Tongue Tie and Lip Tie: Does Your Baby Need Treatment?

A week after giving birth to her daughter, Crystal Norton hit a wall with breastfeeding. Her baby was struggling to latch and she always seemed hungry. Norton was struggling, too—her breasts were engorged and her nipples were raw. Desperate, she went to a lactation specialist, who immediately identified the issue: Norton's daughter had tongue tie.

The familiar term for ankyloglossia, tongue tie occurs when a band of tissue called the lingual frenulum tethers the tongue to the floor of the mouth. "In some babies, the lingual frenulum might be too short, too tight, or it might be attached way up near the tip of the tongue," says Rallie McAllister, M.D., MPH, co-founder of The Mommy MD Guides. She notes that ankyloglossia appears to be more common in boys and tends to run in families.

Lip tie is a different condition that can have similar effects, and which sometimes accompanies ankyloglossia. It happens when the frenulum of the upper lip is too tight or close to the gums.

Symptoms and Complications

A 2017 study published on the National Center for Biotechnology Information's website says that between 4 and 11 percent of babies have tongue tie. If you suspect your child may have tongue tie or lip tie, Dr. McAllister suggests looking out for the following signs: a notched tongue, difficulty latching, difficulty sucking, and nursing pain. Your child might also be unable to stick his tongue out beyond the lower teeth or gum line, says Molly Petersen, certified lactation counselor at Lansinoh.

For most babies, tongue tie and lip tie pose no problems. But both types of ties can make it difficult for infants to nurse and swallow, and can cause nursing pain for mom. That's because these babies have trouble gaping – or opening their jaw wide enough to fit around the nipple. They may also have a shallow latch since they're unable to extend their tongue, says Petersen. Instead of sucking milk out of the breast, a tongue-tied baby may try squeezing it out.

Tongue tie in particular has been linked speech issues starting at around 18 months, including difficulty articulating sounds such as D, L, N, R, S, Sh, T, Th, and Z, because the tongue is so taut. Children may also have challenges playing a musical instrument, licking an ice cream cone, or giving a kiss.

Tongue Tie Treatment and Controversy

Tongue tie sometimes resolves on its own over time as the frenulum relaxes. As a short term solution, Petersen recommends using a nipple shield under the guidance of a lactation professional. "A nipple shield allows the baby to breastfeed using a shallower latch, and can help prevent nipple damage during feeding," she says.

However, if parents continually complain of breastfeeding problems, their pediatrician or lactation consultant may refer them to pediatric dentist. She may perform a simple surgical procedure called a frenotomy, in which she'll use sterilized surgical scissors to clip the frenulum. This treatment usually takes place in the hospital. "Because the tissue doesn't have many nerves or blood vessels, there's not much bleeding or pain," Dr. McAllister says.

In recent years, however, frenotomy procedures have caused a divide amongst medical professionals. Some doctors wholeheartedly advocate for the procedure's benefits, while others claim that frenectomies are happening too often. In fact, the 2017 study found no consistent link between frenectomies and infant breastfeeding success (although getting a frenotomy was shown to decrease breastfeeding mothers' nipple pain).

What's more, in a July 2019 study published in JAMA Otolaryngology—Head & Neck Surgery, researchers examined 115 newborns referred to Massachusetts Eye and Ear clinic for tongue tie surgery. These newborns were examined by a pediatric speech-language pathologist, who found that about 63 percent of newborns didn't actually need the procedure, even though they were recommended for it. Instead, a feeding evaluation helped improve breastfeeding success.

"We have seen the number of tongue-tie and upper lip tether release surgeries increase dramatically nationwide without any real strong data to show these are effective for breastfeeding," Christopher J. Hartnick, MD, MS, Director of the Division of Pediatric Otolaryngology and the Pediatric Airway, Voice and Swallowing Center at Massachusetts Eye and Ear, says in the study. "We don't have a crystal ball that can tell us which infants might benefit most from the tongue-tie or upper lip release, but this preliminary study provides concrete evidence that this pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure."

Linda Dahl, M.D., a otolaryngologist and surgeon at the Dahl Otolaryngology Center in New York City, who has helped at least 21,000 babies with breastfeeding difficulties, claims some dentists and lactation consultants are too quick to diagnose tongue tie. Oftentimes they'll pin nursing complications on tongue tie when there are other factors at play.

"Many breastfeeding problems have no relation to tongue tie," she explains. "Breastfeeding issues can happen because the baby's palate is high and jaw is set back, which prevents the baby from gaping." If this is the case, releasing a baby's frenulum under his lip/tongue may allow him to open his jaw wider, but it won't miraculously solve the breastfeeding woes.

Nursing trouble may also occur from factors like low milk supply and clogged ducts. What's more, mothers may associate nipple pain with a tongue tie, when in reality, some degree of pain is normal after beginning nursing.

All in all, frenectomies can't be considered a universal solution to breastfeeding issues. That's why Dr. Dahl usually only recommends surgery if the baby has gas—a sign that he isn't swallowing air properly. In cases like this, she says surgery can help with breastfeeding success.

When it comes to your own child, carefully weigh the pros and cons, then make an informed decision about how you choose to treat tongue tie or lip tie.