The Basics: Tongue and Lip Ties in Babies
Postpartum is famously known as a transition period with a lot of woes. But if you’re one of the 4-11 percent of U.S. families whose baby has tongue and lip ties, the initial month after birth can feel like a nightmare before you find the right help and resources. The first step is figuring out if your baby has an oral restriction. So in this post, you’ll learn how to tell if your baby has a tongue or lip tie. From there, there are solutions!
Disclaimer: This post is NOT medical advice and is no substitute for visiting a doctor. Everything shared on NavigatingParenthood.com and within this post is meant as an educational tool to close the “I wish I knew” gap. Please share your new knowledge and any questions with your doctor or specialist.
This post was originally published in April 2022 and has been updated.
The Basics: Tongue and Lip Ties in Babies
What do Oral Ties Look Like?
There are different oral ties (or tethered oral tissues) classes of lip ties and tongue ties, which your frenulum specialist will discuss with you. Some ties may be more noticeable, like when an upper lip can’t flange at all, a heart-shaped tongue, a tongue that is completely flat and can’t lift up to the roof of the mouth, a tongue that can’t extend out past the lips, etc. Other ties aren’t as noticeable until much later when you feel like your milk supply is dropping.
Everyone has a lingual frenulum (or band of tissue) that connects the tongue to the floor of the mouth. If it’s tight, restricted, or tethered, and paired with specific symptoms and functional difficulties, a provider may suspect a tongue tie. When looking for a lip tie, you’ll see this same tether as a thick line between the gums and lip. Some come down the gums to where the teeth will be, while others do not. If you see blanching on your baby’s upper lip when you flip it up to look for ties, it is a sign that there is tightness around the lip. Lip blisters and poor feeding are also indicators. Please see a frenulum specialist for an actual diagnosis.
Oral Ties Symptoms
Aside from poor growth and weight gain, tongue tie symptoms and/or lip tie restrictions are often the cause of things like a gassy, uncomfortable baby, a baby that has difficulty latching or latching correctly, a baby who pulls away from the breast, Torticollis, flathead, lipstick nipples, painful breastfeeding, and a baby that isn’t meeting milestones. Keep in mind that providers will first look at weight gain as an indicator, but if you have a strong letdown or are able to feed baby well enough they may not have weight issues at all but a tie could still very much be an issue. Aside from breastfeeding issues, bottle feeding issues, had and neck tension (leading to poor range of motion), oral ties can also contribute to problems when your baby should be babbling, first start to crawl, or when they try solids for the first time.
What Causes Lip and Tongue Ties?
Tongue and lip ties or oral ties/tethered oral tissue (TOTs) is thought to be genetic and possibly linked to the MTHFR gene mutation in some families and a lack of cell death in utero during fetal development. Oral ties have been found to be most common in boys. However, there is still very little research despite a long human history of oral ties — midwives used to cut them with their fingernail, and there are mentions/depictions of tongue ties in the Bible.
Who Diagnoses Oral Ties?
If you think your baby might have a tongue or lip tie, contact a frenulum specialist near you. You can find a list of specialists in your area. And read reviews/experiences from other parents in different Facebook groups created specifically for parents to share their experiences (California/Nevada have a really great group with a provider list).
Pediatricians are not typically trained in oral ties (some are, but most can’t tell) so I really stress seeing the specialist for this. Some lactation consultants and ENTs have oral tie training and may test the tongue’s range of motion. Some parents go through an ENT to cut their baby’s tongue or lip tie. which means their baby or child is put under for surgery in order to perform a frenectomy. When a frenulum specialist (a dentist specially trained in oral ties) performs the procedure it is more likely to be done with a cold laser while your baby is awake. It takes just seconds! Since a frenulum specialist is a dentist, a good chunk of the tie revision may be covered by dental insurance.
Oral Ties Next Steps
From my own personal experience as a mother of four babies (and one teen) who had these oral restrictions and as a specialized wellness practitioner who has worked with experts to support families through this journey, I can tell you that tie treatment requires a whole care approach. Whether or not you revise the oral restrictions with a specialist, there is a lot of work to be done with your care team. If you do decide a revision (called a Frenectomy or frenotomy) is needed, you’ll need to start working with a care team before the procedure and then continue for a long while afterward. Be sure to talk to other providers and parents to find the right specialists for your care team before choosing who will join your family on this journey.
Want to learn more about oral restrictions, who is on the care team, and tips for helping your baby before and after their tie revision? Get my Your Baby’s Tie Care Bestie resource!
Sources: Healthline.com, Milk Matters PT, Dr. Tracy Tran, Dr. Kate Wong, La Leche League
