How to recognize it, what to try first, and how to make an informed decision if it comes to a procedure.

If your baby is struggling to latch, clicking during feedings, slipping off the breast, or not transferring milk effectively despite your best positioning efforts – tongue tie or lip tie may be part of the picture.

These are real, diagnosable conditions that can significantly impact breastfeeding. They are also among the most quickly jumped to in today’s medical landscape, with frenotomy rates rising sharply over the past two decades without a corresponding increase in diagnostic standards.

This article will help you understand what tongue tie and lip tie actually are, how to recognize them, and – most importantly – what to try before anyone picks up a pair of scissors. If conservative approaches don’t resolve the problem and a procedure becomes necessary, we’ll also walk you through what that looks like and how to find someone truly qualified to do it.

What Are Tongue Tie and Lip Tie?

Tongue Tie (Ankyloglossia)

A tongue tie occurs when the lingual frenulum – the thin band of tissue connecting the underside of the tongue to the floor of the mouth – is too short, too thick, or too tightly anchored. This restricts the tongue’s range of motion.

For breastfeeding, this matters enormously. An effectively nursing baby needs to cup the breast with their tongue, draw it deeply into the mouth, and use rhythmic tongue movement to compress the milk ducts and transfer milk. A tongue tie can prevent or limit all of this.

Tongue ties are classified from anterior (visible at the tip of the tongue, the most obvious type) to posterior (further back under the tongue, often missed on casual examination). Posterior ties are frequently overlooked because they sit beneath the mucous membrane and may not be visible without careful assessment by someone trained to look for them.

Lip Tie

A lip tie occurs when the labial frenulum – the tissue connecting the upper lip to the gum line – is too tight or restrictive, preventing the upper lip from flanging outward during feeding. A properly flanged upper lip is part of creating the seal needed for effective milk transfer.

Lip ties often occur alongside tongue ties and may contribute to shallow latch, clicking, gas from air swallowing, and nipple pain. However, lip ties as an isolated issue are more controversial in the research, and many practitioners believe they rarely require intervention on their own.

Signs That Tongue or Lip Tie May Be Affecting Breastfeeding

Many of these signs overlap with other breastfeeding challenges, which is why a thorough assessment matters before concluding tie is the cause. That said, if you are experiencing several of these together despite working on latch and positioning, tie is worth investigating.

Signs in Baby

✔  Poor or shallow latch despite repeated positioning attempts and good technique

✔  Clicking or smacking sounds during feeding – indicating loss of suction

✔  Slipping off the breast frequently during a feeding

✔  Falling asleep at the breast very quickly without transferring much milk

✔  Slow weight gain or difficulty regaining birth weight

✔  Excessive gas or colic from swallowing air due to poor seal

✔  Frustration or fussiness at the breast despite hunger

✔  Upper lip that curls inward rather than flanging outward during feeding (lip tie sign)

✔  Heart-shaped or notched tongue tip when baby cries or sticks out tongue

✔  Limited tongue elevation tongue cannot reach the roof of the mouth or extend past the lower gum line

If you are worried that a latch or tongue tie issue is affecting milk transfer, start by watching the bigger picture: diapers, weight gain, swallowing, and baby’s alertness. This guide on how to tell if your baby is getting enough milk can help you know what signs to track.

Signs in Mother

✔  Persistent nipple pain despite correct latch technique

✔  Nipple damage creasing, blanching, blistering, or bleeding

✔  Incomplete breast drainage leading to engorgement, blocked ducts, or recurring mastitis

✔  Supply concerns that develop despite frequent feeding – because poor transfer means reduced demand signal

See our article: “I Don’t Think I’m Making Enough Milk”

Try This First: Conservative Approaches

The default response to a tongue or lip tie diagnosis should not be immediate referral for a procedure. The International Consortium of Oral Ankylofrenula Professionals, the AAP, and many leading IBCLCs all advocate a conservative, multidisciplinary approach first. This is not about delaying necessary treatment – it is about giving your baby’s body the opportunity to function better before resorting to a surgical intervention that cannot be undone – and comes with risks.

1. Work With an IBCLC First

Before anything else, work with a certified lactation consultant (IBCLC). An IBCLC with experience in oral ties can assess the functional impact of the tie – not just whether it’s present – and help you optimize positioning and latch to work around it. Sometimes latch technique alone significantly reduces or eliminates symptoms.

If the IBCLC assesses that conservative measures alone won’t be sufficient, they will tell you. A knowledgeable IBCLC is your most important first call – before any surgeon or dentist.

See our article: The Latch: Everything You Need to Know

2. Oral Massage

Gentle intraoral massage – performed by a parent with clean hands or a trained therapist – can help loosen tight frenulum tissue, reduce oral tension, and improve tongue mobility over time. Newborn tissues are elastic and responsive in ways they won’t be later, which is why early, consistent massage can sometimes achieve meaningful improvement.

Basic massage techniques include:

• Gently stroking the lips and gum line to relax oral tension before feeding
• Placing a clean finger in the baby’s mouth and allowing them to suck to assess tongue movement and strength
• Gentle lateral tongue sweeps – running a finger along the lower gum to stimulate tongue movement to the sides
• Gentle tongue lifts using a finger under the tongue, held for a few seconds, to begin stretching the frenulum

3. Myofunctional Therapy

Orofacial myofunctional therapy is a specialized program that uses targeted exercises to retrain oral and facial muscles, strengthen the tongue, improve tongue posture and placement, and optimize suck-swallow-breathe coordination.

For infants, a certified myofunctional therapist works with both baby and parent, teaching specific exercises tailored to the baby’s needs. Sessions are gentle, play-based, and designed to be positive experiences for the baby.

Myofunctional therapy is also recommended both before and after a procedure when one does become necessary – preparing the muscles beforehand and helping retrain movement patterns afterward to prevent reattachment and maximize the benefit of the release.

4. Bodywork: Osteopathy, Chiropractic, and Craniosacral Therapy

Many parents and IBCLCs report significant improvement in breastfeeding difficulties following gentle bodywork with a qualified infant-specialized practitioner. The reasoning: birth, regardless of how it unfolds, can leave tension in an infant’s cranium, jaw, neck, and fascial tissue. This tension can affect the mechanics of feeding independently of, or in addition to, a structural tie.

Cranial osteopathy and pediatric chiropractic are the most commonly used modalities in this context. Some research, including a study in the Journal of Human Lactation, suggests osteopathic treatment in conjunction with lactation consultation can reduce biomechanical sucking difficulties in babies under six weeks. Craniosacral therapy has a large body of anecdotal clinical support from IBCLCs and practitioners, though formal evidence remains limited.

Important caveats for any bodywork with an infant:

• Only see a practitioner with specific training and significant experience working with infants – adult techniques applied to babies can be harmful
• Ask specifically about their experience with feeding difficulties and oral ties
• Look for practitioners who work collaboratively with IBCLCs
• Pediatric chiropractic is a distinct specialty – ask about specific infant training, not just general chiropractic certification

When Conservative Approaches Aren’t Enough

Sometimes, despite genuine effort with conservative care, the tie is functionally significant enough that a procedure becomes the right path. This is not a failure. It is a clinical decision based on evidence, made after exhausting gentler options.

The AAP’s 2024 clinical report on ankyloglossia states that frenotomy should be considered when breastfeeding difficulties persist despite lactation support. That “despite lactation support” piece is key. The standard of care is conservative management first – not procedure first.

Signs that conservative care has reached its limit and a procedure may be appropriate:

• Significant maternal nipple pain that has not improved after several weeks of IBCLC support, positioning work, and massage
• Poor infant weight gain that cannot be explained by supply, feeding management issues or other medical issue
• Functional assessment by a qualified provider confirms meaningful restriction
• Multiple conservative approaches have been genuinely tried over several weeks without adequate improvement

If You Proceed: What the Procedure Actually Involves

What Is a Frenotomy / Frenectomy?

A frenotomy (also called frenulotomy or frenectomy, depending on the extent of the procedure) is the release of the frenulum tissue. For infants, the two most common methods are:

Scissors frenotomy: Scissors frenotomy remains the most commonly studied technique for infant frenotomy and is widely used in newborns. A small pair of blunt scissors divides the frenulum in a quick snip. Bleeding is typically minimal. Usually performed without anesthesia in very young infants, as the tissue has few nerve endings at this stage. Fast recovery.

Laser frenectomy: Uses a CO2 or diode laser rather than scissors. Precise, minimal bleeding, and some practitioners prefer laser frenectomy for certain posterior ties. Local anesthetic is usually used. Requires more aftercare – stretching exercises are essential after a laser procedure to prevent reattachment of the tissue as it heals.

Both methods are generally safe when performed by a trained, experienced practitioner. The choice between them often depends on the type and location of the tie and the practitioner’s training.

Who Should Perform It

This is where parents need to be informed and assertive. Not every provider who can perform a frenotomy is equally qualified to assess, diagnose, and treat tongue tie in the context of breastfeeding.

Look for a provider who:

• Understands the functional impact of oral ties on breastfeeding – not just the anatomy. They should ask about feeding, not just look at the frenulum
• Works collaboratively with IBCLCs – ideally requiring IBCLC involvement before and after the procedure
• Uses a validated assessment tool such as the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) to evaluate the tie objectively
• Does not rush to procedure – a provider who pushes immediately to surgery without recommending conservative management first is a red flag
• Has specific, substantial training in oral tie release – ask directly about their training, how many they have performed, and what their complication and revision rates are
• Requires follow-up – a provider who does not schedule post-procedure follow-up has no way of knowing whether their work was effective
• Recommends post-procedure bodywork and exercises – especially after laser, to prevent reattachment

Specialists to Consider

Frenotomies are performed by a range of providers including pediatric dentists, ENTs (otolaryngologists), oral surgeons, IBCLCs in some states, and some pediatricians and breastfeeding medicine physicians. The credential matters less than the expertise. Seek out practitioners who specialize in oral ties specifically, have substantial infant experience, and are embedded in a collaborative care model that includes lactation support.

Questions to ask before committing to any provider:

• How many infant frenotomies have you performed?
• Do you require IBCLC involvement before and after?
• What assessment tool do you use to diagnose functional restriction?
• What is your approach to conservative management before procedure?
• What post-procedure care and follow-up do you provide?
• What are your revision rates?

After the Procedure: What to Expect

Improvement in breastfeeding is not always immediate. Babies often need time to relearn how to use their tongues with the new range of motion. IBCLC support in the days immediately following the procedure is critical.

Post-procedure exercises are essential – particularly after laser frenectomy – to prevent reattachment of the wound site as it heals. Your provider should give you a specific exercise protocol. These exercises involve gentle manual stretching of the release site, typically 4–6 times daily for 3–4 weeks.

Continued bodywork with an osteopath or myofunctional therapist post-procedure helps retrain the muscles and integrate the new tongue movement into feeding patterns.

The Bottom Line

Tongue tie and lip tie are real conditions that genuinely affect breastfeeding for some babies. They are also among the most over-diagnosed and over-treated conditions in the newborn period – with procedure rates climbing sharply and evidence for routine frenotomy remaining mixed.

The path forward is not “snip first, ask questions later.” It is:

Step 1: Get an IBCLC – before anyone else. Assess function, optimize latch, try conservative measures.

Step 2: Explore bodywork and massage – with qualified, infant-experienced practitioners while continuing IBCLC support.

Step 3: Try myofunctional therapy – if symptoms persist. Give it genuine time.

Step 4: If a procedure is warranted – find a specialist who truly understands oral ties, insist on pre- and post-procedure IBCLC involvement, and follow up consistently.

Your baby deserves a thorough, thoughtful approach. So do you.

We’re here. Keep going.