How to Tell if Your Baby Has a Tongue Tie: Signs, Feeding Challenges, and Next Steps
Medically Reviewed by Lisa Coburn, DDS; Marzieh Shafie, DDS; Bret Christensen, DDS; and Kevin Boyd, DDS, MSc
Airway Dentists | Rebis Health
Educational content only. This article is intended for informational purposes and should not replace individualized medical advice from your healthcare provider.
If feeding your baby has become painful, frustrating, or unexpectedly difficult, you're not alone. Many parents notice something doesn't feel quite right long before anyone mentions the possibility of a tongue tie. Your baby may struggle to latch, make clicking sounds while nursing or bottle feeding, feed for long periods without seeming satisfied, or gain weight more slowly than expected.
One possible explanation is tongue tie, also known as ankyloglossia. While tongue tie has received increased attention in recent years, it is also widely misunderstood. Not every baby with a visible frenulum experiences feeding problems, and not every feeding challenge is caused by a tongue tie.
The most important question isn't whether a frenulum is present. It's whether restricted tongue movement is affecting your baby's ability to feed comfortably and efficiently.
A thoughtful evaluation can help determine what's contributing to feeding difficulties and whether treatment, additional support, or simply reassurance is the most appropriate next step.
What Is a Tongue Tie?
A tongue tie, clinically known as ankyloglossia, is a condition present at birth in which the tissue beneath the tongue, called the lingual frenulum, restricts the tongue's normal range of movement.
Every baby has a lingual frenulum. In most infants, it allows the tongue to move freely. In some, the tissue is unusually short, tight, or positioned in a way that limits mobility and interferes with normal function.
During breastfeeding and bottle feeding, the tongue creates a seal, coordinates sucking and swallowing, and transfers milk efficiently. When tongue movement is restricted, feeding may become more difficult for both the baby and the parent.
Reported rates of tongue tie vary because healthcare professionals do not use one universally accepted definition or assessment method. The American Academy of Pediatrics cites studies reporting ankyloglossia in approximately 1.7% to 10.7% of newborns.
Diagnosis Is Based on Function, Not Appearance
A tongue tie is not diagnosed simply because a frenulum is visible.
Diagnosis is based on whether restricted tongue movement is causing functional problems such as:
Ineffective breastfeeding or bottle feeding
Poor milk transfer
Maternal nipple pain during breastfeeding
Impaired oral function
Some babies have an obvious frenulum and feed without difficulty. Others have a less noticeable restriction but experience significant feeding challenges. For this reason, clinicians evaluate tongue function, not appearance, when determining whether treatment is appropriate.
The American Academy of Pediatric Dentistry also recommends that decisions about treatment be based on functional limitations rather than the appearance of the frenulum alone.
The Tongue's Role Beyond Feeding
The tongue does more than help babies eat. During normal development, it rests against the palate between swallowing and breathing. This gentle pressure helps support normal widening of the upper jaw and development of the nasal airway.
Researchers continue to study how restricted tongue mobility may influence facial growth, nasal breathing, and airway development, although many genetic and environmental factors also contribute. Healthy tongue function also supports nasal breathing, and nasal obstruction may contribute to compensatory oral postures that affect feeding.
What Does a Tongue Tie Look Like?
Some tongue ties are easy to recognize, while others are much more subtle.
You or your healthcare provider may notice:
A heart-shaped or notched tongue tip when your baby cries
Difficulty lifting the tongue toward the roof of the mouth
Limited ability to extend the tongue beyond the lower gums
A tight band of tissue beneath the tongue
A tongue that appears pulled downward during movement
Appearance alone cannot determine whether a tongue tie is clinically significant. Some babies with an obvious restriction feed comfortably, while others with a less noticeable frenulum experience significant feeding challenges.
You may also hear the term posterior tongue tie. Although commonly used, there is no universally accepted definition. Rather than relying on this label, experienced clinicians evaluate whether tongue movement is truly restricted and whether that restriction is affecting feeding.
Signs Your Baby May Have a Tongue Tie
The earliest signs of tongue tie usually appear during feeding.
Signs in Your Baby
Your baby may:
Have difficulty achieving or maintaining a deep latch
Make clicking sounds while nursing or bottle feeding
Frequently lose suction during feeds
Leak milk from the corners of the mouth
Feed for long periods without appearing satisfied
Fall asleep before completing a feeding
Become frustrated while feeding
Swallow excessive air and seem unusually gassy
Gain weight more slowly than expected
Bottle-Fed Babies Can Be Affected Too
Tongue tie is often associated with breastfeeding, but bottle-fed infants can experience many of the same challenges.
Signs may include:
Excessive air intake
Difficulty maintaining a seal on the bottle nipple
Frequent loss of suction
Prolonged feeding sessions
Fatigue during feeds
Collapsing bottle nipples caused by inefficient suction
Milk leaking around the mouth
Difficulty coordinating sucking, swallowing, and breathing
Signs for a Breastfeeding Parent
Parents who are breastfeeding may notice:
Persistent nipple pain
Cracked or damaged nipples
Nipples that appear compressed or creased after feeding
Recurrent plugged ducts or breast fullness
Concerns about milk supply
Feeding sessions that remain consistently painful or inefficient
These symptoms are not unique to tongue tie. Similar feeding challenges can result from positioning difficulties, milk supply concerns, prematurity, oral-motor coordination disorders, birth-related muscular tension, or other medical conditions. A comprehensive feeding assessment helps determine the underlying cause rather than focusing on the frenulum alone.
Does Every Tongue Tie Need Treatment?
No.
One of the most important messages for parents is that a visible frenulum alone is not a reason to perform a procedure.
Some babies with restricted-looking anatomy feed comfortably, gain weight appropriately, and never require treatment. Others improve with lactation support, positioning adjustments, or time as feeding skills mature.
When feeding difficulties persist despite conservative measures, a comprehensive evaluation helps determine whether restricted tongue movement is contributing to the problem.
What Happens During a Tongue Tie Evaluation?
A comprehensive evaluation begins with listening.
Your clinician will ask about:
Breastfeeding or bottle-feeding experiences
Latch quality
Feeding duration
Parent comfort
Weight gain
Previous lactation support
Birth and medical history
Whenever possible, observing a feeding provides valuable information that cannot be gathered from an examination alone.
The oral examination evaluates far more than the frenulum. Clinicians assess whether the tongue can:
Elevate toward the palate
Cup around the breast or bottle nipple
Extend beyond the lower gum ridge
Move side to side appropriately
Generate the coordinated, wave-like movements needed for efficient feeding
They also evaluate:
Feeding efficiency
Milk transfer
Oral coordination
Infant growth
Palate shape and width
The relationship between the tongue and palate
Many infants with restricted tongue mobility also have a narrow or high-vaulted palate and reduced tongue-to-palate contact. These findings are considered alongside feeding function and the overall clinical picture rather than in isolation.
Because feeding difficulties often have multiple contributing factors, the evaluation also considers other possible causes, including oral-motor coordination challenges, birth-related muscular tension, and nasal obstruction.
The Academy of Breastfeeding Medicine and the American Academy of Pediatric Dentistry support a comprehensive, multidisciplinary assessment rather than relying on the appearance of the frenulum alone.
Clinical Insight from Dr. Lisa Coburn
"Every week, I see babies, teens, and adults whose tongue restrictions were never recognized early. While we can improve airway health at any age, early evaluation often gives families more options and may help address feeding concerns before they become long-term challenges.
Most importantly, we can't do this in a silo. The best outcomes come from collaboration among healthcare providers and from listening to parents. You know your baby best, and your instincts matter."
If these signs sound familiar, the next step isn’t assuming your baby needs treatment. It’s understand what’s causing the feeding challenges through a comprehensive evaluation.
When Is Treatment Recommended?
When significant feeding problems persist despite appropriate conservative care, a tongue-tie release may improve feeding efficiency, reduce parental discomfort, and support continuation of breastfeeding. Earlier treatment may also be technically simpler than intervention later in childhood.
If a clearly restrictive tongue tie continues to interfere with effective feeding, your healthcare team may discuss a frenotomy or frenectomy as one treatment option. The decision should always include a discussion of expected benefits, potential risks, alternatives, and your family's goals.
At Rebis Health, tongue-tie releases are performed using laser technology because we believe it offers excellent precision, visibility, and patient comfort, while recognizing that both laser and traditional techniques can be appropriate depending on the individual clinical situation.
A tongue-tie release is only one part of treatment. Babies often benefit from lactation support, oral motor therapy, bodywork when appropriate, and carefully instructed stretching exercises following the procedure. These therapies help the tongue learn new movement patterns while reducing the risk of reattachment.
What About Lip Ties?
Parents often ask whether an upper lip tie also requires treatment.
The upper lip frenulum is a normal structure that changes throughout childhood. Current evidence does not support releasing every upper lip frenulum based on appearance alone. Instead, clinicians evaluate lip mobility as part of the overall feeding assessment rather than relying on appearance alone.
When Should You Seek an Evaluation?
If feeding continues to feel difficult despite your best efforts, it's worth asking for help.
Consider requesting an evaluation if:
Breastfeeding remains painful despite lactation support
Your baby repeatedly loses the latch
Feedings are consistently prolonged or stressful
Milk transfer appears inadequate
Your baby is not gaining weight as expected
Your baby coughs, chokes, or struggles during feeds
You continue to feel that feeding simply isn't going well
Parents are often the first to recognize when something doesn't seem right. Seeking an evaluation early can provide reassurance, identify contributing factors, and help your family develop an appropriate plan.
If your baby has poor weight gain, signs of dehydration, difficulty breathing, unusual sleepiness, or other concerning symptoms, contact your pediatrician promptly.
An evaluation is not a commitment to treatment. It is an opportunity to understand why feeding has become difficult and what type of support is most likely to help.
Continue Learning
You may also find these resources helpful:
To learn more about our comprehensive approach to tongue tie evaluation and treatment, visit our Tongue Tie Center.
References
Academy of Breastfeeding Medicine. (2021). Academy of Breastfeeding Medicine position statement on ankyloglossia in breastfeeding dyads. Breastfeeding Medicine, 16(4), 278-281. https://doi.org/10.1089/bfm.2021.29179.ylf
American Academy of Pediatric Dentistry. (2025). Policy on management of the frenulum in pediatric patients. In The Reference Manual of Pediatric Dentistry (pp. 80-85). American Academy of Pediatric Dentistry.
Messner, A. H., Walsh, J., Rosenfeld, R. M., Schwartz, S. R., Ishman, S. L., Baldassari, C., Brietzke, S. E., Darrow, D. H., Goldstein, N., Levi, J., Meyer, A. K., Parikh, S., Simons, J. P., Wohl, D. L., Lambie, E., & Satterfield, L. (2020). Clinical consensus statement: Ankyloglossia in children. Otolaryngology–Head and Neck Surgery, 162(5), 597-611. https://doi.org/10.1177/0194599820915457
Thomas, J., Bunik, M., Holmes, A., Keels, M. A., Poindexter, B., Meyer, A., Gilliland, A., Long, S., Richter, M., Hannon, E., Kellams, A., Williams, T., Feldman-Winter, L., Mass, S., Noble, L., & Young, M. (2024). Identification and management of ankyloglossia and its effect on breastfeeding in infants: Clinical report. Pediatrics, 154(2), e2024067605. https://doi.org/10.1542/peds.2024-067605
