Tongue-tie and lip-tie are conditions where a baby is born with a tight or thick band of tissue connecting the tongue to the floor of the mouth or the upper lip to the gum line, restricting normal movement. They affect roughly 2% to 11% of newborns and are one of the most common reasons breastfeeding becomes painful or ineffective in the early weeks of life.
What Tongue-Tie and Lip-Tie Actually Are
Every person has a small strip of tissue called a frenulum under the tongue and another beneath the upper lip. These are normal structures. In tongue-tie (the medical term is ankyloglossia), the lingual frenulum under the tongue is shortened, thickened, or attached too close to the tip of the tongue, limiting how far the tongue can move. In lip-tie, the tissue connecting the upper lip to the upper gum is unusually tight or thick, preventing the lip from flanging outward the way it needs to during feeding.
Tongue-tie and lip-tie can occur together or separately. A baby with tongue-tie may stick out their tongue and it appears notched or heart-shaped at the tip because the frenulum is pulling the center down. Some ties are obvious at a glance, while others sit further back at the base of the tongue (sometimes called posterior tongue-ties) and are harder to spot without a trained evaluation.
Signs in Breastfeeding Babies
For many families, the first clue is trouble with breastfeeding. A baby needs to extend the tongue over the lower gum and create a seal around the breast to nurse effectively. When the tongue can’t move freely, the baby may chew on the nipple instead of sucking, causing significant pain for the nursing parent. Feeds often take longer, and the baby may not transfer enough milk to gain weight at a normal pace.
Common signs in the baby include:
- A shallow or painful latch that doesn’t improve with repositioning
- Clicking sounds during feeding, caused by the tongue repeatedly breaking its seal
- Excessive gassiness or fussiness from swallowing air during feeds
- Slow weight gain or needing unusually long feeding sessions
- Milk dribbling from the corners of the mouth
For the nursing parent, persistent nipple pain, cracked or blistered nipples, and a drop in milk supply (because the baby isn’t emptying the breast efficiently) are red flags worth investigating. Not every breastfeeding difficulty is caused by a tie, but when standard latch corrections aren’t helping, a tie is one of the things worth checking.
Bottle-fed babies with ties may also struggle. They can have difficulty forming a seal around the bottle nipple, take in excess air, or feed very slowly.
How Tongue-Tie and Lip-Tie Are Diagnosed
Diagnosis is usually based on a physical exam and a feeding assessment. A pediatrician, lactation consultant, pediatric dentist, or ear, nose, and throat specialist may evaluate the baby. Some ties are identified in the hospital right after birth, while others aren’t caught until feeding problems develop in the first few weeks.
During the exam, a provider will look at how the frenulum is attached, how far the baby can lift and extend the tongue, and how the tongue moves during feeding. Clinicians sometimes use a grading system (such as the Coryllos scale) to classify the type and severity of tongue-tie, but the functional impact on feeding matters more than the grade itself. A tie that looks mild on exam can still cause real problems if it restricts the movements needed for an effective latch.
Treatment Options
Not every tongue or lip tie needs to be treated surgically. Some mild ties don’t interfere with feeding or development, and the tissue can stretch or thin over time. When a tie is clearly causing feeding problems, though, there are two main procedures.
A frenotomy is the simpler option. A provider snips the tight band of tissue with sterile scissors. It takes only a few seconds, typically causes minimal bleeding, and most babies can breastfeed immediately afterward. Some doctors recommend doing this before the baby even leaves the hospital.
A frenectomy is a more involved procedure that removes or reshapes the tissue, often using a laser. Lasers reduce bleeding and can speed healing. A frenectomy is more common for thicker ties or for older infants and children who may need local anesthesia. Recovery from either procedure is generally quick for infants. Parents are usually instructed to do gentle stretching exercises under the tongue or lip for a week or two afterward to prevent the tissue from reattaching as it heals.
Working with a lactation consultant before and after a procedure can make a significant difference. Babies who have been compensating for a restricted tongue sometimes need help relearning how to latch and suck effectively, even after the tissue is released.
What Happens if a Tie Goes Untreated
Many parents wonder whether their baby will simply grow out of it. Some ties do become less restrictive over time, but others cause ongoing issues well beyond infancy.
When babies start solid foods, a restricted tongue can make chewing and swallowing textured foods difficult. Children may gravitate toward soft foods, avoid certain textures, or develop unusual chewing patterns. Mealtimes can become frustrating for both the child and the parent.
Speech is another area where untreated tongue-tie can show up. Sounds that require the tongue to reach the roof of the mouth or behind the teeth, like “t,” “d,” “l,” “r,” “s,” and “z,” become harder to produce clearly. Some children compensate well enough that it’s barely noticeable, while others need speech therapy to address articulation issues.
Over time, restricted tongue movement can also affect the shape of the palate and how teeth come in. When the tongue can’t rest in its natural position against the roof of the mouth, the palate may develop narrower than usual, leading to crowded teeth and potential orthodontic work later. These aren’t guaranteed outcomes, but they’re worth weighing when deciding whether to treat a tie that isn’t causing immediate feeding problems.
Tongue-Tie vs. Lip-Tie
Tongue-tie gets far more attention in medical literature and guidelines, while lip-tie is less well studied and more debated among providers. A significant lip-tie can prevent the upper lip from flanging outward during breastfeeding, which weakens the seal and makes latching painful. In some cases, a tight upper lip frenulum can also create a gap between the two front teeth as they come in.
Lip-ties are often identified alongside tongue-ties, and when both are present, releasing only one may not fully resolve feeding difficulties. If your baby has been evaluated for tongue-tie but feeding problems persist, it’s worth asking whether a lip-tie could be contributing.