released during the procedure. We also provide written and video instructions that explain and show the home care exercises. Before you leave, we will book your 5 day and 14 day follow up appointments and Dr. Green will give you her cell phone number just in case you have any questions or concerns.

What Happens if the Problem is Missed or Ignored?

Unfortunately, many medical specialists are not trained to screen for tongue and lip ties. That leads to symptoms of restricted tissue being miscategorized, misdiagnosed or missed altogether. A toddler with a tongue tie has a frenulum that is too short and/or too thick, which has “tied” or “tethered” the tongue to the floor of the mouth. As children with tongue ties grow older, they may experience functional problems that were not noticeable during breast or bottle feeding. Untreated tongue ties in toddlers can sometimes manifest as:
  • Difficulty consuming solid foods
  • Hampered and/or delayed speech development
  • Chronic mouth breathing
  • Snoring
  • Symptoms that mirror ADD/ADHD
  • Fatigue and lack of energy
  • Poor Sleep
  • Pediatric OSA or other sleep related breathing disorders


Will my baby need sedation or general anesthesia for a frenectomy?

Infants typically do not require any type of sedation for a frenectomy. Your baby will be swaddled, protective eyewear placed, and either one or two assistants will keep your baby safe and still. Keep in mind that the laser is very precise and controlled, and is very safe even on a crying infant.

For older babies and children, each situation is evaluated on a case by case depending on symptoms, urgency, physical and emotional well being of your child. For older children we may use a combination of laughing gas, a movie, and numbing.

Will you use numbing for my baby?
As a general rule, for newborns less than 2 weeks old no anesthetic is used.  We find that the procedure can be performed so quickly that the risks outweigh the benefits of numbing. For infants 2 weeks and older, we use a topical numbing cream that is custom formulated and safe for babies. We only use this for lip ties as placing numbing under the tongue causes difficulty nursing afterwards.  For older babies and children we may use a combination of topical local anesthetic along with an injection, if needed.
After the procedure, is there anything we need to do?

The short answer is yes! During your appointment we will thoroughly discuss, demonstrate, and give written instructions on home care as we have found it is critical for the success of the frenectomy.

How will my baby feel afterward?
First and foremost, it is important to understand that every baby is different. On average, the younger the baby is, the less we see fussiness. For the average baby one can expect a couple days of fussiness or soreness. At first, feeding can be disorganized because of the tongue’s new range of motion. Until the soreness goes away and the tongue strengthens, this is normal and part of the rehabilitation process. Dr. Green works closely with lactation consultants, speech therapists, and myofunctional therapists to make sure we have all hands on deck in the care and rehabilitation of your baby.
Can I nurse or bottle feed right after?
There are no restrictions, and in fact, we recommend nursing/feeding right after! Nursing and skin to skin will help relax and soothe your baby. We have private rooms so you can take your time.
Is this procedure only for the benefit of breastfeeding or will it help later in life?
When there is a restriction in the normal range of motion of the tongue, it is often first identified in infancy during breastfeeding. Red flags ( link to signs and symptoms) are raised that something isn’t right. Sometimes babies are able to compensate extremely well or the mother may have an oversupply that masks inefficient nursing. Bottle feeding does not require the same mechanics and is generally easier for the baby, which may contribute to undiagnosed tongue ties at cause feeding or speech issues in older children. There are so many factors surrounding proper diagnosis ( link to team approach) which is why it is so very important to have a team approach and a comprehensive evaluation by a specialist such as an International Board Certified Lactation Consultant (IBCLC) or Speech language pathologist (SLP) prior to meeting with Dr. Green.

If You Have Concerns, Please
Make an Appointment With Us

Many of us here at AFD are parents and some of us have gone through what you are experiencing. When it comes to tongue and lip ties, our diagnostic tools and treatment protocols are designed to give you clear answers to your questions and a quick resolution to the problem.
Play Video

Our Team Approach

Our focus is on compassionate, comprehensive, and conservative care. We pride ourselves in a team approach in order to best support our mothers and babies. A baby that is struggling with nursing or bottle feeding should ideally be referred to an International Board Certified Lactation Consultant (IBCLC) and/or Speech Language Pathologist (SLP). This will allow for a comprehensive assessment of mother, baby, and the feeding dyad to ensure that the most comprehensive approach is taken.
By collaborating as a team with expertise in multiple disciplines, we can identify infants who may benefit from evaluations by: physical therapists, occupational therapists, chiropractors, cranial sacral therapists, or other specialists. We do this before recommending treatment to give our patients the best chance at a successful outcome.. It is our belief that babies and their parents need strong pre and post-operative care, compassionate counseling, easy to understand education, and most importantly a strong support system.