Tongue Tie vs. Lip Tie: Know the Difference

Does your baby have trouble nursing? She may have tongue tie or lip tie. Here's what to expect from the two separate conditions.
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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.

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

While the issue sometimes resolves on its own over time as the frenulum relaxes, it often requires a simple surgical procedure called a frenotomy, where the doctor uses sterilized surgical scissors to clip the frenulum. This treatment usually takes place in the hospital and requires general anesthesia and stitches.

"Because the tissue doesn't have many nerves or blood vessels, there's not much bleeding or pain," Dr. McAllister says.

Under the advice of her doctor, Norton opted for a frenotomy. "The entire procedure took less than a minute," Norton says. "The doctor clipped underneath my daughter's tongue and handed her to me to nurse right afterward. She sobbed for a few minutes while nursing, but quickly calmed down."

Norton immediately detected an improvement in her daughter's latch. "It was a bit scary, but the doctor talked us through it and was easier than expected," she says.

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.

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