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Tongue & Lip Ties

Class lll Anterior Lingual Restriction

I started doing more research on Tongue and Lip Ties a few years ago and quickly learned no one in my small town was concerned or addressing oral restriction in babies. I could never understand the black cloud that seemed to loom over the topic. There were concerns about over diagnosing or chatter that this was "fad" and we should ignore until it went away.

But it didn't go away.

Families were being tossed around to different providers, often with no help or diagnosis and commonly ending up pumping exclusively, formula feeding and feeling unheard. It made me delve into the taboo topic; searching for online studies, books, in-person conferences and hands on training.

So let's delve in!

In this blog I will address Tongue and Lip Ties as "oral restriction" (it is also called Ankyloglossia.) It is described as "an embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement." Retrieved from - International Affiliation of Tongue Tie Professionals

(I am not going to delve into classes of restriction, different kinds of ties etc. There are great blogs and more information from leading specialists, I like Dr. Ghaheri's blog posts!)

Click here for more information on Lip Ties.

Everyone has a Frenulum!

Yes! Everyone has a frenulum under their tongue and lip, the problem is when it becomes restricted and function of the tongue or lip is impaired.

Often times we will see these symptoms in the feeding parent:

  • Painful Nursing/ poor latch

  • Cracked, creased ,flattened nipples

  • Bleeding nipples

  • Low milk supply

  • Plugged ducts, reoccurring mastitis

  • Thrush

  • The need to use a nipple shield

Infant symptoms may include:

  • Poor or shallow latch

  • Long feedings often falling asleep at the breast

  • Slips on and off nipple during feeds

  • Reflux and or colic symptoms

  • Clicking noises while feeding

  • Poor weight gain

  • Chewing or gumming the nipple

  • Inability to flange to the lips on the breast or bottle

  • Milk dribbling out of the mouth when feeding

There are other symptoms not necessarily associated with feeding that we attribute to tongue and lip ties as well. These include:

  • A strong gag reflex

  • Unable to keep a pacifier in the mouth

  • Mouth Breathing

  • Congested nose

  • Frustration at the breast or bottle

Often an IBCLC (International Board Lactation Consultant) will notice the restricted frenulum/ function.


Well, oral anatomy is on our radar. If you hare having feeding issues, an oral assessment with the infant should be part of your consultation with an IBCLC. We examine the tissue under the lip and tongue as well as observe a feed to assess function. We may even use a scoring tool looking to see how the tongue moves, cups, suckles and elevates.

My IBCLC thinks my baby may have a tongue or lip tie, now what?

Your IBCLC should be able to give you some referrals for 1. Bodywork and 2. A diagnosis and revision.

Did you know that a Lactation Consultant cannot diagnose oral restriction? This needs to be done by a Doctor. Most commonly a Pediatric Dentist or ENT.

What is Bodywork?

Bodywork is extremely important in regards to assisting the restriction from releasing. According to Bodyworkers of Ankyloglossia:

"Practitioners use hands-on assessment to locate areas of decreased mobility, tightness or restriction and gently help to mobilize the area using gentle experienced touch. Bodywork helps baby with body awareness and maximizes baby’s access to postural reflexes and natural movement inclinations through the nervous system."

For optimal results bodywork should be done before and after a revision. I am so lucky to work closely with a Chiropractor and a Licsenced Massage Therapist who both specialize in infants and Cranial Sacral Therapy. Your IBCLC should make a referral for bodywork as soon as possible so you can get a session in before the revision.

Here is a list of the Types of Providers regarding Bodywork someone could work with regarding oral restriction.