If feeding hurts and nobody can tell you why, tongue-tie is one of the things worth ruling in or out. It is also one of the things that gets blamed for problems it is not causing.
Tracy Kim, DMD
Board Certified Pediatric Dentist
Both of those are true at once, and holding both is the honest way to talk about this.
What a tongue-tie actually is
The frenulum is the band of tissue under the tongue. In a tongue-tie it tethers the tongue tightly to the floor of the mouth, which limits how far the tongue can move. A lip-tie is the same idea with the band of tissue between the upper lip and the gum.
Movement is the thing that matters here, not appearance. A frenulum that looks short on a photo may not restrict anything, and a less obvious one can genuinely get in the way. What we care about is whether the tongue can lift, extend, and cup the way feeding requires.
Signs in infants
- Difficulty nursing, or a latch that keeps slipping
- Feeding that is painful for the parent
- Poor weight gain
- Trouble holding onto a pacifier or a bottle
- Reflux
- Milk dribbling out during feeds
- Feeds that take a very long time and never seem to finish
None of these on their own confirm a tie. All of them have other possible causes.
Signs in older children and adults
Ties are not only an infant issue. In older children and adults, a restrictive frenulum can show up as difficulty with certain speech sounds, meals that take much longer than they should, and sleep-disordered breathing.
Not every tight frenulum needs a release
This is the part we want to be direct about, because it does not always get said.
Feeding problems are common and tongue-tie is only one explanation. Positioning and latch technique, milk supply, reflux, a strong letdown, and simple newborn inexperience all cause the same symptoms. Releasing a frenulum that was not the problem does not fix feeding, and it means a baby had a procedure for nothing.
So the useful first step for most families is a proper feeding assessment with a lactation consultant or your pediatrician. If feeding improves with better positioning and support, you have your answer. If it does not, and the tongue is clearly restricted, then a release is worth discussing.
We would much rather rule things out with you than rush to treat.
The question is never just whether a frenulum looks tight. It is whether it is the thing actually causing the problem.
What an evaluation looks like here
We look at the frenulum, but more importantly we watch the tongue work. How far it lifts toward the roof of the mouth. How far it extends past the gum. Whether it can cup and move side to side. We go through the full feeding history with you, because the story usually tells us as much as the exam does.
We also coordinate with your lactation consultant rather than working around them. Feeding is a team problem and it gets solved faster by a team.
How the release is done
We use laser technology for both tongue-tie and lip-tie releases. The procedure itself is quick. For infants, families are usually surprised by how brief it is and how soon afterward they can feed.
We will go through exactly what to expect, what the aftercare involves, and what follow up looks like before anything is scheduled, so you can make the decision with the full picture rather than in the moment.
Common questions
What age can this be done?
Ties can affect infants, toddlers, children, adolescents, and adults, and releases are performed across that range. What differs is the assessment and the aftercare, which is why we talk it through case by case.
Will a release fix my child’s speech?
Sometimes it helps, and sometimes speech difficulties have a different cause entirely. We would not promise a speech outcome. Where speech is the main concern, a speech-language pathologist should be part of the conversation alongside us.
Is it painful for the baby?
The procedure is brief, and we will explain exactly what your baby will experience and what comfort measures we use before you decide anything. Most parents find the anticipation harder than the appointment.
What if we are not sure?
Then come in and let us look, with no obligation attached. An evaluation is information. It is not a decision.
If feeding has been hard and you want a straight answer about whether a tie is part of it, come see us on York Avenue. Call 646-762-0256 or email kids@slimdental.com.
This article is general information for parents, not a diagnosis or a treatment recommendation. Feeding difficulties have many possible causes and should be assessed by appropriate professionals, which may include your pediatrician, a lactation consultant, and a speech-language pathologist. Whether a release is appropriate for your child depends on an in person evaluation.
