A new baby with a too tight tongue and/or lip frenum can have trouble sucking and may have
poor weight gain. If the baby cannot make a good seal on the nipple he or she may swallow
air, causing gas, colic and reflux. You may hear clicking noises when baby is taking the
breast or a bottle.
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A nursing mother who experiences significant pain while nursing or whose baby has trouble
latching should consider having her child evaluated for tongue and/or lip tie. A tongue or lip
tie may also cause mastitis, nipple blanching, bleeding, or cracking in addition to the inability
to hold a pacifier. The mother often reports that it is a “full time job” to feed her baby because
he or she is constantly hungry, not getting enough milk and/or spitting up frequently.
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Although it can be overlooked or dismissed by other medical professionals, a tongue and/or
lip tie can often be an underlying cause of feeding problems that not only affect a child’s
weight gain but also lead many mothers to abandon breastfeeding.
 
After releasing the tongue and/or lip tie, some mother’s report immediate relief of pain and a
deeper latch. The symptoms of reflux and colic may diminish and weight gain occurs. The
sooner the tie is addressed the better, as the child will learn to function with an increased
range of motion.

Speech
While the tongue is remarkably able to compensate and some children have no speech impediments due to a tongue tie, many may to struggle. By the age of three, speech problems
– in particular articulation of the sounds L, T, D, N, TH and SH may be noticeable. An evaluation may be needed if more than half of a four year old child’s speech cannot be understood outside of the family. The child with a tongue tie may have a lisp or have difficulty speaking when tired. Tongue ties may also lead to sleep apnea, mouth breathing, other airway issues and cause difficulty chewing and swallowing food.

Speech delay has not been associated with tongue tie in research studies, however; we have
seen that many tongue tied children who do have a speech delay, benefit from a tongue tie
release. There is no guarantee that every child will have immediate results, but there is often
times improvement particularly with the reinforcement of speech therapy.
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Although there is no obvious way to tell in infancy which children with tongue tie will have
speech, feeding or sleep difficulties the following characteristics are common:
   - Heart-shaped tip of the tongue, or a thick band of fibers under the tongue.
   - Inability to touch the roof of the mouth with the tongue, or get close
   - Difficulty moving the tongue from side to side.
 
Feeding
Children that are tongue tied often have eating issues from infancy - such as trouble nursing
or taking a bottle. When transitioning to solid foods, they may choke, gag or spit out food. In
childhood, these eating difficulties can persist and are evidenced by only eating small
amounts of food and slow eating.
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Difficulty swallowing can lead to pickiness, particularly with textures. Certain types of food
can be challenging to swallow.
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In our experience, we have seen children with tongue ties improve after a release. Often
parents have been searching to figure out why their child cannot eat well. All along, the thick,
tight string under the tongue was preventing normal tongue mobility and swallowing.
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Sadly, training on lip and tongue ties is lacking in medical and dental programs. Most
healthcare providers are not comfortable with the latest diagnostic techniques and
procedures. If your child has been told that he or she “does not have a lip or tongue tie” but
exhibits all the symptoms, there is a chance that there may actually be a tie and your child
should be evaluated.
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Certainly not every feeding problem is a result of a tongue tie but it is an important finding to
rule out, in particular if your child is symptomatic.
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Sleep and Tonsils
A tongue tied child will often grind his or her teeth at night, snore or experience other sleep-
disordered breathing problems. Releasing a tongue tie can help a child to sleep more
soundly because the tongue will be able to rest forward on the palate (where it is supposed to
rest) rather than falling back to narrow or block the child’s airways. Sleep-disordered

breathing can cause frequent waking, restlessness, bed-wetting, not waking up refreshed and
accompanying difficulty focusing (which is sometimes misdiagnosed as ADD or ADHD).
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Because multiple factors can contribute to the sleeping difficulties, such as: large tonsils and
adenoids, narrow palate and tongue tie, often a child will be seen by multiple specialists to
try to remedy the problem. In addition, children with tongue ties often have a history of
multiple ear infections, needing ear tubes, and having tonsils and adenoids removed. All of
these can be complicated by mouth breathing that frequently occurs in tongue tied
individuals, due to the low resting posture of the tongue.
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Dental
For older children with a lip tie, it is common to have a gap between the two front teeth. This
often closes if the frenum is removed (typically done before 18 months old or around age 8,
when the permanent teeth erupt). The tongue tie can also pull against the gums on the back
of the teeth and cause recession. The tight lip tie may trap food and make it difficult to
remove plaque from the front teeth, leading to cavities.

A tongue tie is a non-medical term for a relatively common condition that limits the use of the
tongue, called ankyloglossia. A lip tie is a condition where the upper lip cannot be curled or
moved normally.
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As we develop in the womb, multiple cords of tissue guide the development of mouth, these
are called frena. Frena are located in multiple areas of the mouth and also underneath the
tongue. As we continue to develop, these frena are supposed to recede and become thin. The
lingual (underneath the tongue) and labial (underneath the top lip) frena are visible and easily
felt. Everyone has these frena, unfortunately in some people, one or both of these soft tissue
attachments can be tight and/or fail to recede - causing tongue and/or lip immobility.
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The mouth, including lips and tongue, require use a variety of muscles and are important for
all oral functions. Due to the complexity of the oral cavity, having a lip and/or a tongue tie can
lead to nursing, feeding, dental, sleep or speech problems. These problems can even persist
into adulthood and present as migraines, neck pain and shoulder pain.

Both a tongue tie release and a lip tie release are simple procedures. There are virtually no
complications when using a CO2 Solea laser and good technique. The procedure may be
performed as early as a couple of days after birth. Once a tongue tie or lip tie has been
discovered, the sooner it is addressed the better in order to resolve symptoms.

In our office, we use a state-of-the-art Solea laser where we can easily release ties with
minimal to no bleeding and no stitches. The Solea laser takes us 30 seconds to release a lip
and tongue tie.

Older children who may be anxious about the procedure receive some numbing medicine and
laughing gas and generally report no pain at all. Younger children and babies usually cry due
to us working in their mouths and helping them to hold them still.

The procedure takes a total of 5-10 minutes as we take before and after clinical photos for a
child’s records. The Solea laser gently removes the tight tissue with virtually no bleeding and
no stitches. The baby is allowed to nurse immediately after the procedure. Older children
generally will notice an immediate difference in mobility of their tongue. Often times speech
is improved but speech therapy/myofunctional therapy is recommended for children older
than 4 years of age.

It is important to understand that when your child has a tongue and/or lip tie revised
improvement is not always immediate. The release is usually the first step. Your child will
need some time to figure out what to do with the new mobility of his or her tongue and/or lip.
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The tongue is a muscle and just like all of our other muscles, it becomes used to functioning
in a certain way. If a tongue has been restricted by a tight frenum for days, months or even
years, the body has found ways to help compensate. When a tongue tie is released, the child
has no muscle memory of how to use the tongue correctly without the restriction. It takes
time and sometimes help from a medical professional for the brain to figure this out.
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While most mothers notice an immediate improvement in their infants’ ability to nurse, it is
also completely normal for this to take time. In some cases, there may even be a little
regression in sucking for a day or two as your child’s brain tries to sort out how to use his or
her unrestricted tongue. In some circumstances, babies may need chiropractic or
craniosacral therapy to address other issues that can affect nursing.