6 things a lactation consultant wants you to know about tongue ties

 In Kids health, Motherhood, Uncategorized

Eve Coote is an experienced International Board Certified Lactation Consultant (IBCLC), a midwife, mum, and owner of Best Start Lactation Consultancy.


As well as seeing mums in her own business, Eve works with a paediatric dental surgeon, assessing hundreds of babies who come to see whether a frenotomy (tongue/lip tie release) may be necessary. Eve works to provide unbiased, ethical advice; discussing all of the options, of which frenotomy may be one.


Here are 6 things that she wants mums to know about tongue ties


1. Tongue ties have been around for a long time

They are not new, they are not a fad, and they can complicate infant suck reflexes leading to feeding challenges….but….not always!


2. A lingual frenulum is not a tongue tie

A frenulum (the little membrane under the tongue) is a normal variation of anatomy, and palpable in most people. Some people have long, stretchy frenula, others short, thick, inelastic frenula. Some have anterior frenula, others posterior. Does this mean that every frenula must be removed? The short answer is no.


In my opinion, the term ‘tongue tie’ can only really be used if the tongue has compromised function in its ability, due to the tension caused by the frenula under the tongue.


There are many reasons why a baby doesn’t attach well at the breast, and all options must be explored. Tongue tie occurs when a frenulum restricts tongue movements and interferes with tongue function. Ties have gained lots of exposure in recent years and there is increased awareness surrounding the possible effects they have on breastfeeding.


3. Online forums are not the place to get a diagnosis

Nowadays women have access to so much information online – forums, Facebook pages, Instagram, support groups…the list goes on!


Whilst these resources can be fantastic, there is also a lot of misinformation out there, and lots of people giving advice who are not specialists/professionals/experts in the area of interest.


Often these pages have their own agenda, pushing women searching for advice and support to their ‘provider list,’ which is comprised of a select few professionals, chosen by the group admin. Certainly not showing transparency or giving women informed choice.


It is also important to note that photographs are not a reliable source to diagnose a tongue tie as it’s not what the frenulum looks like, rather the effect (if any), it has on tongue function.


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4. A full functional assessment is required

Tongue tie has become a huge area of discussion amongst health professionals who have an interest in infant feeding and development in recent years.


International Board Certified Lactation Consultants specialise in infant feeding and have expert knowledge in infant oral and breast anatomy, therefore, can provide a full assessment of suck function, intra-oral vacuum at the breast, the efficiency of milk transfer, and address other factors that may be associated with breastfeeding challenges.


IBCLCs are not able to offer a diagnosis, but rather support women who have feeding challenges by excluding all possible contributing factors. One of these may be a restricted frenulum.


A frenulum is only a frenulum until it is deemed to be compromising function and your baby’s ability to breastfeed effectively – then, after a full feeding assessment, it may require further evaluation.


Speech Therapists also have expertise in tongue function and for a baby who is formula feeding or an older child, they are the appropriate health professional to liaise with for support.


Dentists are the practitioners who release tongue tie by laser frenotomy, however, their expertise is in oral anatomy, not infant feeding or suck function. Therefore, they are not necessarily the appropriate service to use when initially approaching feeding issues.


Paediatricians are divided in the tongue tie world! Many believe that a tongue tie does not affect the infant’s ability to breastfeed, others will make a diagnosis through observation, but certainly, most do not physically examine the inside of the mouth.


Bodyworkers (chiropractors, osteopaths and physiotherapists) also treat babies for a range of issues, one of them being feeding. They are able to assess for and release tension, which may contribute to poor suck function or tone, but they are not specialists in infant feeding.


However, these practitioners play an integral role in infant health and promote a collaborative approach when working with babies who display tension, digestive issues, poor tone, and a disorganised suck.


5. There is limited evidence suggesting that either lip or buccal ties have an effect on feeding

Lip and buccal ties have become increasingly popular to diagnose and revise. One study links air intake at the breast to a tight labial (upper lip) frenulum, however, other studies dispute it and offer the scenario that if the tongue cannot function well, the top lip compensates, and the masseter and buccal muscles come into play to help support breast tissue in the infant’s mouth. This can lead to the appearance of a tight top lip.


6. Many babies that are affected by tongue-tie display similar symptoms:

They are:

  • fussy at the breast
  • unsettled
  • have a shallow latch
  • pull on and off frequently
  • make a clicking sound whilst feeding
  • dribble milk out of their mouth due to a poor seal
  • cough/splutter/choke at the breast
  • hiccup often
  • regurgitate
  • cause maternal discomfort and misshaping of the nipples
  • won’t hold a dummy in their mouth
  • have a preference to turn their head to one side
  • have facial asymmetry


But … There are also many other reasons these symptoms can occur.


If your baby has any of these symptoms, then a full feeding assessment by an IBCLC is recommended.


There are a few screening tools/scoring systems to try and identify restricted lingual frenulum. They are not fully reliable as it is subjective to the clinician who is scoring, and there is often inconsistent assessment between practitioners.


Many professionals classify ‘oral ties’ differently. I use the Hazelbaker scoring assessment tool for identifying restriction, along with a full feeding assessment, oral function assessment and full history to exclude other factors that may be contributing to feeding issues.


The more I learn about restricted oral tissue, the more I realise there is to learn! Frenotomy is not a quick fix!


I believe a collaborative approach to infant and maternal health promotes the best outcome for feeding challenges, and I think there will be a lot more research in the future to guide and support the appropriate release of restricted frenuluae, promoting positive feeding outcomes.


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If you would like to book in for an appointment with Eve for a full assessment you can find more information on her website.



This post is a collaboration between Best Start Lactation Consultancy and Wholehearted Family Health.

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