Conditions · Feeding & oral function
Tongue Tie and Lip Tie in Babies
What they are, what they look like, and how to find out whether oral function is affecting your baby’s feeding.
If you have been looking in your baby’s mouth and wondering whether something looks different, you are not alone. Tongue tie and lip tie are two of the most searched feeding questions for a reason. They can sometimes be hard to see and easy to miss, especially in the early weeks.
The short answer
Can you tell by looking?
Usually not on its own. A tongue tie or lip tie is easy to misread from a photo or a quick look in the mouth. Some babies have tissue that looks tight or prominent and still feed comfortably. Others have a restriction that is hard to see and still struggle to latch, transfer milk, or feed without pain. What tells us the most is how the tongue and lips move and work during a feed, not how the frenulum looks at rest. That is why a good assessment is about function, not appearance.
The basics
What a tongue tie is
A tongue tie is a band of tissue under the tongue, called the lingual frenulum, that limits how far the tongue can move. It may be tight, short, or thick, or attached too high along the lower gumline. Every baby has this band. It is only described as a tie when it restricts movement enough to matter for feeding.
What parents often notice:
- The tongue does not extend past the lower lip or gum.
- The tongue tip looks notched or heart-shaped when the baby cries or reaches out.
- When the baby sticks out or moves the tongue, the middle dips or divots, or the tongue looks pulled downward.
- The tongue has trouble lifting toward the roof of the mouth, and stays low even when the baby cries.
- Side-to-side movement looks limited.
- A white, milky coating on the tongue, often heavier on the middle and back than the tip.
That coating is usually milk, sometimes called milk tongue, and it wipes away with a soft cloth. A coating that does not wipe off can be thrush, a different issue that may need treatment.
These are observations, not a diagnosis. Movement matters more than appearance, which is why an assessment looks at how the tongue works during feeding, not just how the frenulum looks at rest.
The basics
What a lip tie is
A lip tie is a tight band, the labial frenulum, connecting the upper lip to the gum. Almost every baby has this band, and a visible or even prominent one does not mean there is a feeding problem. When the upper lip cannot flange out well, it can affect the seal at the breast. If feeding is difficult, we look at how the upper lip moves as one part of the whole picture, alongside latch, seal, comfort, jaw, tongue, and milk transfer. A lip tie and a tongue tie can occur together or on their own.
There can even be frenulums attaching the cheeks to the gum, called a cheek tie or buccal tie. This can sometimes limit how the cheek moves and how wide the baby opens when trying to latch. Cheek ties don’t usually cause feeding problems on their own, but alongside other ties, they can make the symptoms worse. So if feeding is difficult, we will also look at how the cheeks move as part of the whole picture.
The whole mouth
Why we look beyond the frenulum
How the tongue rests tells us as much as how it moves. A tongue with good lift rests up toward the palate and sweeps it clean during feeding. A tongue that cannot lift well sits low in the mouth at rest, and because it does not reach the palate, a milky coating tends to linger on the middle and back. That coating is usually just milk and wipes away with a soft cloth, while a coating that does not wipe off can be thrush, a different issue that may need treatment. On its own it does not diagnose anything, but alongside a feed the pattern can be a clue that lift is limited.
The frenulum’s attachment can also leave a sign we can feel. Sometimes it anchors high along the lower gumline, and in those babies we may feel a firm ridge on the inside of the lower gum, where the gum appears to have taken on the shape of that tension over time. It is one of the things we check by hand during an assessment, not something to go looking for at home, and like the rest it means more in the context of a feed than on its own.
The palate matters too, because the tongue and the palate work together. When the palate is high or narrow, the tongue has to work harder to reach it, seal against it, and draw milk, so the demand on tongue function goes up. A baby with a high palate needs better than average tongue function to feed comfortably. Movement that would be enough with an average palate can fall short with a high one, which is part of why two babies whose frenula look similar can feed very differently.
None of these is a yes-or-no test by itself. This is why we look at the whole mouth and a full feed, not one structure in isolation.
A common misunderstanding
“The tongue sticks out, so it is not a tie”
Being able to stick the tongue out is often taken as proof that there is no tongue tie, but it does not rule one out. Sticking out and lifting up are different movements. A baby can poke the tongue past the lips and still not be able to raise it well toward the roof of the mouth, and lifting is the movement that matters most for feeding. A tongue that extends fine can still be restricted in a way that affects latch and milk transfer. The question is not whether the tongue comes out, but how it works during a feed.
When to look more closely
Signs oral function may be affecting feeding
Tongue and lip restrictions show up in feeding more than in looks. The signs we listen for include:
- Pain, pinching, or misshapen nipples after feeds.
- A latch that keeps slipping or feels shallow.
- Clicking, smacking, or other noisy feeding, frequent breaking of suction, or a lot of air during feeds.
- Milk leaking or spilling from the corners of the mouth during feeds.
- A baby who seems uncomfortable feeding, pushing or hitting at the breast.
- Coughing or choking during feeds.
- A sudden refusal of the bottle.
- Long feeds, falling asleep quickly at the breast, or feeds that never seem to satisfy.
- More gas, fussiness, spitting up, or reflux.
- Slow weight gain, or supply that drops because milk is not being moved well.
Any one of these can have several causes. Together, and alongside what we see during a feed, they help build a picture.
Assess, don’t assume
A feeding problem can have more than one cause
Painful or difficult feeding can come from a tongue tie, and it can also come from positioning, latch, a forceful or slow let-down, reflux, or the early learning curve of feeding. Sometimes more than one of these is in play. It is easy to land on a tongue tie too quickly, and just as easy to miss a real one, which is why we look at how your baby actually feeds rather than assuming or dismissing. The goal is to find what is affecting feeding, not to guess.
How we look
How we assess feeding and oral function
When feeding is the concern, the first step is a feeding and lactation assessment. We look at the whole feeding picture, not one piece of tissue. A feeding and lactation assessment with one of our IBCLCs looks at how your baby latches, moves the tongue, and transfers milk, and at how feeding feels for you. This is feeding assessment, within lactation scope. Diagnosing a tongue or lip tie is the role of the provider who would treat it, not something we do. For most feeding concerns, this is where care begins.
A full look at oral function includes more than the tongue. We also look at the shape of the palate and the oral cavity, which is easy to overlook, and we watch how your baby uses their whole body to feed: whether they can comfortably hold the tongue forward, or have to work for it, pulling back or burying their face against the breast to keep going. Signs like these can point to tension that is worth a closer look.
Sometimes the assessment points to more than feeding mechanics. When muscle tension, jaw movement, a head or neck preference, or broader movement concerns appear to be affecting feeding, a separate chiropractic evaluation may help determine whether bodywork could support comfort and movement. That is a separate, self-pay path, and your care team helps you decide whether it is worth considering. It is a second step when the picture calls for it, not the starting point.
A release, sometimes called a frenectomy, is a small surgical procedure that frees the tissue under the tongue or lip. It is performed by a dentist, oral surgeon, or ENT, not by us. Even though it is generally considered low risk, it is still surgery, so we lead with supportive care, work through it first, and make sure a referral is necessary before we make one. If a release does make sense, we refer you to one of these providers and stay involved through the process that follows.
When a release or bodywork is the right step, we refer to and coordinate with a vetted network. See the frenectomy and bodywork providers we work with.
A range of choices
What to do if there is a tongue tie
If an assessment points to a tongue tie that is affecting feeding, there is more than one way forward. The right path depends on your baby, what you want for feeding, and what you are comfortable with.
The choices run from the most conservative to the most direct:
- The most conservative path is to leave the tie alone and manage feeding as it is. Some babies do well enough this way with support for positioning and latch. For others it means moving to pumping and bottle feeding, or stopping breastfeeding. This is a valid choice, and we will keep working with you.
- A middle path is a wait-and-see approach, using feeding support, oral exercises, and bodywork to try to ease tension and improve function while keeping an eye on growth. This does not treat the tie itself, but for some babies it is enough, and it keeps your options open.
- The most direct path is a surgical release, and it is more involved than getting a referral and being done. A release works best with preparation for you and your baby beforehand and therapy as it heals afterward, so we stay involved through the whole process, not just the referral.
None of these is automatically the right choice. We talk through the tradeoffs with you and support the path you take.
If a release is recommended
Wrap Around Care: support through a release and healing
A release changes what the tongue or lip can do, but it does not automatically change how a baby uses that new movement. Because the tongue is a muscle, a release has something in common with orthopedic surgery: even though it is a small procedure, freeing the movement is only the start, and the muscle still has to learn to use it. Babies often need help learning new patterns afterward, and feeding, supply, latch, comfort, and healing all still need attention. This is why a release works best as one part of a larger plan rather than a single appointment. We call that plan Wrap Around Care.
Ideally, this plan starts before the release. Preparing the baby and family ahead of time makes a real difference, and in our experience it is much harder to reach the outcomes we want when the surgery comes first. If a release has already happened, we can still help, though it is harder to make up that groundwork after the fact.
What that support can involve:
- Visits before the release, often two or three, so feeding is supported and the groundwork is in place.
- Coordination with the provider who performs the release, so your care stays consistent, and we are often there with you for added support.
- A follow-up visit a few days after, usually around day two or three.
- Weekly support through healing, with us or with the provider, over a process that usually runs six to eight weeks.
The release is part of the plan, not the end of it. Most babies need time and support to turn new movement into comfortable, effective feeding, and that is the part we stay with you for.
Safety first
When to contact your pediatrician or seek care
When feeding is hard, wanting answers quickly makes sense. Most of what we help with is feeding support. A few signs point to medical care instead, so contact your pediatrician if your baby is not gaining weight as expected, has fewer wet or dirty diapers than usual, is very sleepy and hard to wake for feeds, or shows signs of dehydration. If you are worried about your baby’s breathing or your baby seems unwell, seek medical care right away.
A family’s experience
A parent’s experience with wraparound care
Holly is a clinician and a mother of three. All three of her children were born with oral restrictions, and the care they received looked very different each time. Her youngest was the first to have wraparound support in place before the release and through healing, and in this short video she shares what that meant for her family.
If there’s anything that I could do to influence anyone’s thoughts about how integrated care really can benefit this situation, I would shout it from the rooftops.
This is one family’s experience. Every baby and every family is different, and individual results vary.
Holly, a clinician and parent, on her family’s experience with integrated, wraparound care.
Next step
Find out what is going on
You do not have to figure out whether it is a tongue tie on your own. If your main concern is feeding comfort, latch, or supply, a feeding and lactation visit is the place to start. If oral function and bodywork look like part of the picture, the next step is a chiropractic evaluation.
Common questions
Frequently asked questions
Is tongue tie the reason breastfeeding hurts?
Sometimes, but not always. Pain can also come from latch, positioning, let-down, or other causes. A feeding assessment looks at all of these before pointing to any one of them.
Does every tongue tie need a release?
No. Sometimes babies feed well with support that does not involve a procedure. We work through other supports first and refer for a release only when an assessment shows it is necessary. It is still a procedure, even though it is generally considered low risk, so when a referral is the right step, the decision is made with the provider who would perform it.
Can you help if I do not want surgery?
Yes. Our goal is never to push you toward surgery. If you decide it is not the right choice for your family, for any reason, we will keep working with you on feeding either way.
Do you perform the release procedure?
No. We refer out for the release itself, and we stay with you through the rest. We support feeding beforehand, we coordinate with the provider and are often there with you for the release, and we support healing afterward through our Wrap Around Care process. The procedure is one step, not the whole solution.
How long does the process take after a release?
Healing is a process, not a single appointment. For many families it runs about six to eight weeks, with regular support along the way, which is why we wrap the whole process rather than treating the release as the finish line.
Should the release be done with scissors or a laser?
Both methods are used, and providers are trained in the approach they use. Which one is right is part of the conversation with the provider who performs the release, not something decided here. Our role is the same either way: the assessment beforehand and the support through healing. We can help you think through what to ask when you meet with the provider.
What should I ask before agreeing to a release?
A release is a procedure, so it is reasonable to ask questions first. Helpful ones include what specifically is restricted and how it is affecting feeding, what has been tried before recommending a release, what the procedure involves and how it will be done, and what aftercare and follow-up look like. A good provider welcomes these questions, and we are glad to help you think them through before you meet with the provider who would perform the release.
Do you get paid to refer me to a provider?
No. When we refer you to an outside provider, such as for a release, it is based on what fits your baby, not on any payment to us. We are not paid by the providers we refer to.
Can a lip tie affect feeding on its own?
Sometimes. Almost every baby has an upper-lip band, and a prominent one is not a problem by itself. When feeding is difficult, an upper lip that cannot flange well may affect the seal, so we look at how the upper lip moves as one part of the whole picture rather than on its own. An assessment helps tell whether it is affecting your baby.
What about cheek ties?
Cheek ties are not well defined, and current evidence does not support treating a cheek tie as a stand-alone reason for feeding difficulty or for a release. We may look at how the cheeks move as part of overall oral function, but we do not use the term cheek tie on its own to explain a feeding problem. As with everything else, we look at how your baby actually feeds.
What is the difference between the feeding visit and the chiropractic evaluation?
The feeding and lactation visit assesses how your baby feeds and how feeding feels for you, within lactation scope. The chiropractic evaluation is a separate, self-pay step for oral-function bodywork. Many families use both.
This is general information, not medical advice. For what is right for you and your baby, talk with us and with your doctor. Read our full Medical Disclaimer.