All About Tongue and Lip-Ties

What is a Tongue-tie or Lip-tie?

Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the term for a common physical condition that limits the use of the tongue. It restricts movement of the tongue and therefore affects function.

It affects around 20% of the population.

Lip-­tie is a condition where the upper lip is restricted and cannot move normally.

The tongue and lip are a very complex group of muscles and are important for all oral functions. For this reason, having a tongue-tie can lead to nursing, feeding, dental, speech, sleep, or breathing problems. Problems can even persist into adulthood with sleep issues, headaches, neck pain, shoulder pain, and speech problems. 

   

Does Your Child Have a Lip or Tongue-Tie?

There are many children who have difficulties related to a lip or tongue restriction, but unfortunately, it’s often not identified until later in life.

It can cause various nursing difficulties and pain, failure to gain weight, speech difficulties and speech delay, slow and very picky eating, restless sleep, attention and hyperactivity issues from poor sleep quality, among many other issues.

The symptoms and functional issues the child is having are more important to the diagnosis of tongue-tie than the appearance. In these pictures, you can see the variable presentation of tongue-ties that were all causing problems for some of our patients.

How We Do It

Tongue-tie and lip-tie release is a simple procedure with minimal complications when using a laser with good technique. The procedure may be performed as early as a couple of days after birth and can be performed into adulthood.

Typically, once a problem with a tongue-tie or lip-tie has been discovered, the sooner it is addressed the better the procedure will work and the fewer issues the child will have. The revision can be performed in our office with some numbing jelly. We do not sedate or put the child to sleep and it is typically not more traumatizing than a flu shot.

Dr. Baxter uses the highest quality, state-of-the-art CO2 LightScalpel laser to perform the release. Older children who understand the procedure receive some numbing medicine and laughing gas if needed, and usually report minimal to no pain during the quick procedure. Younger children and babies usually cry more due to us working in their mouth than the pain.

They normally calm down as soon as we pick them back up, although they can be irritable for several minutes afterward and sore for a few days afterward.

Tongue-tie and Lip-tie Procedure

The parents of infants remain in our private consult rooms during the quick procedure for around 3-5 minutes (30 seconds for the procedure and another few minutes to set-up and take photographs of the area). The laser handpiece doesn’t even touch the tissue, and gently removes the tight tissue with virtually no bleeding and no stitches. The baby is allowed to nurse immediately after the procedure, and older children often notice an immediate difference in tongue mobility.

Often speech is improved within a few minutes to a few weeks, but speech and myofunctional therapy are still needed.

Babies and children are normally sore from the procedure anywhere from 1 to 5 days, with the average being 2-3 days. It feels as if you burned your mouth with some hot soup or pizza – so it’s uncomfortable moderate pain. However, all children (and adults) sense pain differently, so some kids act like nothing happened at all, while others are impacted more and may have trouble talking, swallowing, and moving their tongue while it is sore and healing. Babies and young children may drool more as well during healing.

Infants with Feeding and Nursing Issues

Babies With Oral Restrictions

A new baby with a restricted tongue and/or lip can have trouble sucking and may have poor weight gain. If they cannot make a good seal on the nipple, they may swallow air causing gas, colic, and reflux or spitting up.

You may hear clicking noises when the baby is taking the breast or a bottle. Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue and lip tie. It can also cause thrush, mastitis, nipple blanching, bleeding, or cracking in the mother and inability to hold a pacifier.

The mother often feels like it’s a “full-time job” just to feed them because they are constantly hungry, not getting enough milk, and spitting up what they do get.

Dr. Baxter’s video for parents of infants struggling with tongue-tie.

Sometimes a tongue-tie can be “hidden” or “posterior” and can be difficult to diagnose but still cause the same issues as a more visible to-the-tip tie. A tongue and lip-tie can very often be an underlying cause of feeding problems that not only affect a child’s weight gain but lead many mothers to abandon breastfeeding altogether.

Many times, after releasing the tongue and/or lip, mothers report immediate relief of pain and a deeper latch. The symptoms of reflux, gassiness, and colic may also disappear and weight gain may occur rapidly.

Mother's Symptoms

  • Painful nursing
  • Creased or flattened nipples
  • Blistered or cut nipples
  • Incomplete breast drainage
  • Painful nursing
  • Creased or flattened nipples
  • Blistered or cut nipples
  • Incomplete breast drainage
  • Plugged ducts or mastitis
  • Can’t latch without a nipple shield
  • ducts or mastitis
  • Can’t latch without a nipple shield

Baby's Symptoms

  • Poor latch
  • Poor Weight Gain
  • Reflux or spitting up often
  • Clicking or smacking noises
  • Gassy or fussy often
  • Milk dribbles out of mouth
  • Baby is frustrated when eating
  • Unable to hold a pacifier
  • Prolonged nursing or bottle feeding sessions

Infants Struggling With Tongue-Tie

Although it is often overlooked or dismissed by other medical professionals, a tongue and lip-tie can very often be an underlying cause of feeding problems that not only affect a child’s weight gain but lead many mothers to abandon breastfeeding altogether. Very often, after releasing the tongue and/or lip, mothers report immediate relief of pain and a deeper latch.

The symptoms of reflux and colic often disappear and weight gain occurs rapidly. The sooner the tongue-tie is addressed the better the child will learn to use his or her tongue correctly.

Since the baby has developed bad habits not just from nursing, but even from sucking in the womb, it will take some time for the baby to relearn how to suck properly. In some babies, this occurs rapidly, and they are doing better the same day of the procedure.

Others take a week or more to relearn proper sucking patterns. For this reason, we emphasize to all parents the importance of follow up with a lactation consultant and a bodyworker of some type, like a chiropractor or physical therapist to evaluate for any postural or body issues like torticollis (tight neck muscles) that can make nursing harder.

Toddlers & Older Children

Symptoms

Inability to elevate the tongue to the palate with mouth open wide.

Heart-shaped tip of the tongue.

A thick or tight string under the tongue.

Difficulty moving the tongue from side to side.

Speech, Feeding & Sleep

Some children are able to compensate and have no noticeable speech errors due to tongue-tie, but many struggle to adapt. Tongue-tied children often struggle with R, L, S, TH, SH, and Z sounds. Some children with a tongue-tie may have a lisp, talk softly (mumble) or slowly, or even have a speech delay.  Evaluation by a speech therapist should be considered if your child is trying to talk to you or others, but is difficult to understand.

Tongue-tie can also cause difficulty chewing and swallowing food and liquids. Inefficient eating behaviors such as choking, gagging, packing food in the cheeks, or spitting out food can indicate the presence of a tongue-tie. The child may eat slowly or be picky with textures such as meats or mashed potatoes. Even a “hidden” posterior tongue-tie can cause these same speeches and feeding issues in children, which often resolve after a release.

Dr. Baxter’s video for parents on Speech and Feeding Issues From a Tongue-Tie.

Feeding

The Following Characteristics are Common in Children with a Tongue-Tie:

Children that are tongue-tied often eat slowly (are the last one to finish a meal) and eat very picky, especially with textures. Often they had trouble with nursing as a baby or taking a bottle and the problems persist into childhood and even adulthood. When transitioning to solids they may choke, gag, or spit food out. They may refuse to wean because they don’t “like” or tolerate solid food.

They can have difficulty swallowing so they can get distracted while eating further prolonging meal times and leading to grazing on food throughout the day. The textures that are often difficult are purees, mashed potatoes, meats, and other soft mushy foods, but sometimes chewy foods or hard foods can be difficult as well.

We have seen children with tongue-ties (even ones that are not obvious and are “hidden” posterior ties) improve within hours or days of the release. Often parents have been searching for years to figure out why their child cannot eat well, and a thick, tight string under the tongue was preventing normal tongue mobility and swallowing.

Sadly, training on tongue-ties is lacking in medical and dental programs, and many healthcare providers are not up-to-date on the latest diagnostic techniques and procedures. Even if your child has been told that they do not have a tongue-tie, but they have all the symptoms, there is a chance it is a posterior tongue-tie and should be evaluated.

Not every feeding problem is a result of a tongue-tie, but there are many that are, and it is likely the most common reason for feeding issues that are easily overlooked.

Sleep

A tongue-tied child will often grind their teeth at night or snore. Tongue-tie has been associated with sleep-disordered breathing and sleep apnea in children and adults. Releasing the tie can help the child to sleep more soundly because the tongue will then rest on the palate.

If the tongue is resting on the palate, it won’t fall back into the child’s airway and block the child from breathing well (which causes them to wake up easily and snore).

Large tonsils and adenoids, a narrow palate leading to a narrow airway, and a tongue-tie can all contribute to the problem, so getting checked out by multiple specialists like an ENT, pediatric dentist, myofunctional therapist, and an orthodontist is normally the treatment of choice.

Often children with a tongue-tie will have had a history of multiple ear infections, needing ear tubes, and having their tonsils or adenoids out. Many of these issues are related to mouth breathing, which is encouraged in a tongue-tied individual because the tongue has a low resting posture.

Some children may sleep restlessly and wake easily or snore from a tongue-tie. Often after treatment children sleep more peacefully, snore less, and feel more rested. There is no obvious way to tell which children with tongue-tie will have difficulties later, so evaluating the child’s symptoms carefully is critical. The ability to stick the tongue out does not rule out the presence of a tongue-tie!

Parents Share Their Experiences at Our Office

Video Resources From Dr. Baxter

Dr. Baxter’s video on aftercare stretching exercises for babies after their tongue or lip-tie release.

Video testimonials of parents who saw great improvements with their children in speech…

Our technique for infants that is quick with minimal to no bleeding, and highly effective.

Our technique for children that is quick with minimal to no bleeding, no sedation or general anesthesia…