If I had to make a list of the questions parents ask me most often, this one would be near the top.
“Does my baby’s tongue-tie actually need to be treated?”
It’s a reasonable question, but unfortunately there isn’t a simple yes-or-no answer.
By the time many families arrive in my office, they’ve often heard several different opinions. One provider recommended a tongue-tie release. Another said to wait. Someone else told them every baby has a frenulum, while another suggested the tongue-tie was responsible for every feeding problem they were experiencing. It’s no surprise that parents leave feeling confused.
One of the first things I usually tell families is that I don’t make treatment recommendations based on how a tongue-tie looks. I make them based on how it’s functioning.
That may sound like a small difference, but I believe it’s one of the most important concepts in tongue-tie care.
Every baby has a frenulum. Simply finding one doesn’t tell me whether treatment is needed. What I really want to know is whether that tissue is preventing the tongue from doing what it was designed to do. Is it affecting breastfeeding? Is it making bottle-feeding difficult? Is it contributing to poor milk transfer, excessive air swallowing, painful nursing, or other symptoms that are making life difficult for both the baby and the parents?
Those are the questions that matter.
One of the reasons tongue-ties have become such a confusing topic is that appearance and function don’t always match. Over the years, I’ve evaluated babies with very obvious tongue-ties who breastfed beautifully. Their mothers had no pain, the babies transferred milk efficiently, gained weight appropriately, and everyone was happy. Performing a procedure simply because the frenulum looked tight wouldn’t have made much sense.
I’ve also seen the opposite (and see it most days, actually). Some babies have tongue-ties that are much less obvious during a quick examination, yet they’re struggling with almost every feeding. Their mothers are in significant pain. Feedings take an hour. The baby clicks constantly, swallows excessive amounts of air, leaks milk from the corners of the mouth, and never seems satisfied afterward. Looking only at the anatomy would have completely underestimated how much that tongue was affecting function.
That’s one of the reasons I don’t spend much time trying to “grade” a tongue-tie. I spend much more time trying to understand the patient sitting in front of me.
In fact, before I ever examine a baby’s mouth, I spend a long time just listening to the parent’s story.
Parents sometimes apologize because they feel like they’re giving me too much information. They tell me about the pregnancy, the delivery, the first few weeks of feeding, what the lactation consultant noticed, what their pediatrician said, how often the baby nurses, whether bottle feeding is easier, and all of the little things they’ve observed that don’t seem to make sense.
I usually smile and tell them to keep going.
One of the things I’ve learned after evaluating thousands of babies is that parents are often the best historians in the room. They may not know the anatomy of the tongue, but they know their child. They’ll say things like, “He just can’t stay latched,” or “She always seems hungry,” or “I know everyone says things are fine, but feeding just doesn’t feel right.” Those observations don’t diagnose a tongue-tie, but they frequently point me in the right direction before I ever begin the examination.
That’s also why I don’t believe a tongue-tie evaluation should last thirty seconds. A comprehensive evaluation looks at much more than the frenulum. It considers the baby’s feeding history, tongue function, oral anatomy, symptoms, and overall development. It also asks whether something besides a tongue-tie could be contributing to the problem. Sometimes body tension is playing a significant role. Sometimes there are oral motor challenges. Sometimes the issue is related to positioning or milk supply. And sometimes it’s a combination of several things. (Babies, unfortunately, don’t always read the textbook.)
If you’re a parent wondering whether your baby’s tongue-tie needs treatment, my advice is simple: don’t focus on whether a frenulum is present. Focus on whether your baby is functioning well. That’s ultimately what guides my recommendations, and I believe it’s the approach that leads to the best long-term outcomes.
If you’ve been searching for answers and you’re not sure whether your baby would benefit from treatment, we’d be happy to help. Send us a message to schedule a comprehensive evaluation. Our goal isn’t simply to diagnose tongue-ties. It’s to understand why feeding isn’t going the way it should and help your family find the best path forward.
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So, What Actually Makes Me Recommend Treatment?
Parents sometimes ask if there’s one thing I look for that tells me a baby needs a tongue-tie release.
I wish it were that simple.
Instead, I’m trying to put together a puzzle. The feeding history, the physical examination, the tongue’s function, the baby’s symptoms, and my own observations all have to make sense together. When those pieces point in the same direction, I can make a recommendation with much more confidence.
One of the reasons I enjoy evaluating tongue-ties is that no two babies are exactly alike. Some babies have obvious restrictions and obvious symptoms. Others are much more subtle. Occasionally I’ll evaluate a baby that another provider thought definitely needed treatment, but after listening to the parents and completing my examination, I recommend waiting. Other times the opposite happens. A family has been told everything looks normal, yet the history and functional examination strongly suggest that a tongue-tie is contributing to the feeding difficulties.
Neither situation surprises me. Tongue-ties aren’t diagnosed by appearance alone, and they certainly shouldn’t be treated based on appearance alone.
Not Every Tongue-Tie Needs to Be Released
I think this is one of the most important messages I can share with parents.
The goal isn’t to find more tongue-ties. The goal is to help babies feed better.
Sometimes that involves a tongue-tie release. Sometimes it doesn’t.
If I don’t believe a tongue-tie is contributing to your baby’s symptoms, I’ll tell you. Likewise, if I think another issue deserves attention first, whether that’s body tension, feeding mechanics, oral motor function, or something else entirely, we’ll talk about that too. My responsibility isn’t simply to perform a procedure. It’s to help you understand why your baby is struggling and recommend the treatment plan that gives your child the best opportunity for success.
I’ve found that parents appreciate honesty, even when it isn’t the answer they expected. Most families don’t come to see me hoping their baby needs a procedure. They come because they want answers.
That’s exactly what I want to give them.
Why We Take a Team Approach
One thing I’ve become more convinced of over the years is that tongue-tie treatment works best when everyone is working toward the same goal.
If treatment is recommended, the release is only one part of the process. In my experience, excellent outcomes begin with proper patient selection, a thorough history, a comprehensive functional examination, an accurate diagnosis, and a complete release when it’s indicated. They continue with appropriate aftercare, follow-up, and, for many babies, collaboration with the right healthcare professionals.
That’s why we frequently work alongside lactation consultants, speech-language pathologists, occupational therapists, physical therapists, pediatricians, chiropractors experienced with infant care, and other providers. Not every baby needs every member of that team, but I’ve found that having the right people involved at the right time often makes a tremendous difference.
People occasionally ask me if tongue-tie treatment actually works.
My answer is yes, absolutely.
When the diagnosis is correct, the patient is an appropriate candidate, the procedure is performed well, and the family receives the support they need afterward, I’ve found that the overwhelming majority of babies experience meaningful improvement. That’s one of the reasons I’m so passionate about this field. It’s incredibly rewarding to watch a baby who has struggled for weeks or months finally begin feeding comfortably.
Trust Your Instincts
If you’re reading this article because feeding just doesn’t feel right, don’t ignore that feeling.
Parents often tell me, “I know something is wrong, but I can’t explain it.” More often than not, they’re right. Trust your gut. That doesn’t necessarily mean the answer is a tongue-tie, but it does mean your concerns deserve to be taken seriously.
Whether the solution is a tongue-tie release, feeding therapy, lactation support, or something entirely different, the first step is a thoughtful evaluation.
If you’ve been wondering whether your baby’s tongue-tie needs treatment, we’d be honored to help. Send us a message to schedule a comprehensive evaluation with us. We’ll take the time to listen to your concerns, perform a thorough functional examination, and help you understand exactly what we think is contributing to your baby’s feeding difficulties. If treatment is appropriate, we’ll explain why. If it isn’t, we’ll tell you that too.
Also Read: Tongue-Tie and Lip-Tie in Babies: Signs, Symptoms, and When Surgery Helps
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Frequently Asked Questions
Q1. Should every baby with a tongue-tie have surgery?
No. Many babies have a frenulum that doesn’t significantly affect feeding or oral function. The decision to recommend treatment should be based on symptoms, function, and a comprehensive evaluation rather than appearance alone.
Q2. Can two babies with similar-looking tongue-ties need different treatment?
Absolutely. One baby may compensate very well, while another struggles with breastfeeding, bottle feeding, or milk transfer. That’s why function is much more important than appearance.
Q3. What if another provider told me my baby doesn’t have a tongue-tie?
Different providers have different training and experience. (Most medical and dental schools provide little, if any, education on tongue-ties.) If feeding continues to be difficult, it’s reasonable to seek a comprehensive functional evaluation. We don’t require a referral.
Q4. How do I know if I should schedule an evaluation?
If breastfeeding is painful, your baby can’t stay latched, feedings are taking an unusually long time, your baby clicks while feeding, seems hungry all the time, or you’re simply concerned that feeding isn’t going the way it should, it’s worth having your baby evaluated. Even if a tongue-tie isn’t the cause, understanding why your baby is struggling is often the first step toward helping your family.
When Feeding Feels Difficult, Get Answers.
