Tongue Ties: It's About Function, Not Just Appearance

Let's talk about tongue ties, because if you are a parent who has gone down this particular Google rabbit hole, you already know there is a LOT of information out there.

Maybe someone looked in your baby's mouth and told you they have a tongue tie. Maybe breastfeeding hurts. Maybe your baby clicks when they eat, takes forever to finish a feed, or just cannot seem to stay latched.

And now you are wondering, Is their tongue the problem? Do we need to do something about it?

As a nurse, lactation consultant and mom, this is where I want you to know something really important:

We care much more about what your baby's tongue can do than what it looks like.

A tongue tie is not just something we "see"

Every baby has tissue underneath their tongue called a frenulum.

Sometimes that tissue can limit how freely the tongue moves. But seeing a frenulum does not automatically mean there is a problem that needs to be fixed.

I have seen babies with very noticeable tissue under their tongue who feed beautifully.

I have also seen babies whose mouths do not look particularly concerning at first glance, but when you actually watch them feed, you can see how hard they are working.

That is why a quick peek under the tongue only tells us part of the story.

We have to look at function.

So what are we actually looking for?

When I am watching a baby feed, I am paying attention to much more than whether their tongue can stick out.

Can they lift their tongue?

Can they cup it around the breast or bottle?

Can they create and maintain suction?

Are they able to coordinate sucking, swallowing and breathing?

Can they stay latched, or are they constantly popping on and off?

Are they transferring milk efficiently, or are they working really hard without getting much in return?

Those little details tell us a lot.

And as a mom, I also care about what the feeding feels like for you.

Because if your baby is gaining weight but you are crying through every feeding, that matters too.

What might make us look a little closer?

There is not one single symptom that screams "tongue tie."

That would make things much easier, wouldn't it?

Instead, we may start looking more closely at oral function when parents are noticing things like:

• Painful breastfeeding

• Clicking while baby eats

• Milk leaking from the sides of the mouth

• Trouble staying latched

• Very long feeds

• A baby who seems exhausted after eating

• Difficulty maintaining suction

• Frustration at the breast or bottle

• Concerns about milk transfer or weight gain

• Feeding that still feels difficult even after working on positioning and latch

The important thing here is that these symptoms can happen for lots of reasons.

Clicking does not automatically mean tongue tie.

A painful latch does not automatically mean tongue tie.

And having a visible frenulum does not automatically mean your baby needs a procedure.

We have to put all the pieces together.

Feeding is rarely about just one thing

This is probably one of the biggest things I wish parents knew before they started Googling.

Feeding is complicated.

Your baby is trying to use their tongue, lips, cheeks and jaw while coordinating breathing and swallowing, all at the same time.

You are part of that equation too.

We may need to look at your milk supply, how quickly your milk is flowing, positioning, nipple pain and how you and baby are working together during a feed.

Sometimes one small adjustment changes everything.

Sometimes there are a few different things contributing to the struggle.

That is why I never want a parent to feel like the entire feeding experience has been reduced to, "Your baby has a tongue tie."

We want to understand the whole baby and the whole feeding relationship.

Does every tongue tie need to be released?

No.

And I think this is such an important conversation to have.

The goal is not to find a tie and fix it.

The goal is to figure out whether the tongue is actually having trouble doing its job.

If your baby is eating comfortably, transferring milk well, growing and moving their tongue effectively, a visible frenulum may not be causing a functional problem at all.

If we do see concerns with function, then we can talk through what support might help and whether another evaluation is appropriate.

If a procedure is ever part of that conversation, you should understand why.

What are we trying to improve?

What problem are we trying to solve?

What do we expect to be different afterward?

Those are fair questions, and as a parent, you deserve clear answers.

Why we love having lactation and therapy work together

One of my favorite things about our team at Parkview Therapy Services is that we do not have to look at feeding through only one lens.

Our lactation team can look closely at breastfeeding, milk transfer, positioning and the feeding relationship.

Taylor Hudman, M.S., CCC-SLP, CLC, can look more closely at oral movement, coordination and how your baby is using their tongue, lips and jaw during feeding.

When we put those pieces together, we get a much clearer picture.

Sometimes we find something we need to address.

Sometimes we make a few adjustments and things improve.

And sometimes we get to tell a worried parent, "Actually, everything I am seeing looks really good."

That reassurance matters too.

What happens if you bring your baby in?

First, we are going to listen to you.

I always tell parents that what you are seeing at home matters.

You are the one doing the feeds at 3 a.m. You are the one noticing the clicking, the leaking, the frustration or the pain.

Then we look at your baby's oral movements and, when possible, watch an actual feeding.

That is such an important piece.

A baby can stick their tongue out perfectly during an exam and still struggle to use it effectively while eating.

Feeding lets us see the tongue doing its actual job.

From there, we talk through what we are seeing and what makes sense next.

No jumping to conclusions. No treating something just because it looks a certain way.

We want to know whether it is affecting your baby.

Please do not feel like you have to figure this out from pictures online

I say this with love because I know exactly how easy it is to start comparing photos.

Suddenly you have 14 tabs open, you are staring under your baby's tongue with your phone flashlight, and every picture somehow looks like your baby's mouth.

Pictures can be helpful, but they cannot show us function.

They cannot tell us whether your baby is transferring milk.

They cannot tell us whether feeding is comfortable.

They cannot show us how your baby coordinates their mouth during an actual feed.

So instead of asking, "Does my baby's tongue look tied?" I would much rather help you answer:

"How is my baby's tongue working?"

That question gets us much closer to what really matters.

At Parkview Therapy Services, our goal is not to diagnose your baby based on how their mouth looks.

Our goal is to understand how your baby eats, how their mouth is functioning and what we can do to make feeding feel better for both of you.

Because at the end of the day, we are not treating a picture.

We are taking care of a baby and the person feeding them.

Worried about your baby's tongue movement or feeding?

Come talk with us. Our therapy and lactation team can watch a feeding, evaluate oral function and help you understand what may be contributing to the challenges you are seeing at home.