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What Parents Need to Know About Tongue Ties

By Kimberly Rush

What is a tongue tie, lip tie, or cheek tie? (AKA: tethered oral tissues (TOTs))

A frenulum is made of connective tissue and we all have them. Restricted frenulums in the mouth can cause problems with feeding. Having frenulums is normal and what varies within each of us, is where it attaches and the degree of mobility. Having tethered frenulums is not normal. The impact of having a baby with TOTs can be life changing. The good news, so can the treatment.

How common are restricted frenulums?

Research we have tells us that up to 10% of babies are born with tethered oral tissues. Boys have a higher incidence than girls and there is a genetic component, so if one child has it, then your next child might as well. In my practice, I see a high incidence of babies with TOTs, however most people are seeking the assistance of a lactation consultant because there is a problem, so it’s natural that feeding specialists see this issue more often.

The current hypothesis for why we are seeing these restrictions is due to a gene called methylenetetrahydrofolate reductase (MTHFR) which does not allow the body to properly utilize folate from folic acid.

Find a good functional medicine physician who has experience with this if you would like to learn more. The doctor can recommend testing, assist you in interpreting results, and help you with your health across your lifespan. Epigenetics is likely causing such a high incidence of people with this genetic variation. What we eat, where we live, what toxins we are exposed to, how we live our lives, all of these lifestyle variations will alter gene expression.

How do I know if my baby has a restricted frenulum?

Possible symptoms seen in the breastfeeding mother:

Painful latch, nipple damage (cracked, bruised, blistered, bleeding nipples), creased, misshaped or blanched nipples after feeding, low milk supply, incomplete breast drainage, breast or nipple infections including mastitis, and overactive let down.

Possible symptoms seen in the child:

Inability to latch or poor latch, milk dribbling during feeding (breast or bottle), clicking sound during feeding, sliding of the nipple, fussy at the breast, poor weight gain, sleepy or fatigue during feeding, increased gas/reflux/colic, gagging, prolonged feedings, blistered lips, sleep apnea, unable to hold pacifier, gumming or chewing the nipple, choking or gasping during feeding, difficulty eating solid foods, speech difficulties, narrow palate, and excessive drooling.

Symptoms seen in the older child or adult:

Speech difficulties, sleep apnea, dental decay, misalignment of teeth requiring orthodontic care, overactive gag reflex, inability to lick ice cream/lollipop, and possible embarrassment.

How do you assess for a restricted frenulum?

The assessment of your baby’s oral anatomy includes: appearance and function. Evaluation of the tongue when lifted and shape of the tip of the tongue, elasticity of the frenulum, length and thickness of the frenulum, and where it attaches in the mouth, as well as lip/tongue posture at rest.

A few of the tongue functions I look at in my oral assessment: side to side movement, lift of the tongue, how far it extends out of the mouth, spread of the tongue, cupping, and the wave-like movement made when sucking. I also evaluate how baby’s mandible or jaw position looks and how it moves during feedings.

Treatment options

Essentially you can choose no treatment, scissors or scalpel to cut the frenulum, or a laser to evaporate the restricted frenulum. The key is finding a skilled provider with extensive training and experience. Provider options include physicians, pediatric dentists, or otolaryngologists, aka: ear, nose and throat (ENT) doctors.

You should know that restricted frenulums will not correct themselves or stretch over time. And there could be other things contributing to a restricted frenulum, such as torticollis or other body tension, so it is vital to find a provider who can help you look at the whole picture and help you find solutions.

Team approach

This is your best option for care. I encourage you to do your research and ask questions of everyone you are working with. Just because someone knows what a restricted frenulum is, doesn’t mean they know how to treat it, or how to help you. And if the person you are working with is not helping or you are not seeing improvements, consider getting a second opinion. Questions to consider for a treatment provider:

“How many tongue revisions have you done?”

“What can I expect for follow up care from you?”

“Do we need to make a decision to treat right away or can we think about it?”

Expect to be referred to additional community support such as craniosacral therapist, osteopath, or chiropractor, in order to help you and/or baby heal optimally. As a Board Certified Lactation Consultant, I consider myself your companion on this journey and help you every step of the way for the best possible outcome.

Working with TOTs can be a long road to recovery, as there are many contributing factors, but it IS possible to move past these issues and most families report immediate improvement after treatment. The sooner treatment begins, the sooner relearning can occur, and improved feeding function.

Kimberly Rush is a Registered Nurse and International Board Certified Lactation Consultant and passionately offers home consultations in Western North Carolina, oil infused wellness, breast pump rentals, breastfeeding supplies, parenting classes, and her services are covered by health insurance. She can be reached at