Tongue Ties: A Must-Know Guide for Parents

At Lunara we understand the challenges, conflicting information, and most importantly the research-driven answer to the question: what should I do when I’m concerned about a tongue tie? 

Tongue Tie Testimonials

Overall it was a relief to have a confirmation that the tongue tie is not all that scary and that each case is individual rather than just do an expensive procedure

“We’re so thankful to have found Bryan! After having one, then two tongue tie procedures and still struggling with breastfeeding. we realized both we and our little guy needed additional direction and support.”

“We can’t say enough about Dr. Bryan and how helpful he was to us in navigating our son’s tongue tie post-op care!”

“I credit them for the majority of the improvement we experienced with breast feeding. They are an expert with tongue ties and soothing babies!”

“Fabulous addition to our care team pre and post tongue tie release for our 11 week old!”

“Instrumental in preparing our son for his tongue tie procedure and giving us tools to salvage breastfeeding and become successful with bottles after the procedure as well.”

baby breastfeeding


About Tongue Ties

What Is A Tongue Tie? 

Tongue tie occurs when the movement of the tongue is more restricted than expected due to tissue connecting it to the mouth. This tissue is called the frenulum. This tissue is found more towards the front in around 40% of individuals. Medically referred to as ankyloglossia, tongue ties are commonly categorized as anterior or posterior. An anterior tongue tie refers to the tongue being attached to the gum, while a posterior tongue tie is described as a restriction under the tongue, connected to the bottom of the mouth, and wider in shape.

Both types are believed to impact tongue movement, although research is inconclusive about the specific effects they have on the average person. The Bristol Tongue Assessment Tool examines both the functionality of the tongue and the location of attachment to determine if the tie is unlikely to have a negative impact on the child.

What Causes A Tongue Tie?

There are a number of hypotheses regarding the cause of tongue tie. The most likely one is related to genetics with one or both parents often having a more anterior frenulum.. There is not good evidence on this hypothesis or others as they have not been studied and rely on correlation and anecdotal evidence. Unfortunately we do not know exact causes for a tongue tie.

Who Can diagnose and Treat a Baby’s Tongue Tie?

Medical diagnosis should be conducted solely by physicians, while oral diagnosis falls within the purview of dentists. Functional diagnosis, on the other hand, is the domain of physical therapists (PTs), occupational therapists (OTs), or speech-language pathologists (SLPs). Each provider’s expertise and legal authority govern the assessment results they deliver. 

It is important to note that while approximately 40% of babies may be diagnosed with tongue tie, not all of them require frenectomy. If you require assistance, the initial step should be consulting a lactation consultant or feeding specialist. If interventions fail to yield improvements, seeking the guidance of a therapist can empower your baby. Ultimately, if necessary, a dentist or ear, nose, and throat specialist (ENT) can perform frenectomy, particularly for severe cases of restricted tongues. 

How Do You Check For a Tongue Tie?

You can tell if a baby has a tongue tie by using the Bristol Tongue Assessment Tool, this tool is the only tool that has looked at long term breastfeeding outcomes and frenectomy. It is used to determine if a baby is unlikely to benefit from the procedure. 

How Common is Tongue Tie in Babies? 

The definition of tongue tie can vary, leading to a wide range of estimates regarding its prevalence in babies, from 1.5% to 40%. A study conducted in New Zealand revealed that if only 3.5% of infants undergo a frenectomy, the breastfeeding outcomes at 6 months are comparable to those where 12% of all babies have the procedure. This indicates that approximately 1 in 30 babies may derive breastfeeding benefits from frenectomy. 

How Can I Tell if My Baby is Tongue-Tied? 

As of 2023, the Bristol Tongue Assessment Tool stands as the sole instrument employed in research to identify babies who may not derive significant benefits from frenectomy. You can access the assessment tool directly or opt for a virtual discovery session to discuss your concerns in detail. 

Baby drinking from bottle

Feeding & Tongue Ties

Do Babies With Tongue Tie Have Difficulties With Breastfeeding? 

The majority of infants with a tongue tie generally do not experience breastfeeding challenges. This is due to the fact that tongue tie has a lesser impact on breastfeeding compared to factors such as milk flow rate, milk volume, feeding position, infant’s head control, nipple shape, nipple length, latch depth, infant’s jaw position, and numerous others. In summary, tongue tie is considered one of the least common causes of breastfeeding difficulties. 

Can Babies With Tongue Tie Drink Effectively From a Bottle? 

The majority of infants with tongue tie can effectively consume milk from a bottle. Factors that significantly affect bottle feeding include the flow rate, nipple shape, size of the baby’s mouth and palate, bottle feeding position, and the baby’s positioning during feeding. 

How To Breastfeed A Baby With Tongue Tie?

Most babies with tongue tie can breastfeed just like any other baby. If you’re experiencing breastfeeding challenges, especially pain, it’s important to seek individualized support. Various factors can contribute to breastfeeding discomfort, including baby’s position, strength, tension, swallowing ability, reflexes, latch depth, nipple shape and length, milk flow rate, and more.

Addressing breastfeeding difficulties requires personalized assistance, and it’s worth noting that tongue tie is just one aspect. In fact, many tongue-tied babies can quickly improve their breastfeeding without the need for surgery.

How to Feed A Baby With Tongue Tie? 

Feeding a baby with tongue tie often requires a slower flow bottle with a wider flange to support the jaw movement and limit compression. Additionally side feeding is also beneficial because if a baby is limited in their ability to swallow they are then able to control the rate of swallow and improve their comfort with feeding.

Baby neck exam

Interventions For Tongue Tie

What Treatments Are Available For a Baby’s Tongue Tie? 

Non-surgical treatments for an infant’s tongue tie encompass physical, occupational, or speech therapy. The objective is to enhance your baby’s movement through manual therapy and exercise, while also providing feeding and lactation support if feeding is the primary concern. Scissor and laser frenectomy may be surgical options in severe cases. However, in most instances of tongue tie, changing the tie is not necessary to observe improvements in breastfeeding and the baby’s comfort. 

Does a Baby’s Tongue Tie Always Require Intervention? 

Approximately 40% of individuals experience some form of tongue tie. It is important to note that the term “tongue tie” encompasses a wide range of conditions, and the majority of infants with a tongue tie do not require surgical intervention. Research from New Zealand suggests that for parents experiencing breastfeeding pain (which is the most common reason for frenectomy), about 75% of cases are likely to resolve without frenectomy. 

Is Surgery Always Necessary for Addressing a Baby’s Tongue Tie? 

Even if a baby experiences limited mobility, leading to breastfeeding discomfort, there are alternative options available. Furthermore, the transfer of volume lacks comprehensive research, and the effectiveness of frenectomy in addressing concerns such as reflux, volume transfer, or gastrointestinal discomfort remains inconclusive. The most reliable research on breastfeeding pain indicates an average pain reduction of 1.3 on a 0-10-point scale. Often, lactation consultants, physical therapy, and feeding support can provide the necessary interventions to facilitate successful breastfeeding. 



How Much is Tongue Tie Surgery/Frenectomy? 

Out of pocket expense for a tongue tie surgery for an infant ranges from 600-1000 dollars. Every region is different and some providers accept insurance. Insurance benefit is individual and does not guarantee cost reduction.

Can a Baby’s Tongue Tie Grow Back After Frenectomy? 

Although a baby’s tongue tie does not “grow back,” there is a potential for the wound to heal in a manner that restricts movement. Consequently, post-frenectomy exercises are recommended, even though there is no conclusive evidence to support their efficacy. 

Is a Frenectomy For Tongue Tie Painful? 

Indeed, frenectomy, whether performed using scissors or laser, inevitably causes discomfort for the baby throughout the procedure, during post-care exercises, and due to the natural inflammatory response triggered by tissue damage. The most intense pain is typically experienced within the initial 48 hours. According to the CRIES scale, which mirrors our 0-10 pain scale, the pain level is estimated to be around 5.4 out of 10 during this time. However, after just 30 minutes of rest, the pain subsides to less than 2 out of 10.