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The condition known as ankyloglossia has been around for thousands of years. The most recent definition proposed by the International Affiliation of Tongue-Tie Professionals (IATP), states that the tongue-tie is "an embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement." This means that it is a tight string of tissue under the tongue that can prevent the tongue from functioning properly. In order for the oral structures to meet the criteria for a tongue-tie, there must be a functional limitation, as well as an anatomical finding upon examination under the tongue. The process of diagnosing a tongue-tie involves taking an in-depth history, completing in-person pretreatment assessments, and examining the oral cavity and extraoral structures. 


The nursing relationship between mother and baby is vital, and plays a significant role in the baby's health during a critical time of development.  A proper functional exam for ties starts with the feeding assessment. How does the baby latch and position at the breast? Red flags that often arise with feeding are low-tone sucking, in which the baby cannot latch or latches poorly, and high-tone sucking, which may result in pain and damage to the nipples due to improper balance or forces of the lips and cheeks. Babies with tongue-ties have disorganized swallows, producing clicking or smacking sounds while they feed in addition to gulping, coughing, gagging and choking noises. We strongly encourage our families to establish care with Lactation Consultants who will support mother-baby dyads on their breastfeeding journeys. Patience, time and effort through therapy are required for successful rehabilitation.


A lip tie refers to a restrictive frenum located under the upper lip that prevents normal movement of the oral tissues. The lip tie can contribute to nursing difficulties for the baby and can independently make breastfeeding painful and difficult for the mother. It can contribute to a poor seal on the breast due to the inability of the upper lip to flange outward normally. According to Dr. Bobby Ghaheri, an ENT and well-known authority on tongue-ties, if there is blanching in the area where the frenum attaches to the tissue, if there is a dimple on the upper surface of the lip, if there is a notch in the gum tissue or bone, and/or if the lactation consultant determines the baby has a latch suggesting a lip-tie, then a lip-tie may be present, and a release should be considered. Some lip frena are especially thick, tight, or broad. Their shape is highly variable, but the main factor is their impact on function.


The lip-tie, or restrictive maxillary frenum, can very much affect nursing and a quality latch. If the baby has an ineffective seal on the breast (or bottle), there will be a clicking or smacking noise heard when the baby eats. This sound is a sign that air is entering the baby's mouth and the baby is swallowing pockets of air. Aerophagia, or eating air, may result in a distended or hard belly, gassiness and fussiness. The air either comes back up from the belly as big burps or spit-up, or passes through and is released to toots. The lip-tie can contribute to nursing difficulties for the baby and can independently make breastfeeding painful and difficult for the mother.

Restrictive lip and tongue-ties can affect your child's speech, feeding habits, sleep & airway.

Coordination of a variety of oral structures along with adequate air flow is required for speech sound production.  Limited range of motion when a tongue-tie is present can affect the tongue's ability to reach various placement points in the mouth to produce different speech sounds. This can also affect oral resonance, which is a vital part of speech production, articulation, voicing and fluency. If movement of the tongue is restricted, a person may not be able to raise the back of their tongue to create the "K" and "G" sounds, or have difficulty coordinating their tongue muscles to make "L" and "R.' The presence of a tongue-tie can also cause speech sounds to be distorted. This is due to the airflow coming from the lungs being directed or restricted in a different way. Fluency of speech may also be affected because a tie can cause incoordination and ineffeciency, which can lead to stuttering. Speech-related symptoms that can be caused by a tie are frustration with communication, poor speech intelligibility, speech delays or disorders, particularly errors with sounds "K", "G", "NG", "SH", "CH", "DGE", "TH", "L", "R", "S", "Z". It is pertinent to have your child evaluated by a speech-language pathologist prior to and after a tongue-tie release.

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Struggle to nurse or take a bottle?

Leak milk from his or her mouth while eating?

Make clicking or smacking noises when eating?

Gag, choke or cough when eating?

Have sucking blisters or callouses on lips?

Wake often or sleep restlessly?

Have constipation or irregular stools?

Exhibit slow or poor weight gain?

Display reflux or colic symptoms?

Experience lots of gas or continually fuss?

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Sleep restlessly?

Speak softly (mumble) or struggle to be understood?

Exhibit slow or picky eating?

Choke or gag on liquids or foods?

Have a strong gag reflex?

Show signs of speech delay?

Grind teeth at night, snore, or sleep with his or her mouth open?

If so, your child may have a lip- or tongue-tie. 

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