Infant Tongue Ties: Read this before releasing!!!

view this post on Instagram

This post is collaborated with Dr. Hal Stewart & Dr. Adriana Corredor (airway dentists), Crystel Corbin (RN, IBCLC), Madison Maxey (LMT, CST), and Gina VanDeusen, MA, CCC-SLP (myo therapist)

The tongue plays a crucial role as the body’s natural palate expander.

Tongue, lip, and cheek ties are more than just minor anatomical quirks—they’re oral restrictions that can impact everything from feeding and sleep to speech and facial development. The tongue plays a crucial role as the body’s natural palate expander. When it isn’t able to rest properly against the roof of the mouth—its ideal position—due to factors like tongue-tie, low muscle tone, or weak tongue strength, this can contribute to mouth breathing and improper jaw development. As a result, a variety of issues may arise, including speech difficulties, crowded teeth, increased risk of cavities, poor sleep quality, bedwetting, dark under-eye circles, persistent allergies, snoring, symptoms resembling ADHD, sleep apnea, behavioral challenges such as defiance or aggression, learning struggles, and more.

Yet, despite growing awareness, many families are left confused or misled because not all providers are qualified to diagnose or treat ties appropriately. In fact, most pediatricians, ENTs, and even some dentists receive little to no training in infant oral restrictions, which often leads to dismissals, misdiagnosis, or poorly done releases. That’s why who you see matters just as much as whether or not your baby has a tie. In this post, we’ll break down what these ties are, how they affect your child, and most importantly—how to find the right providers who are properly equipped to help.

I am purposefully not including "real life" images throughout. I have talked to too many moms who have told me they have seen photos of tongue ties online, evaluated their child themselves, and determined they don't have a tie. I am a firm believer in moms educating themselves and many times knowing just as much as the "experts." However, this is not one of those cases. Unless extremely severe, an oral restriction cannot be determined just by looking.

What is a tongue, lip, & cheek tie?

What is a frenulum?

A frenulum is a small band of connective tissue that links two parts of the body. In the mouth, these tissues help stabilize movement, but when they’re too short or tight they can interfere with normal functions like breastfeeding, eating, speaking, oral and facial growth, and airway development.

• Tongue Ties (Ankyloglossia): happen when the lingual frenulum, the tissue under the tongue, is too restrictive and limits the tongue's range of motion, interfering with its normal function.

• Lip (Labial) Ties: involve a tight labial frenulum, the tissue connecting the upper or lower lip to the gums.

• Cheek (Buccal) Ties: refer to a tight buccal frenulum, which anchors the inner cheek to the gum and may restrict mobility or comfort.

How Can Oral Restrictions Affect Infants?

Feeding Challenges

• A tongue tie can limit how well the tongue moves, making it hard for a baby to latch correctly to the breast or bottle. This may lead to shallow latching, fussiness, or poor milk transfer.

• A lip tie can prevent the upper lip from flanging (turning outward) during feeding. Without this outward curl, babies may struggle to form a good seal, which can cause discomfort for the nursing parent and make feeding inefficient.

• A cheek tie may interfere with a baby's ability to generate strong suction. When the buccal frenulum is tight, it can limit natural cheek movement, disrupting the rhythmic muscle motion needed for a consistent and effective suck.

Breathing Concerns

• A tight lingual frenulum (tongue tie) may impact how the tongue rests in the mouth, especially when sleeping. Restricted tongue movement can compromise tongue posture, potentially leading to airway issues or contributing to mouth breathing and snoring.

• This can lead to a myriad of co-morbidities and developmental delays - both physically and emotionally.

  
  

Signs and Symptoms of Infant Oral Restrictions

MOM

• Nipple pain

• Nipple trauma

• Incomplete breast emptying 

• Pain throughout feedings

• Decreased milk supply

• Engorgement and oversupply

• Raw nipples that stay sore regardless of what you put on them to heal

• Frequent mastitis 

• Use of nipple shields long-term 

• "Lipstick" shaped nipple after feeding

BABY

• Difficulty breastfeeding or bottle feeding 

• Prolonged feeding times (45+ min)

• Fussy feeding

• Gas and Reflux

• Difficulty with pacifier use

• Limited tongue movement 

• Difficulty swallowing solid foods

• Oral hygiene challenges 

• Snoring or sleep apnea 

• Blisters on lips

• Milk constantly coating the tongue

• Thrush or yeast infections

• Latch issues

• Pocketing or leaking milk

• Lethargic at the breast

• Hourly feeds after 2 weeks old

• Baby is exhausted and cries immediately after waking

• Sleeps for 1-2 hours at a time day or night

• Sleeps with mouth open 

• Unable to latch 

• Jaundice

• Use of bili lights in the hospital 

• Reflux

• High palate 

• Recessed chin

• Collapsing bottle nipple

*Just because a mom/infant has a symptom listed above, does not automatically mean that there is a tie. Some of these symptoms can have other causations.

Consequences of Not Releasing Oral Restrictions

The tongue’s natural resting position in the mouth plays an important role in oral development. When positioned correctly against the roof of the mouth, the tongue applies a light, consistent pressure that supports the proper growth of the upper jaw and encourages correct tooth alignment.

When the tongue is at rest—not involved in talking, eating, or swallowing—it should sit gently against the roof of the mouth. Ideally, the tip rests just behind the upper front teeth, while the back of the tongue makes contact with the soft palate.

How the tongue rests during childhood has a significant impact on the development of the jaws, palate, and overall facial structure. Poor tongue posture can result in a high or narrow palate, misaligned teeth (malocclusion), and other growth deficiencies.

Correct tongue posture helps maintain an open and healthy airway. When the tongue rests improperly—especially during sleep—it can contribute to issues like mouth breathing and sleep apnea.

Good tongue posture plays a key role in producing clear and precise speech. When the tongue doesn’t rest or move correctly, it can lead to challenges like lisps or articulation problems.

Some possible consequences include:

• overactive gag reflex when they start to eat solid foods

• bottle refusal when you go back to work or difficulty finding a bottle they “like."

• higher probability of choking due to pocketing food like they have done with their milk

• improper jaw development, narrow palate, crooked teeth

• headaches, migraines

• delayed speech, lisps

• ADHD, learning and behavior difficulties

• sleep disorders like sleep apnea and upper airway resistance syndrome

• tonsils, adenoids, and airway issues

• frequent illness

• sinus congestion, allergies, asthma

• anxiety, depression

• high blood pressure later in life

• diabetes, heart disease, and other chronic illnesses later in life

• just to name a few...

  
  

So, Your Baby has a Tie. Who Should You See?

The tongue and lip tie industry is booming. This is good in the sense that oral restrictions can wreak havoc on the body, and it is ideal for proper growth and development if they are caught and treated in the early weeks.

However, most providers are not properly trained. This leads to misdiagnosis on both sides and/or improper releases.

My first step would be an airway dentist

I would not trust the hospital’s diagnosis. I would not trust a pediatrician’s diagnosis. I would not trust ~most~ ENT’s diagnosis (there are exceptions). I would maybe trust a properly trained IBCLC (or myofunctional therapist for older kids and adults), but they can’t release. My first step would be an airway dentist, and let them refer from there.

The Importance of a Team Approach

Oral restrictions should be treated by a team approach. Typically an airway focused dentist, IBCLC/feeding therapist/myofunctional therapist (depending on age), and craniosacral therapist. We'll get to this more below. A properly trained airway dentist will have referrals they trust to help you build your team - that's why I would start there, and let them refer you out. It will ultimately cause less stress on your part.

Many times mom will see an IBCLC first. This is great! I would just make sure they are properly trained and knowledgable in ties. If that's the case, most likely they will have dentist and CST referrals for you as well.

Infant Tongue Tie Providers: RED FLAGS

A properly trained provider should be asking you what interventions you've already tried to see if there has been any improvement. They should not be offering to release right then and there. It should be a team approach. In fact, often times craniosacral therapy and feeding therapy alone can fix many problems.

Are They Mentioning an IBCLC?

They should ask if you're working with an IBCLC, even if you are pumping or bottle-feeding. If not, they should connect you with one they trust. (If your child is no longer an infant, but under age 4, then a feeding therapist; and if 4yrs or older a myofunctional therapist).

A key role of an International Board Certified Lactation Consultant (IBCLC) is to support mothers in reaching their feeding goals. When working with babies who have tongue ties, the IBCLC focuses on maintaining the mother’s milk supply and making sure the baby is feeding well enough to grow and thrive. It's important to get a baby as healthy, and feeding as well as possible before a release.

The IBCLC will observe how the baby latches and their positioning during feeds to ensure effective milk transfer. During this assessment, they’ll work to identify any underlying issues affecting breastfeeding—these could range from maternal factors like low milk supply due to thyroid imbalance or nutrient deficiencies, to baby-related challenges such as ineffective latching. Both too much and too little milk can present problems, so the IBCLC carefully evaluates for either scenario. In some cases, they can even help the baby achieve a comfortable, effective latch despite a tongue tie, which can be especially valuable in preparing both mother and baby for better outcomes if a release procedure is planned.

Based on what the IBCLC discovers during their assessment, they may suggest specific steps for both the baby and parents to take before moving forward with a tongue-tie release. These preparatory measures can help set the stage for a smoother recovery and better long-term feeding outcomes.

IBCLCs may also introduce pre-surgical oral exercises to help parents become comfortable exploring and working inside their baby’s mouth. These exercises prepare both the parents and the baby’s nervous system for the changes to come. When performed consistently in the week or two leading up to the release, these gentle movements can greatly enhance the benefits of the procedure.

Are They Mentioning Craniosacral Therapy?

If not, I would seek out another provider. They should be asking if you've seen a craniosacral therapist (some may refer to is as bodywork/bodyworker), specifically one who specializes in craniosacral therapy. If you haven't already, then they should refer you to one before considering a release.

Craniosacral therapy can be provided by DOs, LMTs, OTs, DCs, PTs, sometimes even myofunctional therapists. Really anyone can practice craniosacral therapy if properly trained. Again, your tongue tie provider or IBCLC/Myofunctional Therapist should have well-qualified referrals.

Infant receiving CST

Craniosacral therapy is a gentle, hands-on bodywork technique that can release fascial restrictions, help regulate the central nervous system, release tension patterns, and restore healthy movement.

Focusing solely on oral ties without addressing the underlying cause can still lead to complications. Tongue, lip, or cheek ties are often external signs of deeper fascial tightness. If the rest of the body isn’t also considered and treated, there's a risk that the tie may reattach or become restricted again due to scar tissue formation.

The tongue is just one visible part of the body’s larger fascial network, which extends all the way down to the toes. This interconnectedness is why, in some cases, an infant may experience improved nursing after a tongue-tie release, but other issues—such as reflux, irritability, or discomfort—may persist. For some babies, the release brings full relief; for others, it doesn't.

How fascial tension presents in infants: You may notice effects on digestion and leg movement. When there is tightness in the core or midline of the body, it can create tension that radiates outward, limiting mobility and function in other areas. This is why many times a mom and baby will see improvement in feeding just from CST.

Signs of fascial tension in infants may look like:

• Shows a strong preference for one side of the body when moving arms or legs

• Discomfort or crying during tummy time or diaper changes

• Tends to arch the back frequently, especially when upset

• Often clenches hands into fists or keeps them near the mouth

• Exhibits tension or stiffness in arms and legs

• Becomes fussy or unsettled when placed in car seats or other baby containers

• Experiences frequent gas, bloating, or signs of constipation

• Has trouble feeding effectively (e.g., poor latch, slow weight gain, etc.)

• Diagnosed with a tongue or lip tie

• Displays symptoms like spitting up, colic, reflux, or frequent gagging

• Noticeable flatness or asymmetry in the shape of the head

Why is Craniosacral Therapy Important Before/After Releases?

Pre release: A baby forms their oral ties in the first trimester, and starts to suck and swallow in the second trimester. The stability of the body comes from its ability to move properly. Craniosacral therapy releases tension in the jaw, hard palate, tongue, floor of the mouth, and cranial bones, which are ALL important for proper oral function. Releasing a tongue tie with tension present could result in not releasing enough, releasing too much, and/or the tongue loosing proper oral function - working against the exact goal of the release.

In fact, many times a mom and baby will see improvement in feeding just from craniosacral therapy.

Post release: The procedure is trauma. The exercises are traumatic to a newborns system. However, they are a necessary evil. If pre and post therapy is done correctly with a full team of providers, then the recovery is quicker, easier, and helps ensure optimal results.

The tongue is fully formed at just 8 weeks in utero! It then begins to separate from the base of the mouth, becoming free to move around.

Remember, the tongue is a muscle, and the frenulum forms in the first trimester of pregnancy. For many babies, this means they’ve never had full tongue function. If the release is done without any preparation, the body can enter fight-or-flight mode due to the sudden trauma of a new incision, disorganized sucking and swallowing, and the challenge of learning to move the tongue in new ways. This may cause the shoulders to tighten again and mobility to decrease after the procedure.

Preparation is key. Think of it like running a marathon. If you’ve never trained and you go out and run one tomorrow, you might start off okay, but quickly become exhausted, struggle to finish, or even injure yourself.

The same concept applies to a tongue that has been restricted by a tie. It’s a weak muscle that relied on the frenulum for support. Once released, if that tongue hasn’t been strengthened and supported through mobility work, it’s now loose but still weak. You may see initial improvement for a day or two, but without proper preparation and follow-up, issues like poor tongue elevation, tongue retraction, thrusting, milk pocketing, and inefficient feeding can return.

What Equipment Do They Use and How Many Releases Do They Do?

Ask what they use to perform releases. Look for a pediatric dentist who has a Solea laser or CO2 laser. A provider with a cheaper laser may not be as invested. Additionally, the healing time and outcomes may be poor due to the thickness of the incision, and it may heal with a thick scar tissue band in place of the frenulum.

Ask how many babies they see per month. A good pediatric dentist is highly sought after, and should see 3-10+ babies per week, depending on your location.

Other Red Flags I Frequently Hear:

• If a provider says "they'll grow out of it."

• The provider only looks at the tongue, and doesn't feel for tension or function.

• A provider says, "there's a tie, but it's not that bad."

• A provider offers to release a restriction right then and there with no team/collaborative care

• If. provider says there's no tie because they can stick their tongue all the way out

  • There is so much more than goes into a tongue tie evaluation than just looking. A provider should be looking at medical and birth history, appearance of the mouth structures and frenulum, tongue mobility, tension, oral rest posture, sleep screening, body compensation, symptoms reported by parent/caregiver ad/or child if older, speech sound assessment if applicable, and feeding/swallowing abilities

Release Done? It Shouldn't Stop There!

Now that your baby has completed the above, craniofacial work shouldn't stop there! Your baby is growing a face. They need to stimulate growth in their bones, palate, and jaw by breastfeeding and CHEWING!!! If your baby is bottle-fed consider these things.

When it comes time to start solids soft purées are not recommended as the main source of food as they do not require the chewing action needed to help develop oral muscles and cranial growth. Food pouches are also not recommended because they encourage an extended sucking pattern when children should be transitioning to the chew pattern. This can lead to incorrect swallow patterns.

Baby led weaning allows for children to safely begin to work on their chew pattern while also working the muscles of the jaw to stimulate that optimal cranial and facial development. Safety should be taken into consideration to foods served, paying attention to which teeth have erupted. The app Solids Starts is a great resource. You can easily search any food, and they will visually show you how to properly prepare it for baby's age.

As children grow, crunchy and chewy foods such as carrot sticks, apples, and beef jerky are great examples of foods that encourage chewing.

You can also consider a myofunctional friendly cup (NO SIPPY or 360 CUPS!!!)

Looking for a Provider?

These are a few reputable training programs. If a provider has these certifications or has been trained under these programs - that's a green flag. *This is not an all-inclusive list. There are certainly other great programs and qualifications out there.

• Trained under The Breathe Institute - Affiliates (they have a search engine)

• TOTS (they have a search engine)

• Trained under The Tongue-Tied Academy with Dr. Richard Baxter (no search engine, but you can email)

• I also have an ongoing list of tongue tie and airway/expander providers

  • If you have a provider that meets all the criteria mentioned in this guide I would love to add them to my list. Please shoot me a message on Instagram.

• I have also found Chat GPT to be a really helpful starting place.

  Insert and customize this:

  • Are there any dentists who perform [infant/child/adult] tongue tie releases in [insert city] who recommend seeing an [IBCLC or myofunctional therapist] and craniosacral therapist?

  
  

  Don't take Chat GPT's suggestions as gospel. Instead, look through the websites of their suggestions and gauge for yourself - but I have found some pretty great recommendations this way.

  
  

  When I put in: Are there any dentists who perform infant tongue tie releases in Dallas who recommend seeing an IBCLC and craniosacral therapist in? One of the suggestions I got was Beyond Pediatric Dentistry. They did my daughter's and are phenomenal.

  
  

  I did one for a girl in Phoenix, and said "Are there any dentists who perform infant tongue tie releases in Phoenix, AZ who recommend seeing an IBCLC and craniosacral therapist?" And was suggested this practice, which I was very impressed with!

This is a great podcast episode I recorded with my dad, Dr. Hal Stewart (airway dentist) all about tongue ties and sleep disorders. It's specifically geared towards kids 4years-adults, however there is a ton of applicable information for infants. I have recorded one specifically on infants with my step-mom, Dr. Adriana Corredor-Stewart. As soon as I get that edited I will upload it here, as well.

Additional resources:

Dr. Nora Zaghi has some amazing information on her site for infant tongue ties if you're not already overwhelmed and want to deep dive even further ;)

---

Encouragement to moms who may be reading all of this and already had a release done on their child, before knowing all of this.

This is a sensitive subject, and it's so easy for mom's to hold guilt. We have all been there. I know I have! All we can do is the best we can with what we know. YOU CAN'T KNOW WHAT YOU DON'T KNOW - and that's okay!!! And guess what? If you ever notice symptoms of restrictions starting to reemerge, it's not too late! We have 60-70+ year old patients in the practice I work at getting releases, and benefiting greatly!

A personal note from Crystal, IBCLC:

"I hold guilt for my son who has a tongue tie. He is almost 12. I tried and tried for months to breastfeed him. I felt so guilty and felt like a failure. I felt like there was something wrong with me. The hospital IBCLCs kept telling me to try harder and that I was “doing a good job.” But nothing improved.

When he was 10, we went to a new pediatrician who saw his high palate and noted his tongue tie. I felt so guilty—being an IBCLC for 2–3 years at that time, I felt like I should have checked. Somebody should have checked! So we did myofunctional therapy after that due to his baby teeth not falling out on their own. Then he had a palate expander put in, then braces.

He previously had his tonsils and adenoids removed when he was 3, had ADHD symptoms, GI issues when he was a baby and a small child, constipation, and he has a recessed chin. I still feel guilty.

I would just encourage them that they are always doing the best they can from what they know. If nobody tells you any different, how would you know? We trust the medical doctors to know everything about everything, but unfortunately, it’s not in everyone's wheelhouse. Not every provider will look for this or correlate most of these issues.

For me, my faith is my foundation. I know that God sees every child as perfect—and they are. Moms are providing comfort and love regardless of their feeding difficulties. Children will love you regardless of how they eat. My son was mostly formula-fed due to poor weight gain, and he is at the top of his class—even for Math. (And he was fed a formula that now tests high in heavy metals… deep sigh.)

A personal note from Madison, CST:

It’s NEVER too late. Get help ASAP and we can work it out! It truly takes a team effort for a full care plan. We utilize lactation consultants, feeding therapists, oral motor therapists, and physical therapists to obtain the goal, especially if we are back tracking. It is STILL easier to address this as a baby than it is with older kiddos. If your kiddo had the release and is now 2-3 years old, mouth breathing, picky eater, chokes on food a lot, shoves too much in their mouth at a time, night terrors, etc. - there’s still a way to address. It will take more time, commitment, and work. But it CAN be done. I am living proof of doing it with my older kiddo now!