I love kindergarten rules… but sometimes I really want to break the one that says “Keep your hands, feet, and objects to yourself.”
“Oh, your baby has reflux?” My hand twitches a bit as I force it to stay by my side.
“You’re struggling with low milk supply?” I put my hand in my pocket . . . it can’t be trusted.
“Your baby is waking every two hours to nurse at six months old?” At this point the urge is so strong I use my other hand to slap myself.
What do I want to do? Check for a tongue / lip tie, of course! They can be such a source of SO. MUCH. MISERY. for nursing mamas and their sweet babes, including me.
Unfortunately, the symptoms are often misdiagnosed as other conditions like colic, reflux, and failure to thrive because many pediatricians and lactation do not know how to properly identify them. Since writing about this subject three years ago I cannot count the number of messages I have received that said, “My pedi said there was nothing wrong so we suffered for months, then we got a second opinion and discovered a severe tie!”
Fortunately, Word Is Getting Out
While I was in New York getting Levi’s ties revised last month, Dr. Kotlow informed me that he gets at least one family per week who heard about him here. (If you’re not familiar with him, Dr. Kotlow is considered the foremost expert on tongue/lip ties in the United States.)
Where are all these people hearing about my story? From YOU. Thank you for sharing my posts and helping get the word out – you have changed more lives than you know!
In this post I’m going to share with you some new tips Dr. K showed me for identifying tongue and lip ties at home, plus I’ll share the #1 critical mistake they make when assessing a tie.
Bottom line: If you’re a mama and you suspect a problem there probably is one. Tongue ties are not just about structure, they’re about function, and there is no one more qualified than you to determine if a baby’s latch feels “off.” Of course, these statements have not been evaluated by the FDA and are not intended to diagnose, treat, or cure any disease. I’m simply saying that a mama’s sense should be trusted, so if your gut says something is off and a home exam gives you reason to believe a tie might be an issue, find an informed care provider that will take your concerns seriously.
Now let’s get started!
Step 1: Focus on the symptoms first
“The most important diagnostic tool is not looking at the lip, or looking at the tongue. Although it’s important to clinically evaluate them… it’s mother’s symptoms,” Dr. Kotlow told me.
Why? Because a mother’s breast can come in many different sizes and shapes, as can a baby’s mouth. The crucial factor is how the two function together. Here are some things to look for when determining whether there is a concern:
- Creased/flat/blanched nipple after feedings
- Cracked/blistered/bleeding nipples
- Discomfort while nursing
- Plugged ducts
- Sleep deprivation (Because baby is not able to nurse efficiently they compensate by nursing more often, leading to frequent night feedings. My first son was still nursing every 2 hours at 8 months old)
- Difficulty latching on or falls off the breast easily
- Gumming or chewing the nipple while nursing
- Unable to hold a paci or bottle
- Gassy (babies with ties often swallow a lot of air because they cannot maintain suction properly)
- Poor weight gain
- Excessive drooling
- Baby is not able to fully drain breast
- Choking on milk or popping off to gasp for air while nursing
- Falling asleep during feedings, then waking a short while later to nurse again
- Sleep deprivation (due to the need for frequent feedings)
- Extended nursing episodes – aka marathon nursing sessions
- Clicking noises while sucking
- Popping on and off breast often
- Biting – Babies who have trouble grasping the nipple sometimes try to use their teeth to hold on. (Once they come in, of course)
- Gap between teeth/jaw issues
Problems Associated With Tongue and Lip Ties
- Babies may not be able to stimulate milk production through vigorous nursing, leading to low milk supply
- Painful nursing/early weaning because child gets too frustrated
- Improper tongue mobility may prevent babies from clearing milk from their mouth, causing tooth decay (especially in the front teeth)
- Sleep deprivation for mama and baby (due to the need for frequent feedings)
- Speech difficulties
- Gap between teeth/jaw issues
If some of these issues are present, move on to step 2.
Step 2: Examine the baby
What is the #1 mistake pediatricians and lactation consultants make when diagnosing tongue ties? According to Dr. Kotlow, it’s how they position baby for the exam.
“Correct examination of infants requires the infant be placed on the examiners lap with the infant’s head facing the same direction as the person evaluating the infant and the infant’s feet facing away from them. Just looking at the frenum in the mother’s lap will most likely lead to an incorrect or missed diagnosis.” (Source: Tongue-Tie Fact Sheet provided by Dr. Kotlow)
Now that you know how to position baby, here’s how to check for a tie:
Look at the tongue
Here is a step-by-step exam guide from lactation consultant Catherine Genna.
Though anterior ties (at the front of the mouth) are pretty straightforward, posterior ties may be a bit tricky to identify. Here’s a video in which Dr. Kotlow demonstrates how to get a sneaky posterior tie to reveal itself:
Look at the lip
See that bulbous section in this baby’s lip? ↓
It’s called a lip callus, and it forms when babies can’t flange their lip out properly when nursing. Here’s what a latch should look like:
When the lip is not able to flange or “flip out” properly – as is the case with a lip tie – a friction-induced callus can form. Is baby free from a lip tie if you don’t discover a callus? Not necessarily, but if you find one chances are pretty good a tie is present.
Now let’s look for the source of many nursing problems – including the lip callus – a maxillary tie (aka lip tie). Once you lift the lip, look for a band of tissue that connects the lip to the gum area. If the frenulum (aka the band of tissue) is tight, a lip tie is likely.
Some of the complications associated with a lip tie are:
- restricted function which leads to discomfort while nursing
- gassiness/reflux/colic due to an improper seal that causes baby to swallow excess air
- tooth decay
Tooth decay occurs because baby may not be able to clear their mouth properly, causing pockets of milk to collect near the upper lip. As the top four teeth come in the milk may rest on them and cause decay.
Check baby’s sucking pattern
Reach in to your mouth with your thumb and feel the roof of your mouth. Toward the back you’ll notice a spot where the hard palate meets the soft palate. Now, using your index finger find this same spot in your baby’s mouth. If you feel compression along the entire length of your finger – like a gentle massage – this is good function.
If most of the compression is at the front of the mouth, this is an indication that your baby is actually grabbing the nipple to hold on instead of compressing the whole breast. This kind of latch often results in discomfort and poor milk stimulation.
Step 3: Confirm Your Diagnosis & Explore Treatment Options
In this post I share how to connect with Dr. Kotlow, who is the leading expert on tongue/lip ties in the United States. He doesn’t diagnose via email, but if you send him a photo of your child’s mouth along with any symptoms you’ve noticed, he’ll let you know for FREE if the photo/symptoms are suggestive of a tie. I also discuss different treatment options and link to providers around the country.
Also, here’s an article on post-treatment care.
A quick personal note . . .
I recently learned that I have the MTHFR genetic mutation, which researcher Dr. Ben Lynch believes may be one of the causes of tongue and lip ties. (source) According to some estimates, about 50% of the U.S. population has at least one form of the mutation. If you’d like to learn more on this subject, I’ve put together a beginner’s guide to MTHFR here, and a FAQ page here.
Questions, insights, doctor recommendations?
Please share them in the comments!
Tongue Tie Fact Sheet by Dr. Lawrence Kotlow
Congenital Tongue-Tie & Its Impact On Breastfeeding
Photo credits: Diathesis (on Flickr), Blausen.com staff. “Blausen gallery 2014“. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762.
Read My Comment Policy
I’m pretty sure my first 2 kids were tongue tied. I had all the symptoms listed. It was so bad that I pumped and bottle feed as my oldest refused to nurse after a few days.
My second had the same issues as did I and we suffered through it for several months till she refused to nurse and I turned again to the pump.
She has speech issues. Could this be causing it? Or at least affecting it?
She is 3 now, can a tie be fixed this late?
I have 2 more kiddos and we all had a month of hell nursing starting off but thankfully things got better and I was able to nurse them normally.
It’s sad but I’ve asked the doctors to check them for ties and they alway look at me like I’m crazy and say they are perfectly normal. :/ (I’d like them have the nipples of fire and death for a while and see how normal that is)
Fire and death sounds about right.
Many healthcare professionals still don’t know about posterior tongue-ties and even less how to clip them. The good news is, if your 3 year old is indeed tongue tied, it can totally be corrected. Try and find a professional in your area who will know how to diagnose and treat it. 🙂
Emily, I am so sorry for what you went through! Yes, tongue ties can sometimes be a source of speech problems. You might want to email Dr. Kotlow to get his opinion on your little ones – he may even be able to suggest a provider near you.
How do I email her. My email address is [email protected]
You can reach out to Dr. Kotlow here: https://kiddsteeth.com/breastfeeding.php
Emily, it can totally be corrected and the sooner the better. I grew up with tongue tie and it was not corrected until I was 18. My mom was a trooper for 6 months breastfeeding my twin and pumping for me! My tongue tie was not diagnosed until I was 15. Teachers were always trying to put me in special ed because of the way I spoke when they first met me. They couldn’t though, because I didn’t qualify…… I guess I just sounded like I did. I had trouble being understood and always felt like I wasn’t smart because of it. I didn’t want to talk to people. My tongue is still deformed from developing with a severe tie but at least I have not trouble speaking now. If you believe your child is tongue tied definitely consult an authority on the subject (which doesn’t mean any old doctor) and see what your options are.
So are there certain sounds in particular that are a problem. I have a foster daughter who is 15. Her speach sounds like that of a younger child, maybe like she has a mental handi-cap. I had never thought of being tong tied as being the possible cause.
Referring to Fire and Death: my twin ate a month old and they’re ate times throughout the day when they are NOT nursing that my nipple or the area around it feels like a dull constant pain almost like it’s on fire. Could this be what you are taking about? We have other symptoms listed above but not all of them. And my three of kids have all had delayed speech. I’m new to learning about tounge /lip ties and wondering if this is our problem!
The pain you are describing could be thrush which needs treatment, both for you and your babies.
I experience the same thing!! And part of my nipple will turn white for a bit of time also. The lactation consultant suggested it could be some synfrom, can’t remember the name of it at all, but basically the symptom can be described as similar to when your feet fall asleep and start to regain bloood flow…that tingly/burning feeling. I knew it wasn’t thrush, and it had to be something else. So, if could be this syndrome? or she said it could be due to imporper latch and it cutting off blood flow to that part of the nipple. Either way, we have FINALLY been properly diagnosed with a severe upper lip tie as well as a tongue tie. I spoke to the pediatrician and a couple Lc’s, all thought maybe our issues could be corrected with a different hold. It’s rather infuriating that pediatricians and lactation consultants are not more properly trained. My daughter failed to gain her first month. I had to pump after nursing to build a proper supply for her.
I wish you all the best and for true relief and extinguishment of your nipple fire ?!
Hi Emily, I’m interested to know if you were able to resolve your toddlers tongue tie. I had all these issues with my now 4.5 year old. I had a lactation consultant tell me he was tongue tied but all the doctors I checked with scoffed and being an anxious first time mother I didn’t fix it. He has extreme pickiness with food and textures and I just know it’s connected to the tongue tie, but haven’t been able to get any support from doctors across three continents. We travel a lot. Now we ar the US abs possibly the best place too address it.
You can check Dr. Palmer contacts – http://www.brianpalmerdds.com/about.htm
He is a globally known author of frenulum-related presentations, so I’d give it a try.
Has anyone noticed if their kids with tongue ties can roll their Rs?
I’m a speech therapist and a new mom. It’s extremely likely that a tongue tie would prevent a child from rolling an R. But there are lots of ways to make an R… so have a speech therapist check her tongue 🙂
My child has had speech therapy in school for 13 years. A recent dental visit with a new dental hygienist revealed a severe tongue tie. Are speech therapists aware of this issue? Do they look for this problem? Thank you
I have a tongue tie that wasn’t diagnosed until I was around 5. They tried to make me repeat kindergarten because they thought I was dumb. I couldn’t pronounce my Rs or Ls, they became Ws. At that late in the game and it wasn’t a severe tongue tie, my mom chose speech therapy. You wouldn’t know I had speech therapy for several years now unless I am half asleep or inebriated.
I am a FTM of a week old little girl and we are having breastfeeding issues. I’m going to be making the rounds to find out if she is tongue tied also and to get it fixed.
Justyna Urda Zimmer
I had the same problem. Hated nursing be a use of it. Both had tongue tie. Now I am finding out that one has lip tie . He is 9 months . We have been at Ent and I don’t get it why they didn’t see it then . Now after 8 months we have to go again.
I just read this and cried. It’s the first time I feel validated as I’m almost sure this is what’s happening to my baby. 8 months old, she struggles with feeding, can’t take a bottle/dummy (paci), feeds every hour and a half all night every night. People said that it was because I was too attached to my baby so I created bad habits. I’ve been ignored and labelled a hysterical new mum, who just needs to ‘sleep train’ my baby.
Now I’ve just got to go and make someone listen to me finally!
Thank you for an eye opening post.
This confirmed for me what I already believed to be true for my daughter. Her lip tie extends all the way to her Papilla. I am in Washington State, is there a doctor in my area that can help is? When she was born she had very loud clicking, she still spits up a lot. I only wish I would have found out earlier.
I am in your same situation! My daughter has a lip tie that also goes to her papilla touching her two front teeth. She is 21 months. I wish these health practitioners were more informed 🙁 Wondering if there is a doctor in the Houston/Austin/Dallas/San Antonio area of Texas that would do the procedure under local anesthetic?
There are only a few drs in Houston that will properly diagnose and clip a lip/tongue tie. Unfortunately I don’t remember their names, however you can contact BABE and they will give them to you. I don’t believe they use anesthesia though, so you might ask about it when calling.
Dr. Stacy Cole in Ft Worth is fabulous! http://www.svcole.com
Dr. Hugh Oser in Keller (North Ft Worth area) is great too.
I have been working with a Lactation Consultant with the Milc group here in San Antonio who referred my daughter to the Green Apple Dentistry group in Austin for her posterior tongue tie. We have an appt to see them on Tuesday, so cannot speak from experience. They apparently use a laser to resolve the tongue tie that requires no general anesthesia.
Who is your lactation consultant?
Justyna Urda Zimmer
I heard that prosecute is so quick and painless like tongue tie. No need to put u out . 🙂
Bobby Ghaheri MD
Dr Maryann Ohara in Seattle is great. I’m in Portland. Both of my daughters have this I treat about 600 babies/year so contact me if you have questions.
Bobby Ghaheri MD
Hello Dr . Ghaheri,
I am located in new Jersey (too far from you unfortunately) but I was wondering if I could speak to you and show a picture of my son’s upper lip. I believe he has a lip tie but not too severe. I have been exclusively breastfeeding for 3 months and he just hit 10 lbs. I hope to hear from you soon.
Hi Ashley, I’m not sure whether Dr. Ghareri will see your comment, but you can contact him here: http://wrinklewhisperer.squarespace.com/social-media-policy/
A link to email him is also here:
He’s in the PNW!
Amanda @ Mommypotamus Support
Krystal, I am so sorry for what you went through! You might want to email Dr. Kotlow to get his opinion on your little one – he may even be able to suggest a provider near you.
There is one in Portland and one in Seattle that specializes in it. I am looking into it as well because my 6 moth old has a severe lip tie and is tongue ties as well and my ped says she is fine…well at 6 months old im pretty sure she should be more than 12lbs!
This is the one in Portland
Check with Children’s in Tacoma.
Even though I don’t have any children, I read this post with utter interest.. So interesting and really necessary knowledge to have. I’m lucky to read all those posts before having a baby.. I’m so sure that I know more about babies from this blog than from anywhere else (how to swaddle for example, this one was also very interesting and good thing to know..i mean, who would have guessed). Thanks for educating us:)
My kiddos are almost 2 and 5 and after reading this, it seems like they had this. Should I still be worried about getting a tie fixed?
Thank you for posting this, I will be forwarding it to all my preggo friends…
According to Dr. Kotlow, NYU and a few other institutions are looking at the effect of tongue ties in adults. There may be some correlation between a tight frenulum and TMJ, plus other issues. It may be worthwhile to send him an email and discuss your concerns.
I am a 54 year old woman who is tongue tied and never had it fixed. My speech is perfect, no problems with any letters or sounds, in fact I have been told many times how articulate I am when I speak. The only thing I can’t do is stick out my tongue as far as most people. Just wanted to let the mothers know that it doesn’t always need to be clipped.
I am one of those fortunate mamas whose nursing relationship was saved by you and Dr. Kotlow! After so much pain and so many tears (on my end…. baby was gassy but happy) it was such a relief to read your initial post and realize that I would be able to continue breastfeeding with no pain. We took him to Albany when he was 4 months (so lucky to live only 3 hours away) and we have an awesome nursing relationship now at 7 months. Two lactation consultants and the pediatrician did not have this issue on their radars at all. So THANK YOU THANK YOU THANK YOU. <3
My question is, when we are ready for the next one, how soon can you identify and correct a lip or tongue tie in a newborn? Is it obvious immediately? How old does the baby need to be for the procedure? I'm assuming I'll need to plow through at least a few weeks of painful feeding… but it would be so much easier this time around, knowing that it won't be 4 months of the same.
Andrea, this makes me SO HAPPY to read! I’m glad you found my previous posts helpful. To answer your question, if you know what to look for you can often identify a tie immediately. I knew my son Levi was tied within the first few hours after he was born. The procedure can be done anytime depending on your ability to travel to the doctor/dentist. We had my son’s revision done when he was two weeks old.
Andrea, was it painful for your baby at 4 months? Did they use laser? How was the revovery?
I had started a local breastfeeding support group when my son was 9 months old (he’s 2 now) and this is one of the biggest issues I kept hearing about. So out of curiosity and so I could help other moms spot it, I inspected my son and LO an behold he had a stage 4 liptie! No wonder we had such issues nursing- if it wasnt for my determination to breastfeed and teach him how to suck properly using a pacifier to hold his tongue down we would have never succeeded. I took him to Dr. James Jesse in Loma Linda, CA while we were on vacation and had it lasered at 22 months just to prevent future dentistry issues (he has a huge gap in his front teeth from it) Dr. James is one of the few that will do it and do it properly (local anesthetic and not general). He’s amazing and it was so not a big deal during and after! I just held my son on my lap while the assistants and my mother helped hold him still- my son was more agitated about being held that tightly but it was so fast the tears only lasted a few minutes. We were in and out in 10 minutes 🙂 Thank you for spreading the word on this devastating condition that so many moms are unknowingly heartbroken from not being able to successfully breastfeed. Now I just wish there were more dentists that can do this- our local dentist said there wasn’t anything he could do until my son was older, because they want to put them totally under. I’m lucky I have family in California that I was able to get this done- I’m currently pregnant again and told Dr. James if this one had the same issue I’m road tripping out there asap (I’m in Colorado). He said his youngest patient was 2 days old! Good for that mama 🙂
Hi! Do they do laser with local for tongue and lip tie? My daughter is 13 months and I don’t want to put her under..
My grandbaby is 2 weeks old, today and just had posterior and lip tie revision done by Dr Cole in Ft Worth. —and latched with out a nipple shield immediately– He didn’t latch at all until he was 5 days old–and that was finally -after CST.
I am sure they don’t put them ‘under’.
No kids yet, but I’m currently training to be a birth doula and lactation consultant, and I will most definitely implement this information into my practice!
My 21 month old daughter has a lip tie that also goes to her papilla touching her two front teeth. I wish these health practitioners were more informed 🙁 Wondering if there is a doctor in the Houston/Austin/Dallas/San Antonio area of Texas that would do the procedure under local anesthetic?
Thanks for this great summary! We also went to Dr. Kotlow for our second child’s ULT and posterior tongue tie. I’m really glad that we did, and I see SO many missed diagnoses for ties.
This article is excellent. I am a doula that offers lactation support and I am a mom who has 2 children that need lip and tongue ties corrected by Dr. Kotlow a year ago.
Liz Pevytoe RN IBCLC (@askthelc)
What about those who cannot afford to go to NY to see Dr. Kotlow? Even if he does a free “email consult” will they be able to afford to go to NY to have the laser revision? Seems like it would make more sense to refer them to a LOCAL IBCLC who can assess and refer to a qualified physician then assist them through the lengthy recovery process. There are IBCLC’s like myself who have been trained by Kotlow and are very competent.
Mom’s can find a local IBCLC on ILCA.org
Hi Liz, in Step 3 I link to a post which lists the carrier providers I am aware of 🙂
Hello my 2 month old has all the systems I was spoon feeding her at one point. Please tell me are there any referrals in Ohio?
It might be helpful to add that a cleft in the tongue can be a sign of tongue tie. (Speaking from experience.)
Thanks for this. As a mom who struggled with a tongue and lip tied baby, I can relate. We also went to Dr. Jesse. Our story is here: http://www.staciebingham.com/2/post/2013/06/hes-just-a-bad-nurser-part-1.html It is my understanding that only doctors can diagnose, though — not even IBCLCs diagnose ties. Thanks for spreading awareness. Here is an info sheet that parents and professionals may find useful — feel free to share, it is for public use created by me and others in ATTE (www.tongue-tie-education.com). <3
Hi, I found your story quite interesting. I too had my 3 month old go through a tongue tie revision and am now thinking he needs a lip tie revision too. He’s still having trouble latching properly and there is a clicking sound when he nurses. I am hesitant about having that procedure done because I don’t know if it will resolve the problem. Have you noticed any negative effects after getting his lip tie revised?
I neglected to post the link to the info handout: http://www.tongue-tie-education.com/uploads/2/9/9/0/2990748/atte_quickguide_2013.pdf
My 7 month old doesn’t flange and has the bulbous upper lip but feeds ok. Will this be a problem later in life? Speech?
I had read your previous post and thought my daughter probably had a lip tie, although the only symptoms were that she spit up a bit and made a clicking noise sometimes while she ate, and night waking. Other than that we were getting along fine. I had an appointment set up with a ped. dentist who does laser correction, but a few days before we were at her well child check and the pediatrician took a look and said it looked fine. He was worried the pediatric dentists were performing unnecessary procedures, so I cancelled the appointment, not wanting her to have to go through the pain if it was unnecessary. She is 9 months now, growing very well but still not sleeping great (waking once per night), so I’m not sure if I should have gone ahead with it. It’s so hard to know!
As far as issues later, there is a list of potential problems that may arise (and then again, they may not). Speech issues, delayed eating of solids or gagging on solids, GERD or reflux, apnea, snoring, and many others. The link I shared above has a thorough list of evidence-based symptoms that could come with ties: http://www.tongue-tie-education.com/uploads/2/9/9/0/2990748/atte_quickguide_2013.pdf
I have a posterior tongue tie myself, which I plan to have Dr. Jesse treat, and I get debilitating tension headaches from my neck; I also clench and grind my teeth and have mandibular tori (bony growths) — which can all be associated with ties. I have had a handful of friends with regular migraines who, upon inspection, also have PTTs — it’s a good thing to check out if you have migraine or headache issues with no seeming cause.
I also suspect I may have had a tongue / lip tie as an infant based on my mom’s experience with me and was wondering if it resolved on it’s own / as I grew or if I still have it. I am in my 5th of 6 years of treatment to correct TMJ issues. How did you and your friends determine you did as adults??
It is wise to note that any claims offered to a lip/posterior tongue affecting breastfeeding have NO empirical evidence and only “borrow” the incredible research that has been completed regarding an Anterior tongue tie. In our clinic in Toronto we see babies daily who have had the procedures done (sometimes more than once) with little to no improvement in pain, latching, supply, etc. A word to wisdom to all practitioners…like many tools in lactation, this is not a silver bullet to fix all problems. Please see the most recent issue of Breastfeeding Medicine for some good information on this by a leading pioneer in the field of Lactation.
Thanks for your comments, Shelly. I don’t know that I would say there is no empirical evidence, though. Dr. Kotlow keeps before/after records on his patients and there seems to be a strong indication that it does benefit nursing pairs in many cases.
Bobby Ghaheri, MD
Actually Shelly, there are good studies that have shown improvement, most recently Cliff O’Callahan’s study of almost 300 kids who showed significant improvement.
As an example of why this argument shouldn’t dissuade moms from seeking help, there are NO empirical studies saying that jumping out of an airplane without a parachute can be harmful to your health. So should we jump just because data aren’t present?
I think many lactation consultants and providers are threatened by the concept that others can actually fix a problem. And while I agree that this procedure is not a silver bullet, I think you’re doing a disservice to moms and babies everywhere when you say these sorts of things.
Many babies also need bodywork and chiropractic as well as proper CST to be able to allow their jaws to become unrestricted and be able to nurse well. The tongue tie release is simply the first step of the process!
“I think many lactation consultants and providers are threatened by the concept that others can actually fix a problem.”
Seriously, Dr. Ghaheri!? You really must not have knowledge concerning what goes on for many birthing center unit. IBCLC’s fight hard for our mamas and babies, but on many birthing/postpartum units we practically have a gag order where lip and tongue tie are concerned. Perhaps you should be addressing the pediatricians… AKA the real source of the problem.
Shelly, I see Dr. Bobby addressed your comment, and likely more thoroughly. Your comment was brought to my attention. I, too, was going to cite the O’Callahan article from last year. If my memory serves me, he treated 299 babies with tongue tie, in an office setting with topical anesthesia (which he no longer uses). 85% had PTT and the remaining 15% had ATT. Procedure was done in an office setting and there was statistically significant improvement after the procedure. Can’t remember the exact measures, but I think it might have been an increase in breastfeeding and decrease in pain? I’ve read so many studies I get mixed up of what studies used which measures, but I’m sure you will find the article very interesting. Perhaps your physicians are not fully releasing the PTT????? Just a thought. Thanks for your interest in helping moms and babies. It is my goal that the emotional distress (and physical exhaustion) I went through for 2 months with my older daughter will be minimized in the future.
Thanks for sharing this information! Are you part of the Tongue Tie Babies Support group on Facebook? I don’t remember seeing their group linked in your blog, but if you wouldn’t mind sharing it so other moms can get help wherever they may be, that would be really cool 🙂
I am – will add the link now!
Thank you for sharing more of your insightful research, Heather! I would love to be your neighbor, even if the closest is a mile away. Question for you: are there reasons to correct lip tie if you are past breastfeeding? My daughter is almost 4 and nursed for 2 1/2 years. I now see those symptoms were present and also some speech obstacles, which I think she will overcome. If you have any thoughts, I’d value them!
Hi Virginia! According to Dr. Kotlow, NYU and a few other institutions are looking at the effect of tongue ties in adults. There may be some correlation between a tight frenulum and TMJ, plus other issues. It may be worthwhile to send him an email and discuss your concerns.
I realized, through your posts, that not only did my youngest have lip/tongue tie, but so did my oldest and my husband! I nursed for 27 months total before realizing this and it made me want to cry in relief that I was NOT CRAZY!
We had our youngest son’s tongue tie corrected in December of last year and then his lip tie corrected yesterday….the issue I see now is that he has nursed improperly for a year! How can I correct his latch?
Also, for anyone in the phoenix area – dr Agarwal of agave pediatrics or dr Briggs are both highly recommended. I personally saw the former and was very impressed with the care and the method.
Where is Dr Briggs located?
Free Share Get
I do accept all of the concepts you could have provided on your publish. They’re persuading and definately will undoubtedly work. Still, the particular blogposts are way too brief for freshies. May perhaps you want lengthen all of them somewhat by the next occasion? Many thanks for the actual write-up.
This is so helpful. Can anyone recommend a doctor in the Cincinnati or Louisville areas?
Bobby Ghaheri MD
Greg Notestine DDS in Dayton is one of the best in the country.
I second dr. Notestine. I live in Louisville and have taken both my boys to Dr. N. There is no one good in Louisville.
thank you for this wonderful article! My 5 1/2 month old son and I have many of the symptoms listed above. Can you tell me if it is normal for an EBF 5 1/2 month old to still be nursing every 2 hours? the evening peak Western feed every hour. At bedtime he will go for about 4 sometimes 5 hours without a feed. But during the day its every two hours, in the evening every hour. I am wondering if a tongue tied could be the cause for such frequent nursing. Or at his age should be nursing sessions be further apart?
Emily, both of my older children had tongue/lip ties that were not corrected by five months so I honestly can’t say what’s considered normal. I do know that my son’s feedings increased in frequency as he grew due to his increased need for calories and his inefficient latch. By 8 months he was nursing every two hours at night again despite sleeping stretches of 5 hours prior to that. For us, having the tie corrected did increase the length of time between nursing sessions. Long story short, I would check with a lactation consultant on what’s normal. If something seems off it might be worth exploring the possibility that a tongue/lip tie is present. (And depending on what symptoms you’re having it might be worth looking into anyway!)
Bobby Ghaheri MD
Greg Notestine DDS in Dayton is one of the best in the country.
Hi, is there anyone recommended near Bethlehem Pennsylvania? Thank you.
My 8 month old actually just had his lip and tongue tie revision done last week. I noticed in a previous posted that Micah was the same age when you had his done. Just wondering if he ended up having any residual feeding/swallowing/speech issues because of the ties. Did you seek out any therapy for him? I’d love to know how it worked out for your little one! Thank you!
Hi Kate, after his procedure he FINALLY started sleeping better. It was an amazing difference! He already had some pretty bad habits with his latch that I was never fully able to re-train, but things did improve and he continued nursing until he was 2+ with no problems. We did cranio-sacral therapy following the procedure and found it helpful. No speech issues 🙂
Thanks for posting this! My son (now 14 months) had some of these symptoms as an infant, while I had zero symptoms. He now has no trouble nursing, however, he has a gap between his two front teeth. Are gaps like this normal in children? When should you be concerned? Thank you!
Hi Carissa! You might want to join the Tongue Tie Support Group linked to at the bottom of the post. There are a lot of mamas in there that can direct you to good info on your questions.
never thought to look for this with either of my two kids even though i did have slight difficulties nursing. fortunately i was blessed with a more than ample milk supply, so even though i occasionally had sore nipples, i didn’t notice any of the other issues, and was able to nurse both children past the age of 1. Just now checked my now 3.5yo and 2 year old and both of them have class III lip ties. my 2yo actually still has a visible lip callus (probably from sippy cups at this point). i was willing to nurse them both much longer than i actually did, but stopped because of what seemed to be lack of interest on their part. i imagine now that my diminishing supply combined with their poor latches was the more likely cause. here’s hoping to better results with baby#3, now on the way!
Love this article. I so appreciate the time it takes to write these articles and they are so very helpful. I am certain my daughter had this and wish I’d known then. She just had her son 4 months ago and he also has the lip-tie. She had it repaired last week.
Thank you so much for this information. After I read this I asked my sister to check her 1 week old son for a tie because he was having so many issues eating and was gulping air with every drink. He has a tie and they are on their way now to have it taken care of. So hoping that this will help the little fella, and she can get back to breast feeding-he hated the breast because he couldn’t get what he needed and they have been on formula since 4 days old- He will be 2 weeks tomorrow and I am so happy they are getting it fixed. So again Thank you Thank you for your post!
Wow, Heather, I am SO HAPPY to hear that! I hope it makes a big difference.
I’m a little concerned about the lip callus as a sign of a tie. So many absolutely normal babies get these in the first two months. Some get one or two that fall off naturally, just because they are using their lips so frequently. All my five had lip calluses, and I’ve had great nursing (almost ideal) experiences with each.
Thank you so much for posting this. I’d like to share my personal story since yours and others have helped me so much.
My daughter is now 13.5 months old. We just had her severe lip tie and mild tongue diagnosed and corrected via laser yesterday. Yesterday, after 13.5 months of inconsistent latch, very little sleep, discomfort nursing, and resistance to any non-finger food.
I was told by her pediatrician at one month old that my concerns about a tongue tie were unfounded. Even though dad and grandpa have them, even though she has a shallow latch, even though she vomits after feeding.
I got a second opinion from a periatrician at a different practice and got the same answer. So i countinued nursing through it all. It was usually uncomfortable and occasionally painful. I thought the all-night feedings was just reverse cycling. I began to read more due to a recent increase in biting (serious, clamp down and refuse to open up kind of biting) and was reminded of my early concern by your post. I knew once I saw the images that the lip tie was present. I searched for and made an appointment with a pediatic dentist the next day.
I am pleased with the work of Dr. Tanios-Rafla in East Brunswick, NJ. She has a nursing room in her office and I found the staff to be professional. I was hesitant because I read of a previous sanction (related basically to allowing assistants to adjust braces) but after reading the report and talking to my husband, we agreed that everyone makes mistakes and if we felt uncomfortable we could leave. I briefly worked for a dentist in high school and knew to look closely for cleanliness, etc. I am so glad we gave her a chance. She even waited until after we nursed to talk with us and get a high five so my daughter wouldn’t be afraid to come back. I have never had a doctor take time like that.
Again, thank you so much. I hope this information helps to inform more parents to trust their instincts and understand how uninformed pediatricians can be about these issues. I only wish I went sooner because the procedure was more difficult due to the more developed, thicker muscle. I noticed an immediate change in the appearance of her lips and her latch.
My son was diagnosed with lip tie and posterior tongue tie after we’d been working with a lactation consultant for 5 weeks, and she ran out of other suggestions. We had him treated at six weeks old (the soonest he could be seen) by Dr. Branton Richter, a pediatric dental specialist in Utah. Dr. Richter was trained by Dr. Kotlow and uses a laser for treatment. Dr. Richter was great and definitely knows what he’s doing. We were finally able to breastfeed exclusively (with no pumping or SNS) when my son was about two months old. It was a hard decision to have the procedure done when there were no guarantees that it would help, but he’s six months old now and we’re still nursing, which seemed an impossible goal in the beginning. Good luck!
Wow, you worked with an LC for 5 weeks? That’s some determination! So glad you are still going strong 🙂
Thank you thank you thank you. I was googling my six-week-old daughter’s weird sleep patterns (at least once a night she’ll go for four or five hours straight nursing and seem totally unsatisfied) and came across this blog post. Even though her weight gain is great, we have SO many of the symptoms here–pain (me) and popping off the breast and clicking sounds and gas (her!). I asked my midwives about it at our postpartum visit today and they confirmed that she has both a lip and posterior tongue tie. Since we’re in NY state, they work closely with Dr. Kotlow and gave us his card. I can’t wait to call and make an appointment and get me and my baby some relief!
I just started research on this due to my 5 week old. I am pretty sure he has stage 4 lip tie and a tongue tie. Then I checked my 3 yr old And I think she has both as well she also has speech issues so I am anxious to get both of them in to see if I am correct. I plan on talking to our pediatrician… but just in case they aren’t familiar with this does anyone know of a Dr who is around Boise Idaho? Thank you so much for all this information.
Did you find a dentist in Boise to correct the lip tie? After major nursing issues with all of my kids, I’m just discovering that it looks like all three have lip ties. The symptoms line up exactly and no pediatrician, dentist, lactation consultant, nurse, or occupational therapist (I counted 18 specialists I’ve seen for BF issues over the years) has ever picked it up.
did you find someone in Boise to help with this? My 1 month old is having same problems.
I’m also curious if you found someone in boise.
Thank you so much for getting out info about tongue ties. I am now just finding out my 8 yr old has a posterior tongue tie. I could just cry for all the nights he’d wake up screaming and be inconsolable and this went on for 2 yrs. The stress of no sleep for 2 yrs, severe reflux, my own PPD, and other health problems lead us to have him as an only child. To add insult to injury, we had a lactation consultant come and proclaim that there was no tongue tie. Oh, if only we knew! More mothers need to read your opening remarks.
Heather, thank you so much for these wonderfully informative posts on tongue and lip ties! Long story short, I thought my newborn daughter was having trouble with my “overactive letdown” (shallow latch, popping on and off, choking, gagging, refux, among other problems) when instead she is struggling due to a posterior tongue and a lip tie! Have an exam and (if I’m right) a laser revison with Dr Notestine in Dayton scheduled next week. *Praying this is the answer to our breastfeeding struggles!* Never would have proactively researched and questioned without these posts!!! I feel like there is hope for our breastfeeding relationship now. I found this blog post and a WAPF article- could an awesome Mommypotamus-style post be in order on the Dr Price-narrow palate-tongue tie- dietary- environmental toxins connection? Found it very interesting, and you have a way with condensing info and making it totally understandable. Just a suggestion from an avid follower 🙂 Blessings!
I’m so glad I found this!!! My 4 month old and I have both been miserable since she was born and now I think I found the answer! Does anyone know of a doctor in Wisconsin??
Hi kathy, I recently figured out my 11 month old has a lip tie causing her upper front teeth to come in with quite a space between! I will be taking her to a pediatric dentist clinic called Smiles In Motion, which is in chippewa falls wisconsin. You could look them up online. They are very friendly and helpful and can do the Lazer procedure to reverse tongue and lip ties! We are very excited to have this done, just wish we had it done a lot earlier as I had lots of trouble and difficulty nursing her!
Hi — Just wanted to chime in, in case anybody else is looking in Wisconsin. There are two clinics in Hudson, St. Croix Kidds & LaPetite Dentistry.
Also, both places take BadgerCare with prior authorization.
I want to cry (happy tears) after finding this blog and article. I just took my LO to his third weight check in because he hasn’t been gaining fast enough. After his 8 week appt, they suggested I supplement with formula. After going from bottle to breast he was having a rough time, so we did bottle only. Then my milk supply drastically started to dry up and now he’s formula only. When we were still bf, he was nursing for over an hour at a time and still not gaining, in addition to having 90% of the other symptoms listed above. I feel so angry that no one ever checked for this – we could still be nursing right now *and* he would be gaining the necessary weight! Thank you SO much for putting this information out there to hopefully help other mamas having issues – hopefully more doctors will start checking for/diagnosing ties!
Hi all. This information is so great but I just thought I would share my experience. I was thrilled to discover this and made an appointment with Dr. Margolis near Chicago who charges $1200. My daughter was, gagging, choking air, refluxing like crazy and had extreme pain with a lot of gas. She screamed like bees were stinging her constantly etc. etc. etc. My pediatrician finally had me try Nutramigen for babies with cow’s milk allergy and all of her problems disappeared the same day and have not come back in over a week. We still may do the lip tie later for dental or speech reasons but bless her heart this is a completely different child.
Hi all. This information is great but I just had to share my story briefly. My baby suffered miserably from birth until just over a week ago.(4-1/2 months). She gagged and choked during feedings and refluxed like crazy. She screamed like bees were stinging her constantly, had a lot of gas and was in severe pain. I was excited to find this information and booked an appointment with Dr Margolis near Chicago to release her lip tie. He charges $1200. THEN…the pediatrician had us try Nutramigen for babies with cows milk allergies. Her problems disappeared the same day and have been gone for over a week!! She is a completely different child! We may end up lasering the lip tie for dental or speech reasons later but it turned out that a milk allergy was the immediate problem. Best to everyone.
Many times food allergies & ties go hand in hand– some thing one genetic mutation affects both of them. Both my kids have ties, both have food allergies. Celiac disease is commonly associated w ties as well!
Oops. I thought my first post disappeared. Now I see it twice. Sorry about that…
Wow, I’m pretty sure I have a tongue tie and a lip tie- I wonder what my mother went through to breast feed me! I never even knew it was a problem…
I had heard of a tongue tie but not a lip tie! My 4 mon old has been diagnosed with sagittal craniosynostosis and I heard that tongue/lip ties were common with his diagnosis. Sure enough, he has a pretty severe lip tie from what I can determine : / He nurses, but struggles staying latched on. I don’t experience much pain but he does seem to get extra gassy and falls asleep a lot while nursing. I’m also concerned with teeth decay and placement so the sooner this gets treated the better! I live near Las Vegas. Are there any Drs you can refer me to?
Help please! I am in desperate need of a dental surgeon or Dr. that will take our sons Severe posterior tongue as well as lip tie seriously! We have received a class 4 diagnosis on both from an orofacial myofunctional therapist but when we visited the dental surgeon he said he only saw a lip tie not tongue (he didn’t look at him from the correct position!), and he scheduled surgery for 6 weeks from now, b/c that’s when he gets a surgery block at the hospital. We have every single symptom…we have been to drs., lactation consultants, a breast feeding specialist Pediatrician, and an ENT, and gotten tubes in ears all just trying to figure this out….we live in Central Nebraska but will drive for help of course! Our son is now 8 mo. old and, although still somewhat chubby, has gone from the 75% for weight down to the 16%. Our family doc said that it’s just normal at this age b/c they get easily distracted while nursing…..I tried to hold back the mama bear inside. Does anyone know of someone at least in the Midwest to help us? We would happily drive to any city within 8hrs., Maybe even farther. I wish NY was closer. Thank you for any help! It’s getting very hard to keep up the pumping required to keep up my supply and our little guy can’t take a bottle without gagging and throwing up often…we desperately want to keep nursing.
Fred Margolis near chicago
Bobby Ghaheri MD
You have several options but you’ll need to drive.
1) Fitzik dentistry in Wichita Kansas. http://fetzikdentistry.com/
2) Mindy Hochgesang in Bettendorf Iowa. [email protected] – she’s very open to emails.
You can email me if you need more direction – [email protected]
Thank you Dr.Ghaheri! We will look into those immediately.
Do you know if there is anyone near Springfield, IL? Preferably one that uses lasers. Thank you.
Did you find a doctor in Springfield, Il that uses a laser? I am also looking for one. Thanks!
I believe I just discovered both my children – 3yo and 9mo – have lip ties, which explains SO much of my troubles over the past 3 years. I know Dr. Kotlow is in Albany, but can anyone recommend a doctor who uses lasers in the NYC metro area? We live in Brooklyn, so don’t have a car, and I’ve found the following names in my research:
Scott Siegel in Long Island
Gina Tanios-Rafla in New Jersey
Leonard Kundel in Connecticut
Scott Siegel is excellent and close to you. Lenny is also excellent. I’ve never heard of Gina.
I am pretty sure my son has a mxillary lip tie. He is 10 weeks and has completely fallen off the growth curve. Do you know of any good docs in the gulf coast area (anywhere from New Orleans to south Florida?
Thank you!! I was about to give up BF cuz my baby is 4 weeks and my nipples still hurt and I can’t figure out how to get him to latch any better. I have had to supplement with formula cuz his weight gain was so low. My LC noticed that his top lip wasn’t popped up like it should be during a feeding just yesterday and she looked and said she thought it was lip tie. My ped looked at me like I was crazy and thought my concern was painful nipples vs lip tie cuz he said it was fine. I can handle the painful latching/feeding but he doesn’t stay awake for more than 2 min. He doesn’t feed long enough and needs to eat every hr or less. I have a 4 yr old and a husband who works out of town and that BF schedule is not manageable. I’m calling a dentist that someone recommended tomorrow in hopes to get this fixed and have a happy ever after also. I wasn’t convinced on calling until I read your article though so thank you so much for sharing!!
Thank you for the info like you said we mom can tell if something wrong I think my one week old has lip tie and or tounge tie. Can any one recommend a doc In California I Live in Los Angeles
James Jesse DDS in San Bernadino is your best option for a laser procedure. I’m not aware of anyone in LA who does a good job.
I just had my son go see Dr. James Jesse for an upper lip frenectomy. He was fantastic! I actually flew down to see him. Well worth the trip. It was very quick and painless for my child. They let me be in the room and I held my son’s hand, and everyone made me and my child feel welcome and very comfortable. I highly recommend him!
Oops- I forgot to mention that Dr Jesse uses laser, and I HIGHLY recommend laser instead of clipping.
My son was diagnosed with failure to thrive and admitted to the hospital at 3 months old. He weighed in at 8 pounds and change. It was confusing because he was the happiest baby and never cried, but was skin and bones. He struggled both with breastfeeding and bottle feeding. (Breast milk and formula.) We saw the lactation consultant and went in for weighings. The pediatrician who ordered that he be admitted accused me of neglect, and of purposefully starving my baby. It was the most horrifying day/week of my life.
Once admitted, he was in the hospital for 5 days. During this time they watched me during feedings to “make sure I was actually feeding him.” They ran every test they could think of, and after 5 days–he weighed LESS than when we came in–they said they didn’t know what was wrong with him, but that they needed our room for somebody else and that we had to go home, and they sent me home with my little 3 month old, 8 pound baby. I reluctantly started him on pureed avocado and sweet potato because I didn’t know what else to do to keep him from starving, and he started gaining weight.
Fast forward 4 years. Just got home from the dentist today, where I found out he has a SIGNIFICANT tongue tie. I asked if this could contribute to failure to thrive and she said “Oh if he had failure to thrive this is absolutely why, no question.” She also said there is no reason the doctors and lactation consultants shouldn’t have caught this, especially after almost a WEEK in the hospital and THOUSANDS and THOUSANDS of dollars in hospital bills. Because of my son’s extended bout of failure to thrive, he now has developmental delays that effect his–and our family’s–everyday lives. Language delay has caused communication to be extremely difficult, resulting in all sorts of emotional and social problems for him. Sensory Processing Disorder causes seemingly small irritations to bring his world crashing down, multiple times a day. Frustration abounds. Because NONE of these MANY medical professionals could diagnose a simple tongue tie? Am I wrong to be livid??
No you are right!!
My son and daughter both had mild SPD and my son was heading down a road of withdrawal that would have ended in a diagnosis of RAD (reactive attachment disorder) or ASD. He was sleeping more and more, refusing eye contact with me… at 2 months old, the poor baby thought I was abusing him I’m sure– he aspirated every time he nursed!
I will say that at 3 months we got his tie released, and began therapies, including oral motor, and dry brushing & joint compression, and he began to steadily improve. We did sensory play and I incorporated as much OT into our daily lives (tooth brushing, water play, bean box etc), as guided by friends who are SLTs or have kiddos with SPD.
He is now 2 and is absolutely not on the SPD spectrum. He struggles a tiny bit with chewing meat but that is the only remnant of his tongue tie symptoms. He is very affectionate, trusting, cooperative and verbal. My daughter is also considered “normal.”. We also use essential oils to help them balance out when they get overwhelmed.
All that to say– kids are very resiliant and often improve a LOT. Even though your son is older and has already suffered so much there is so much hope!
How do you find a doctor who knows about lip ties?
We live in an extremely rural area of Arkansas. I have four daughters, none of whom were able to breastfeed. The oldest has apraxia, so I put her inability to latch down to that.
The other three couldn’t latch properly, either, though. A couple of months ago, I was looking up tongue ties (because I’m pre-med and curious!). I saw a picture of an upper lip tie and realized that all four of my children have them. I had always wondered why their little gums looked so funny, but none of their doctors were concerned, so I just thought it was normal.
I’m not sure if I need to have them clipped or not. I gave up trying to nurse the youngest a couple of months ago (I have hormonal issues as well.). The oldest doesn’t seem to be having any issues with her teeth, but the middle two have gaps between their two front teeth, I’m assuming caused by the tie.
The doctors here have never even heard of a lip tie, so they don’t see the potential for a problem. We also don’t have dental coverage, so it’s not like I can just take all four of them in for exams when I don’t know if the particular dentist will even know what I’m talking about. 🙁
There’s no one in Arkansas that I’m aware of, so you may have to travel. Here’s a list of practitioners:
Hello, we live outside of Little Rock Arkansas and after our pediatrician diagnosed our 6 month old with a tongue tie we were then referred to Arkansas Children’s Hospital. We had a lot of the symptoms listed here, reflux, little weight gain, and no sleep being the hardest issues to deal with. On our first visit at ACH they confirmed the tongue tie and it took them 5 minutes to snip it. We saw improvement in her symptoms almost immediately. She still has some trouble gaining weight and now at 18 months she gets choked ALOT.
May I ask who you saw at ACH? Think we need to be evaluated for this!
Thank you so much for your post. i have a somewhat similar question to the person above, do you know of any online submissions of photos I can submit to see just an opinion about a tongue tie. I suspect my 21 yr old daughter, who has been dealign with difficulty with speech and eating might actually be tongue tied and we never knew. I know it is best to go to a doctor (we have a scheduled in a few weeks, but i wanted to get another opinion if possible. Thanks!
You could email me at [email protected] if you want to run stuff by me.
I emailed you. I cannot thank you enough.
I am afraid that my baby’s lip tie reconnected. We had the procedure done at 6 weeks (almost 2 weeks ago). Our doctor didn’t give us any aftercare instructions so we didn’t start stretching the area until a few days later. Nursing isn’t going well and I can’t seem to get a good latch or have a pain free session. How do I know if it reattached?
I meant tongue tie! The lip was done too but it looks good!
LOVE this post!! I recently typed up a list of all the therapies & stretches & websites that helped me both before and after my babies’ revisions.
For my son, the revision at 3 mos was a game-changer, but he was so affected my nursing improperly, choking, aspirating, projectile vomiting, etc, that he just didn’t know how to nurse or want to after the revision… so we needed a team of therapists and multiple aspects of therapy. We re-released his tie at 1 year old along with my daughter’s (she was 3 1/2 at the time). I continued nursing him until 2.5, and he did better and better the longer we nursed– it was finally 100% pain-free the last 3 months or so!
I am so relieved to have come across all of this wonderful material regarding tongue and lip ties. My baby boy went to the ENT yesterday and they released his posterior tongue tie. They said they did not recommend releasing the ULT unless it looks like it will cause a gap between his teeth. I’m a little unsure about that since he is only 2 1/2 months old. But I am grateful to have the tongue released which just since last night he is nursing better and getting more milk. Hopefully this will solve our problems. Thank you everyone for sharing your stories. It’s nice to know I’m not the only mom going through this.
My two year old has a severe cavity and another one forming. I was absolutely shocked as we eat very healthy, very little honey and even less sugar and juice, brushed her teeth regularly, etc. Even though I have always nursed her a lot at night, I didn’t think it would cause a problem. I took her to the Pediatric Dentist who said they’d have to put her under anesthesia to get them filled and have caps put on her teeth. When I came home I started looking for any other options and found information on healing tooth decay and the reasons why an otherwise healthy child would have tooth problems. I looked in her mouth and she has a lip tie! I never knew, although the signs were there, I just had no information on it at all. She always nursed VERY frequently, as in every twenty minutes for months! I co-slept and she would nurse all night and would never take a pacifier, it would just come right back out. Luckily, I did not have problems with low milk supply, but I did have problems with mastitis and she got a severe case of thrush. In addition, she had a big nursing callous for quite awhile but I was told it was normal. She drooled a TON. In fact, for several months she had to constantly wear a bib. I was told it was just from teething, although she drooled that much for several months before teeth came through. She has also always been tiny for her age (Around 3rd percentile) despite her massive appetite. Is it too late to get it fixed? Is it difficult to have fixed? Interestingly, I found that I have a lip tie as well and I can remember my mother saying how colicky I was. I wonder if it was because of it. Should I go forward with the anesthesia and fillings or wait to see if I can heal them naturally? I’m just worried because one of the cavities is brown in the middle and extends just about to the root 🙁
Debra Beckman, MS, CCC-SLP
Many of the symptoms described above could be due to factors other than a structural problem of the lip or tongue. It is very important to have a functional assessment of oral motor patterns prior to cutting any baby’s lip or tongue. The best one to use for babies is Beckman Oral Motor Protocol. If muscle function is impaired, surgery will not solve the problem. It is possible to have both muscle impairment as well as structural concerns. By addressing the oral motor movement concerns for durational strength first, any surgery will have better outcome, and may not be needed at all.
Any recommendations for Doctors in Germany or Europe who will handle this sensibly? I can’t find anyone here who will use a laser/ won’t insist on putting my 15 month old fully under (intubation, etc, shudder!) for the procedure.
Thank you for posting this. I had my daughter examined for a tongue tie, at the recommendation of a lactation consultant. We’ve had to work at it, but she’s not a terrible nurser, and I don’t many of the symptoms (at least not after the first few weeks). What pushed me to have it looked at is the fact that she could not take a bottle. She understood how to do it, but just couldn’t get her tongue to work with the nipples. We finally found ONE that works for her (Mam, if anyone else is having troubles). She never took a paci, and I suspect it’s for the same reason. The doc said that it’s not severe enough for clipping, especially since she was 4 months old and nursing well (and gaining weight like a champ). We have to watch for speech issues and may need to address it then. BUT – the lip callus! She is 6 months old and STILL has one. That’s news to me, and worth checking out again…it’s frustrating that this is such an overlooked condition. Our pediatrician and FOUR lactation consultants checked her, and it still took four months to get it looked at!
Just wanted to leave a note to recommend Dr. Allen Sprinkle at Pride Dental in North Arlington, TX. He does great work doing frenectomies on newborns and is part of a holistic/biological dental practice.
Thank you for bringing awareness to this subject. This is something that definitely needs more research and parents bringing up their concerns is the first step in getting that. I think it would be helpful if you also included some pictures of the range of normal frenulums. Everybody has a lingual and labial frenulum. Some are shorter than others without being “ties.” If you’re somebody that isn’t particularly familiar with oral anatomy and doesn’t spend a lot of time looking in other people’s mouths, it might be easy to self-diagnose a tie when there really isn’t one.
Well, ties are diagnosed by both structure and function– so how they look is half, but how they are affecting daily life (eating, drinking, nursing, swallowing, breathing, etc) is another part of an equation. A mom with a baby doing just fine probably won’t be looking in her baby’s mouth for troubleshooting anyway. Moms who have babies choking, crying, struggling to gain weight… they would look. That would just be a starting point, though. The next step would be to find a care provider to confirm the diagnosis and move towards either revision or functional improvement via stretches and oral motor therapy.
Oh, how I wish I had found out about this a number of years back. My daughter is now 8 and has a severe lip tie. Her dentist noticed it last year and referred us to an orthodontist because of it. We were nursing constantly for the first 2 years of her life, to the point where it was hard to get anything at all done. It was all nursing, diaper changing or laundry. And sleep? Yeah, there wasn’t much of that — for me anyways. I went through those 2 years in a total blur, hardly able to put a coherent sentence together. We even went to a breastfeeding specialist. Why on earth do doctors not know about this?
It’s interesting to see that lip ties can affect later speech. I had no idea. My daughter has some speech issues and it never even occurred to me that there might be a connection. I’ll have to look into that.
Hi. I was thinking that proper latch probably includes a flanged upper lip. You may want to modify the proper latch image to reflect that (well, maybe not the image but adding text to point that out). We suspect an upper lip tie on our baby. She has a tendency to curl her upper lip (at bottle or breast).
Are there any good doctors near NE Montana? My daughter has a lip tie for sure, and at 8weeks old I can barley handle breastfeeding her due to how painful it is! We share many of the symptoms listed above… I had same issues with my first daughter but suffered through it for three months until it got better. I didn’t know anything about lip/tongue tie. Will just any ol doctor (family doc) be able to clip it ok or do I need to go to a specialist?
Wow, I could literally start bawling. I have a 5 day old and 3 other children. I just stopped trying to nurse my new born because of the pain. It was just to much and because I could tell he was starving! I was unsuccessful nursing my other 3 children as well to the point that my first ended up in the hospital because she was so underweight. After reading your article, I think all my kids are tongue tied. Every symptom for momma matched except thrush! Even the clicking noise from baby, all of my kids did this even my 5 day old!
do you recommend a Dr in Tacoma Washington? I have seen a lactation consultant and was told I have very large nipples and that the reason my kids cant nurse is because they cant get enough areola into their mouths! But I think its this! Thank you!
I am sad yet relieved to have come across this article. 12yrs. ago I felt the pressing need to to stop nursing my little girl (which I always regret) because she was diagnosed with having severe reflux. We tried for 5 1/2 months she just wouldn’t gain weight & her thrush caused a very bad infection for me. Her dentist discovered the extra skin under lip & recommended having it cut when she was three. No one ever said anything about being the possible cause of our nursing troubles. Having successfully nursed both her older & younger siblings for 2 full years, I really feel like we were cheated. I am expecting another child soon, so if any similar issues arrive I know feel prepared, thanks!
Hi! My 13 month old son just got his lip and tongue revised by dr Kotlow ( we are driving back home to NJ as I type). He is very sweet and patient. He did tell me to use Tylenol or Motrin and topical oragell if my son is in pain. I was wondering if anyone could suggest a natural alternative to pain relieving. I am new to this… Thank you all!
I used a homeopathic remedy called “Rescue Remedy for Kids” with my little one and felt it helped significantly. I gave it to him before the procedure, in the hours and days after the procedure, and when we had to do stretching exercises. For me, the hardest part is that he disliked doing the stretching exercises. Eventually I figured out that it wasn’t so much due to discomfort, but due to the fact that he didn’t like my husband’s huge fingers pressing around in his mouth. We started waiting until he was asleep to do them. We gave him the Rescue Remedy with a dropper as he slept, then waited 10 minutes and did the exercises. He fussed a little but didn’t even wake up most of the time.
Oh Thank you so much! As always you are a great help! I am having a hard time with the exercises. He is 13 months and bites down really hard. I am able to do the lip but the tongue is impossible. I am going to try while he is asleep. I sent my husband out to get the rescue remedy and it helped big time. I should have asked before… Thanks to you I had this done early enough not to cause him any speech and decay problems. Dr. Kotlow still doesn’t understand how I was able to breastfeed him till now, his tongue was the most severe case. I guess it was God who helped me.
Wow!! I always wondered why I had so much trouble nursing my daughter and now I have my answer 12 years later!!! Wish this information had been available to me then. Would have saved us both from 12 months of sleep deprivation, painful nursing and colic!!
Any recommendations for a dr in Los angeles, ca. I am just noticing my son has a tongue tie… And it wasn’t caught either… He is now 5 months… Thanks in advance
Thank you for this information! Who can recommend a pediatrician or dental practice in western Pennsylvania to treat an infant’s lip tie? If not the Pittsburgh-Erie area, then Cleveland, Columbus, Cincinnati, Buffalo, Harrisburg, Philadelphia, Baltimore, or Washington, DC. As long as we can drive it in a day, we’ll go. I just want to find a true expert who will take this condition seriously and preferably use a laser. Thank you!
Bobby Ghaheri MD
The best person in your area is Greg Notestine in Dayton Ohio. He’s fantastic and uses laser.
I was just giving my 7 month old daughter teething tablets and noticed what looks for sure like a lip tie. Up until recently we hadn’t had any trouble nursing. And recently I think our troubles have to do more with other things. I feel like it’s still a concern because of the things it could effect later on. But do you think it’s actually a lip tie if there’s no issues arising from it. And will a doctor even care then?
Do you have pictures of what the mouth of a baby WITHOUT a tongue/lip tie looks like, by any chance?
This would be so helpful…
Any chance anyone has a recommendation for a provider in the Washington, DC area?
Is there a chance you can add Dr Ghaheri’s info as a link up above? I love your TT and LT information. Dr. Ghaheri was trained by Kotlow and is on the opposite coast. He is wonderful and a TT and a LT conference speaker now, as well. http://www.drghaheri.com
How do I find the best person in Australia to perform correction of posterior tongue tie for my 7 year old? My son attends speech therapy and OTHER has difficulty with chewing (often chokes) but development is normal is every other way …speech therapist says has posterior tongue tie …but general doc says don’t worry about it…I believe his inability to pronounce letters is affecting his reading and spelling …could this be true? Thanks for any info is appreciated
Bobby Ghaheri MD
Yes it’s quite possible. The most commonly affected letters are R, S, L, CH, SH, TH, D, Z and occasionally K and G. Where in Australia are you? I have multiple contacts.
Great site! I had my daughter’s tongue and lip tie diagnosed today after both my midwife team and pediatrician said she didn’t have tongue tie so I definitely appreciate you trying to help everyone identify it easier.
My poor daughter could have avoided a lot if her tongue tie was identified sooner. When she was four days old she had to go to the hospital for two days because she got jaundice from not feeding enough. Since then, she’s had poor weight gain and constantly seems fussy and hungry – she’s still only at her birth weight and she’s three and a half weeks old.
Keep up with your efforts. I’d be happy to send pictures of her tongue or video of her nursing (frequent unlatching/latching, her frustration, my pinched nipple) if that helps you guys show people what symptoms of tongue tie look like.
I am in Australia, Canberra and would appreciate a professional diagnosis. Do you have any contacts in Canberra? My son has the lip callus, receding chin, flat philtrum, his tongue bowls when he screams/cries, his outer upper incisors have worn away and he has had so many issues with eating solids (to the point of becoming anemic), he has been constantly congested with ear-infections since he was about 6 months. Recently, we started a dairy diet for him and he is not sick as often anymore…but still sounds congested when he sleeps. He is 2 1/2 now. Still has issues with solids and although he falls asleep easily, he doesn’t often stay asleep for long periods….still wakes up often through the night. Have you found a correlation between posterior tongue-ties and breathing issues? BTW, he had noisy Laryngomalacia when he was born till about 10 months old. Any hints to help diagnose what’s going on would be appreciated. ATM, he is having possible behavioral issues, SPD and a delay in communication. However, he is very clever in other areas he can count forever, he knows his ABCs and can play matching cards and re-sing any song he hears.
I suspect my 1 week old has a lip and tongue tie. Any recommendations of a specialist in atlanta, ga area? Thanks!
I should have followed my instincts. Struggled so much with my lb who is now four months. My ped mentioned he had a tongue tie at six week visit but insisted nothing could be done unless it effected his weight gain. He struggled severely with sucking in enormous amounts of wind all the time and makes click sounds when feeding. Saw the ENT today as i the ped refer us. ENT says little one has both a severe tongue and upper lip tie and would have helped at week one had he seen Liam. So disappointed my lb and i struggled so long when the situation could have been helped. Going to set my ped very straight at my next visit. Follow your instincts mommies!!
This is such great information! I have a 2 month old, he’s gaining weight well but I have bruises under my nipple, he drools a lot and gags frequently. The lactation consultant also said he has a high palate and suspects a lower lip tie. Are there any experts in the south Florida area? My pedestrian says the drooling is teething related and is not concerned about anything else since he’s gaining weight well. Please let me know who to take him to fit a proper evaluation.
I’m pretty sure my 12 month old has lip tie. I noticed the frenulum connecting to the tissue between her two front teeth (which are gapped) recently, she has had lip blisters pretty consistently, gagged/choked on milk a lot, fell asleep nursing, lost weight (she only breastfed for 3 weeks due to this), had severe reflux and gas, and is now really struggling with solids. She’s fine with a bottle now and loves purees and mandarin oranges, but will chew and spit out most other finger foods. Does anyone know of a good provider in the Denver area?
Looking for a good provider in the Charlotte,NC area………any suggestions???
My daughter is now 18months and has a speech delay because no one checked for tongue ties untill 10months. Is NICU or a Pediatrician supposed to look for this? Being a new mom, I didn’t even know what this was! My sister found while checking for new teeth. Apparently my daughter had lip, tongue and buccal ties which were lasered but now she has a speech delay 🙁
I just want to say I wish I knew all this 12 years ago. My daughter was born with a bad lip tie and I remember asking the dr if that was ok like that. He said she should grow out of it, she was born at 32 weeks. Her teeth came in with a huge gap due to it blocking the natural formation. Even now with her adult teeth in she has a gap. I will be going and talking to her dr now and maybe seeing if anything can be done because it still very pronounced compared to my 10 year olds. Plus I have tmj so if that makes it worse I definitely want it taken care of. Thank you so much. I never had heard of this.
Our son had both a lip and tongue tie and luckily, our lactation consultant figured it out right away when she came over (he was 4 days old and just didn’t latch and eat like his sister did and we KNEW something was wrong). We went to see Dr Frank Sierra in Tampa and he remedied both with a laser. Our son didn’t cry and there wasn’t even any blood. He latched and ate (enthusiastically) right away.
Like this post says, if you THINK something is wrong, don’t wait!
I know this post is old…
My daughter had her severe tongue tie released at 7.5months old. She’s had gas reflux issues since birth but due to incessant nursing around the clock has gained weight okay. I wasted to ask, how long after having the tongue tie revised with an older baby did you see an improvement? It took four weeks for her to be able to stick her tongue out which she can do now, and she’s finally able to move food round her mouth and so gags so much less on food! However we are still nursing 3-4 tîmes per night at 8.5 months old and she wakes up an hour afterwards with terrible burp pain and needs to burp then wants to nurse again. Any advice? I’m on my knees
Corrected typo in email address- x
Hi, I have had major problems with getting my baby to nurse and have been suspicious that she might have a lip tie. She is also not gaining weight…on and off the breast constantly and still waking up to nurse every 2 hrs at 7 months. I am located in Mitchell, South Dakota. Do you know of a doctor to recommend? I have had her to a local pediatrician several times and she has never even looked for a lip/tongue tie. She just recommends to feed her solid food to help with weight gain but I would love if my baby could keep nursing for a few more months. Thanks in advance!
A dear friend has a little boy that just turned one. Nurses fine and is very healthy (chubby). He will not eat. Anything! Plays in the food. I’ve only tried to feed him peas, banana, applesauce and gerber puffs…he spits them all out. Doesn’t gag, just instantly spits them out. All the food thyve tried at home he spits out too. Could tongue tie be something to consider? He nurses and drinks breastmilk from a bottle just fine.
Hi, I’ve had my daughters lip and tongue revised twice. Unfortunately they have reattached. I’m wondering if I or my husband or baby has MTHFR if revising a 3rd time will cause reattachment again? I will also be traveling to have Dr Kotlow do the revision thus time around. Any info would be so helpful!
Check out these wound care videos. The “exercises” help prevent reattachment. http://www.dryazdi.com/frenectomy.html
Dr Yazdi treated both my daughter’s lip and tongue ties. He is located in the San Francisco bay area and is a pediatric dentist specializing in treating children with frenulum/breastfeeding issues. I highly recommend him. He uses a Co2 laser (the best/fastest option), it’s so quick no local anesthetic is used since injecting the meds takes longer than the cutting which takes about 4 seconds.
Hi, my oldest child had a tongue tie which didn’t get recognized til 2 1/2 due to speech problems. He breastfed well so that was good. I looked out for tongue ties in my other 2 children but never knew of lip ties. My youngest was the worst breastfeeding experience I ever had. I couldn’t understand what was wrong since she didn’t look like she was tongue tied. She’s 18 months now and reading about lip ties I finally figured out what the problem was. I stuck it out with all the pain and the problems we had breastfeeding and she’s still nursing now. I did contact Dr. Kotlows office and they scheduled the appointment that same week. She did in fact have a tongue and lip tie but due to her age he only did the lip tie. He said he tongue tie wouldn’t effect her speech and had I took her when she was younger he would have done both procedures. I really wish I would have know sooner to have it corrected earlier, but at least she had it done Friday. She’s doing great, healing good. So glad I caught it. Thank you for sharing and next time I know just to get the baby checked out right away, it’s worth it.
My daughter is almost 4 years old now. Nursing was not successful even after several lactation consultations. I brought her to 2 ENTs so they could determine if she was tongue tied. Neither ENT could give me a definitive answer. Both thought maybe she does or maybe she does not. Now my daughter’s speech is not as clear as most kids her age. She doesn’t like hard foods like carrots and she gags from time to time. At 4 years old should I see someone again for possible tongue tie? I am a bit nervous about going down that road again because the previous ENT was leaving it in my hands to decide whether or not to have the procedure. I certainly do not want to do an unnecessary procedure. Any advice is appreciated.
Wow. What a fascinating article! I had literally never heard of lip or tongue ties before but after reading this I wouldn’t be surprised if my son has them. Sadly, I was forced to stop breastfeeding him when he was 3 months old so that I could undergo cancer treatments. However up to that time breastfeeding did not seem to come naturally for either of us no matter how much I wanted it to. I’ve always felt so guilty for having to switch him to formula (especially at such a young age). I wish I would have had the guts and the knowledge to find a natural path to healing instead of blindly agreeing to radiation and surgeries. Anyway, my son is almost 3 now. He speaks very clearly for someone of his age. Do you think it would be necessary or wise to look into this more for him? Or is it kind of irrelevant now? So glad I read this either way. If I am ever blessed with more children I’ll at least have this on my radar if something feels off with the breastfeeding experience.
Wow!!! This article was like a lightbulb to my mom and I (we just broked down for almost 20 minutes). This is an actual thing and I’m not an alien. Yaaay!!! I am 23 years old with 2 lip ties and a severe tongue tie. All the pain and struggles that we both went through…….I am still struggling with these ties. Constantly gagging, not being able to whistle, chew and move food around my mouth, not being able to swish with mouthwash, brush the back of my teeth, and floss more than the 8 teeth in the front. Heck, I can’t even lick my lips. All the times of screaming when nurses would jam a thermometer ‘under’ my tongue and I was thinking to myself “What? People can actually raise and move their tongue to put something under there?” All dentist visits were/are living nightmares for me. I can’t roll my R’s or even say words like train. I can’t even eat a whole apple or corn on the cob. Is there anything I could do to get at least my bottom lip tie taken care of? I live in North Idaho. Thank you sooo much for this article!!!! Save your children from the pain and consequences of having these ties. It has been so difficult for me.
Thank you very much for posting this! I remember when my daughter (now 15 months) had some of these symptoms as an infant. I cannot recall if I had any of these symptoms my self. She recently has been having trouble nursing because of the large split in between her teeth. Do you believe this could be the problem to our nursing troubles?
Hi. My 8 month old son has a lip tie. Do I need to fix if he is now 20 lbs and high percentiles for height and weight (always has been). He did have more symptoms when he was really young. Should I be worried but other issues like speech or teeth gaps if not fixed. Does anyone have an older child with a lip tie that is unaffected by it?
You mention that we can email Dr Kotlow with photos for him to comment on . . Can you let me know how I couldn’t see it in the article ( sorry only have my phone which could make it harder to see) I have a 8 week old so difficult feeding that we gave up at 6 weeks after I reached out for help more times than I could count to be told “all normal” chronic wind, clicking on breast and bottle, never have full clues and would just fall asleep, always hungry, takes 30mins at least to drink 100mls, nipples blisterd and cracked first week so had to express week one then tried to continue breastfeeding. Chews the teat, chokes at times. I don’t think they worried because he was still gaining weight. He was so unsettled after 3 weeks I thought he had colic.
Hi Casey, this is Dr. Kotlow’s website: https://www.kiddsteeth.com/
HI, just wondering why nothing is mentioned about bottle feeding and tongue/lip ties…….
I think my 6 month old has a tongue tie. We have marathon nursing, blanched and flat nipples, nursing to sleep and then waking to nurse again poor milk supply, baby doesn’t take a pacior bottle, and baby is not gaining weight. Where can I get her evaluates near Park Ridge/ Chicago? I keep asking her pediatrician but I feel like she is evaluating her wrong. To start she has the baby face her not away! Help Please!!! My baby only weighs 12lbs!
This is such a helpful article, thank you. You mention being able to email the doctor photos- could you share an email address (there isn’t one on his website)? Everything about feeding my newborn is textbook right except it’s still very painful two weeks in ans my nipples are mishapen when he unlatches. ‘This is different from with my first child so I’m concerned he is lip/ tongue tied.
Hi Heather.Thank you so much for such a helpful topic!My son is 14 months old and was born with an extremely low birth weight at 29 weeks!So being a severe preterm with a weight of 730g,he spent about 2 months in the incubator.Paediatric nurses were first to see the tongue tie but his paediatrician said nothing about it despite all enquiries l made with him.He simply said he had a high tone and the same was said by the audilogist/speech therapist!Now am really getting worried because he now has 4 teeth at the botton and the top 2 are emerging.From the list of symptoms,my boy seems to be having quite a number of them and l don’t know where to find a specialist to correct that.I am in Zimbabwe,Southern Africa.
How about lower lip tie? I have looked and looked, even with specifically typing in “lower lip tie in newborns” only upper lip tie and tongue tie pop up with maybe a sentence for lower lip ties. My newborn has an upper tie, but possibly a lower one too. I always have to pull both her upper and lower lips out once she is latched. Why is lower lip tie not talked about?
Nandhini K M
Such useful information and thanks for it. Recently, my friend’s newborn baby is having tongue-tie. She is 20 days old baby and literally struggles to feed. Her tongue-tie is affecting suckling reflex and we were worried whether she becomes malnourished. We were not sure whether to opt for frenectomy or to try with tongue positioning therapy. Your article has provided good insights and would like to try out with understanding the sucking pattern first before opting for the higher procedure.