Infant Feeding · Tongue-Tie & Oral Ties
A tongue-tie happens when the tissue under the tongue limits how freely the tongue can move.
Some babies with a tongue-tie feed well. Others struggle to latch, tire quickly or gain weight slowly. That's why the most important question isn't how the tissue looks, but how your child's mouth works when they eat. Here's what tongue-ties, lip-ties and cheek ties are, what current research says about each, and how a feeding evaluation helps you decide on next steps.
What Is Tethered Oral Tissue?
Everyone has small bands of tissue called frenula that connect the tongue, lips and cheeks to the mouth. They're a normal part of anatomy, and they come in many shapes and thicknesses. Tethered oral tissue (sometimes shortened to TOTs) is a term for frenula that are short, thick or tight enough to restrict movement and get in the way of feeding or other functions.
You'll hear about three types. They aren't equally well understood, so we've noted how strong the research is for each.
Tongue-tie
Under the tongue (lingual frenulum)
Also called ankyloglossia. Found in roughly 4 to 11% of newborns. Can affect latch and milk transfer in some babies.
Most researchLip-tie
Upper lip to gums (labial frenulum)
Almost every baby has a visible upper lip frenulum, and its shape varies widely. Its role in feeding problems is not well established.
Limited researchCheek (buccal) tie
Inside of the cheek to the gums
There's no agreed definition yet, and little research linking cheek bands to feeding or development problems.
Least researchHow a Tongue-Tie Can Affect Feeding
The tongue does a lot of work during a feed. It cups around the nipple or bottle teat, makes a seal and moves in a wave to draw milk out. When movement is restricted, some babies have a hard time doing that work efficiently. You might notice:
- A shallow latch, or slipping off the breast or bottle
- Clicking sounds or milk leaking from the corners of the mouth
- Very long feeds, or tiring and falling asleep before finishing
- Swallowing a lot of air, with extra gassiness or spit-up
- Slow weight gain
- Nipple pain or damage for the breastfeeding parent
Here's the important part: every one of these signs has other possible causes, like positioning, bottle flow rate, reflux, muscle tone, milk supply or a baby who is still coordinating suck, swallow and breathe. That's why a feeding evaluation looks at the whole picture, not just the tissue. For more on bottle-fed babies, read Overcoming Bottle-Feeding Aversion.
Beyond the Newborn Months
As children grow, the tongue takes on new jobs. Restricted movement may show up in a few areas, though research here is still developing:
Solids & chewing
The tongue moves food side to side and clears it from the cheeks and teeth. Some children with restricted movement pocket food, gag on mixed textures or prefer softer foods.
Speech
Most children with a tongue-tie develop clear speech. A smaller number have trouble with sounds that need the tongue tip lifted, like l, t, d or th. A speech-language evaluation can sort this out.
Resting posture
Ideally, the tongue rests up against the roof of the mouth with lips closed. A restricted tongue may rest low, which some clinicians link to open-mouth posture.
Breathing & sleep
Mouth breathing and snoring have many causes, such as enlarged tonsils or allergies. If you notice them, talk with your pediatrician rather than assuming a tie is the reason.
What the research says
Diagnoses and procedures for oral ties have risen sharply in recent years. In 2024, the American Academy of Pediatrics noted that tongue-tie can be a real cause of breastfeeding problems for some babies, but that many babies are diagnosed and treated without a full feeding evaluation first. Both the AAP and a 2020 expert panel of ear, nose and throat specialists found little evidence that lip-ties or cheek ties cause feeding problems, and recommend a careful look at how a baby feeds before any procedure.
Function First: How We Evaluate
A frenulum that looks tight isn't always a problem, and one that looks typical can still restrict movement. What matters is function. A thorough evaluation usually includes:
A full feeding history.
How feeds go, how long they take, weight gain, comfort and anything you've already tried.
Watching a real feed.
Breast, bottle or both, to see latch, suck rhythm, breathing and how your baby copes as the feed goes on.
An oral motor assessment.
How well the tongue lifts, extends, cups and moves side to side, and how the lips and jaw support it.
The whole picture.
Positioning, bottle and nipple choice, reflux, muscle tone, milk supply and body tension can all look like a tie.
A team plan.
Many babies improve with feeding therapy and small changes alone. If a release (frenotomy) is considered, coordinating with your pediatrician, a lactation consultant and the provider, plus feeding support before and after, gives the best chance of a good outcome.
When to reach out for support
Talk with your pediatrician or a pediatric feeding specialist if you notice:
- Slow weight gain, or feeds that regularly take longer than 30 to 40 minutes
- Ongoing pain or nipple damage while breastfeeding
- Frequent clicking, leaking or coming off the breast or bottle
- Coughing, choking or color changes during feeds
- Trouble moving to solids, pocketing food or gagging on textures
- You've been told your baby has a tie and aren't sure what to do next
Frequently Asked Questions
Does every tongue-tie need to be released?
No. Many babies with a visible tongue-tie feed and grow well and never need a procedure. A release is considered when a tie is clearly limiting function and other causes have been looked at. Feeding support before and after any release is part of good care.
Can a tongue-tie stretch or improve on its own?
The frenulum itself doesn't usually stretch much, but babies are very adaptable. As they grow and get stronger, many learn to feed well with the tongue movement they have, especially with the right positioning and support.
Does a lip-tie cause a gap between the front teeth?
A gap between the upper front teeth is common in young children and often closes as adult teeth come in. Current guidance does not recommend lip-tie procedures in babies to prevent a future gap.
Who diagnoses a tongue-tie?
A pediatrician, ENT, pediatric dentist or lactation consultant may spot it. A feeding specialist, like a speech-language pathologist with infant feeding training, looks at how the tongue actually works during feeding, which is key to deciding whether it's causing problems.
Questions About Your Baby's Feeding?
Whether you've been told your baby has a tie or you're simply not sure why feeds feel so hard, you don't have to figure it out alone. Book a free 15-minute call and we'll talk through what you're seeing and the next best step.
Want a full plan right away? Book a Comprehensive Feeding Consultation.
Selected References
- Thomas J, Bunik M, Holmes A, et al. Identification and management of ankyloglossia and its effect on breastfeeding in infants: clinical report. Pediatrics. 2024;153(5).
- Messner AH, Walsh J, Rosenfeld RM, et al. Clinical consensus statement: ankyloglossia in children. Otolaryngol Head Neck Surg. 2020;162(5):597–611.
- Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Can Fam Physician. 2007;53(6):1027–1033.
- LeFort Y, Evans A, Livingstone V, et al. Academy of Breastfeeding Medicine position statement on ankyloglossia in breastfeeding dyads. Breastfeed Med. 2021;16(4):278–281.
