- Atypical facial features affecting the jaw, lips or palate.
- Tongue movement and coordination while sucking on a gloved finger.
- Appearance of lingual frenulum, including the inability of the infant to extend tongue over the lower alveolar ridge or lift tongue midway to the palate, or a heart-shaped tongue on extension.
- Milk transfer using pre- and post breastfeeding weights, observation of a feeding session, and assessment of weight gain over time.
An Infant Feeding Specialist can help determination if a consult to an ENT or Oral Surgeon is warranted to discuss surgical treatment. As well as connecting you to a particular specialist in your area.
Our services include:
- Infant Feeding Evaluations: Identify whether feeding difficulties are related to a tongue-tie or other factors, and receive a customized feeding plan
- Customized Feeding Plans: Focus on safety, endurance, and positive experiences.
- Ongoing Developmental Support: Support motor skills, growth, and parent-baby connection.
- If your infant is still in the NICU, we can help provide valuable education so you can show up for baby with more knowledge and confidence. Learn about our NICU Feeding Consults.
Tongue Tie and Lip Tie in Newborns: Understanding if it is Normal or Not
What are the long-term outcomes?
Most babies with tongue-tie do well, whether or not they have the surgical procedure. There is no strong evidence that tongue-tie causes long-term problems with speech or eating solid foods. Many feeding issues can improve over time, even without the frenotomy.
Reassurance: Most babies outgrow their feeding difficulties associated with tongue-tie with the right supports.
How Infant Feeding Specialists Helps Babies with Tongue- and Lip-Tie Thrive
When support is needed, options include:
- Adjusting feeding positions
- Trying different feeding equipment such as vented bottles or slower flowing nipples.
- Using breast shields
- Bodywork including infant massage or trigger point release to reduce tension affecting tongue and lip movement
If challenges persist, a surgical procedure called a frenotomy, frenectomy, or frenulectomy (cutting the tight tissue) may be considered. This procedure may improve oral feedings, but it is not always required.
The American Academy of Pediatrics (AAP) does not recommend surgical treatment for lip-ties or buccal-ties (the tissue between the cheeks and gums). These are normal oral structures unrelated to feeding mechanics and do not require surgical intervention to improve feedings.
What is a Lip-Tie
A lip-tie is not a well defined occurrence. It often refers to the band of tissue that connects the underside of the upper lip to the front of the gum ridge, medically known as the maxillary labial freunum. The presence of this tissue is normal. While there are some concerns that it results in poor lip flanging, lip dimpling, frenulum blanching with elevation and gastroesophageal reflux, overall feeding success is still maintained. Surgical intervention for a lip-tie is not recommended. Recent studies showed that symptoms do not improve if this tissue is treated surgically, but does cause stress for the infant and family.
Signs of Tongue- or Lip-Tie in a Newborn
At the Breast:
- Difficulty latching or staying latched
- Shallow latch
- Fussiness during feeding
- Painful or cracked nipples for the parent
- Clicking or smacking sounds while feeding
- Feedings that last <5 minutes or >30 minutes
- Messy eating with milk spilling from mouth
- Slow milk transfer with poor weight gain
- Sleep during feeds
Bottle Feeding:
- Trouble maintaining a seal on the bottle nipple
- Swallowing air, leading to gas or discomfort
- Clicking or smacking sounds while feeding
- Fussiness during feeding
- Messy eating with milk spilling from mouth
- Feedings that last <5 minutes or >30 minutes
- Slow milk transfer with poor weight gain
- Sleepy during feeds
Other Possible Signs:
- Limited tongue movement or difficulty sticking out the tongue past lip boarder
Even if your baby shows some of these signs, it doesn’t always mean treatment is needed. Many babies feed well with the right guidance and positioning support.
Lip-Ties are not well defined. The maxillary labial frenulum is normal and does not negatively affect feedings. Some normal feeding variations may be noticed due to the presence of the labial frenulum, such as lip curling under breast or bottle, aka poor lip flanging, lip dimpling, or benign flat, white sucking blisters on the lips. These normal variations do not need intervention.
When to Seek Support
- Tongue-tie and lip-tie are common concerns for parents, but are not always problematic.
- There was a surge of misinformation about tongue- and lip-ties, but the AAP published a position statement in 2024 which clarified best practices for these infants.
- Some babies with a tongue-tie experience feeding challenges, while others thrive without intervention.
- Early evaluation and support can improve feeding, growth, and comfort for both babies and parents.
According to the Pediatric Feeding Disorders Task Force, if your infant demonstrates any of the signs listed above they may benefit from an appointment with an infant feeding specialists. Even if your baby is growing well, in the presence of any of these other signs an evaluation can give you peace of mind and practical strategies to optimize feedings by mouth.
Early guidance can prevent small challenges from becoming bigger issues. An Infant Feeding Specialists can help identify whether a tongue- or lip-tie is affecting your baby, suggest adjustments to feeding techniques, and support both your baby’s growth and your confidence as a parent.
Parent Note: Hearing different opinions from various professionals about the presence of your infant’s tongue- or lip-tie can leave you feeling frustrated and confused. That’s completely normal — but appropriate support is available. Our Infant Feeding Specialists are up-to-date with the most important evidence on this topic to help you and your infant have successful feedings.
What is a Tongue-Tie?
Tongue-Tie, medically known as ankyloglossia, is a term you may have heard from friends, family, social media or from your baby’s care team. It refers to the band of tissue under the tongue (the lingual frenulum) when it is shorter or tighter than usual. This can limit how much the tongue can move. The American Academy of Pediatrics defines it as a restrictive lingual frenulum that causes problems with feeding that are not improved with feeding or lactation support. It is important to note that the presence of a lingual frenulum is a normal part of our anatomy; it is only problematic if it restricts movement of the tongue and causes feeding difficulties.
At Infant Feeding Specialists, we help families navigate these concerns to support feeding, growth, and overall development. We assess your infant as a unique individual, with unique needs.
Treatment Options for Tongue- and Lip-Tie
- Tongue-tie is when the tissue under the tongue limits movement and affects feedings, while lip-tie is actually normal tissue between the underside of the lip and front of the gums that does not affect feedings.
Can tongue- or lip-tie cause long-term speech problems?
- Most babies develop speech normally. Early intervention is only needed if feeding or oral development is affected.
How do I know if my baby’s feeding issues are caused by a tie?
- Signs include difficulty latching, clicking during feeding, swallowing air, or prolonged feeding times. An Infant Feeding Specialist can evaluate and guide you.
Does every baby with tongue- or lip-tie need surgery?
- No. Many babies feed successfully without intervention. Surgery is considered only if feeding challenges persist despite support. Surgery for a lip-tie is never recommended because that tissue is normal and does not affect feedings.
FAQs About Tongue and Lip Tie
References:
- Thomas, J., Bunik, M., Holmes, A., et al. (2024). Identification and management of ankyloglossia and its effect on breastfeeding in infants: Clinical report. Pediatrics, 154(2), e2024067605. https://doi.org/10.1542/peds.2024-067605
- O'Shea, J. E., Foster, J. P., O'Donnell, C. P., et al. (2017). Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews, 2017(3), CD011065. https://doi.org/10.1002/14651858.CD011065.pub2
- Messner, A. H., Walsh, J., Rosenfeld, R. M., et al. (2020). Clinical consensus statement: Ankyloglossia in children. Otolaryngology–Head and Neck Surgery, 162(5), 597–611. https://doi.org/10.1177/0194599820915457
- Walsh, J., & Tunkel, D. (2017). Diagnosis and treatment of ankyloglossia in newborns and infants: A review. JAMA Otolaryngology–Head & Neck Surgery, 143(10), 1032–1039. https://doi.org/10.1001/jamaoto.2017.0948
- Akbari, D., Bogaardt, H., & Docking, K. (2023). Ankyloglossia in Central Australia: Prevalence, identification and management in infants. International Journal of Pediatric Otorhinolaryngology, 170, 111604. https://doi.org/10.1016/j.ijporl.2023.111604
- Jones, H., Hintze, J., Walsh, M., O'Leary, M., & Heffernan, C. (2024). Lingual frenotomy for ankyloglossia in infants with breastfeeding difficulties: A longitudinal observational study. European Journal of Pediatrics, 183(12), 5245–5254. https://doi.org/10.1007/s00431-024-05799-7
Confident, Comfortable Feeding Starts Here
If you suspect your baby has a tongue-tie, our specialists can guide you every step of the way. Together, we’ll create a personalized plan to support comfortable feeding, healthy growth, and a joyful parent-baby connection.
Disclosure: The information on this page is for educational purposes only and is not medical advice, diagnosis, or treatment. It should not replace consultation with a qualified healthcare professional. Always seek the guidance of your physician or other licensed provider with any questions about a medical condition. If you think you may be experiencing a medical emergency, call your local emergency number immediately.