Tongue & Lip Ties

Crystal P.

Updated July 02, 2025 20:43

My baby’s having trouble latching deeply, and my nipples are super sore—could it be a lip or tongue tie?

There are a few reasons why a baby might not be getting a deep latch, and oral ties are one possible cause. (We’ll explore this further, but first, [click here] to read more about what else can cause latch difficulties.) Make sure you’re using proper positioning techniques—this is very important to ensure your baby has the best opportunity to achieve a good latch!

What Is a Lip or Tongue Tie?

A lip or tongue tie restricts the movement of the tongue or lip, which can cause breastfeeding issues or other complications. This restriction occurs within the frenulum—a thin, ropelike band of tissue. Babies can develop a “tight frenulum” in the womb, during the first trimester.

A frenulum connects two structures in the body. There are two types of frenula in the mouth, and babies can have issues with one or both—resulting in a lip tie, a tongue tie, or both.

Lip tie

A lip tie is a problem with the labial frenulum, which connects the lip to the gums. This tissue may be too short or too thick and can prevent the baby’s lips from curling out and creating a tight seal around the breast. (The frenulum above and between the two front teeth is usually the most noticeable.) A lower lip tie is much less common than an upper lip tie.

Tongue Tie

A tongue tie is an issue with the lingual frenulum, the tissue that connects the tongue to the floor of the mouth. It may be too short or too thick, and can limit the movement of the tongue and baby’s ability to transfer milk effectively. It could also be abnormally attached—too close to the tip of the tongue or too far back.

*Labial and lingual restrictions are the most commonly diagnosed, but other ties—such as buccal—can also affect breastfeeding.

Signs of a Lip or Tongue Tie

Your baby may:

- Make clicking, choking, gasping, gulping, or gurgling sounds while breastfeeding or bottle-feeding
- Leak milk from the corners of the mouth
- Struggle to maintain a latch or keep slipping off the breast
- Chew or gum on the nipple
- Nurse for long periods or fall asleep quickly at the breast
- Feed frequently but only for short durations
- Transfer less milk than is available
- Lose weight or fail to gain appropriately
- Be excessively fussy or appear uncomfortable during or after feeds
- Arch their back while feeding
- Spit up often or show signs of gas or reflux
- Have a bloated or distended belly
- Display irregular pooping patterns (too frequent or too infrequent)
- Sleep poorly or wake often
- Struggle to keep a bottle or pacifier in their mouth
- Develop lip calluses or blisters

You may:

- Experience pain during the entire feeding
- Notice cracked, bruised, or bleeding nipples due to a shallow latch
- Observe your nipple appears misshapen or “lipstick-shaped” after feeding
- Have a low milk supply from poor milk removal
- Deal with engorgement, plugged ducts, inflammation, or mastitis due to ineffective emptying
- Suffer from recurrent thrush
- Find yourself relying on a nipple shield to maintain feeding
- Feel like breastfeeding has become a full-time job

Getting a Diagnosis

If you think your baby might have a lip or tongue tie, have them evaluated by a trained healthcare provider. Some pediatricians are skilled at identifying ties, but dentists, speech pathologists, and myofunctional therapists, who work with infants, often have more experience. Many dentists accept insurance, including Medicaid. You can ask your doctor for a referral, or visit with your peer counselor about trusted dentists available in your area.

How Are Oral Ties Treated?

Some providers recommend starting with a more conservative approach, especially if the tongue or lip tie isn’t severe. Working with a lactation consultant, checking milk transfer and weight gain, and using special positions and latch techniques may be all that’s needed for milder ties.

If your baby's tie is more severe, your healthcare provider might suggest a frenotomy (also called a frenectomy). These are two names for the same quick procedure, usually done in a clinic or dental office. The goal is to give your baby more freedom to move their lip or tongue.

Scissor Release

The provider makes a small cut in the frenulum to release the tie. The procedure takes only a few minutes, and anesthesia is rarely used. This method seems to be preferred for younger infants.

Laser Release

A laser is used to make a precise cut in the frenulum, releasing the tie. Your provider may use numbing medicine for this method. This method can be used at any age, but typically is more suitable for older infants or those with more complex ties.

Some providers and lactation consultants prefer the laser method because it may:

- Reduce bleeding
- Heal faster
- Lower the risk of infection
- Be more comfortable
- Decrease the chance of the tissue growing back

Both methods are considered safe and effective. Opinions vary and more research is still being done to compare the two methods. Which one is best depends on your baby, your provider, and what you're comfortable with.

What Happens After the Procedure?

Breastfeeding can continue right away. In fact, feeding immediately after the procedure helps comfort your baby and supports healing.

Post-procedure care is very important. Your provider will give you instructions for gentle stretches or massages to help prevent the tissue from reattaching.

This video demonstrates infant suck training exercises. It can be used to teach strength and range of motion in babies with no oral ties, or reteach babies, who have had a release, how to use their tongue.

[Click here] for more information on what to expect after the procedure.

Getting Support

A lactation consultant can point out possible signs of a tie, but only a doctor or dentist can make a diagnosis. Your breastfeeding peer counselor team is here to support you—we can help you prepare for your appointment and give tips for latching and protecting your milk supply. Reach out for help—you’re not alone!

Breastfeeding with Tongue Tie.jpeg What is a tongue tie.jpg