What is Tongue Tie &
What are its Signs & Symptoms 

Tongue tie or “ankyloglossia” occurs when a baby’s lingual frenulum is too tight, too short, or too thick. The lingual frenulum is the small band of tissue that connects the underside of the tongue to the floor of the mouth. When this tissue restricts the tongue’s reach, an infant may not be able to properly latch when breastfeeding, often causing pain for mother. The tongues restriction can also cause issues with the seal on a bottle causing issues such as gas pain and reflux. In toddler-hood, some children with tongue ties may have trouble articulating certain sounds or sticking out their tongue, making it difficult to perform simple activities like licking an ice cream cone. It has also been reported to be associated with sleep issues such as sleep apnea.

At Agave Pediatrics, we believe that the presence of a tongue tie and/or lip tie can pose a major obstacle for healthy feeding and oral function. Tongue tie treatment procedures have been routinely performed by doctors and midwives for a long time & all over the world. Surprisingly, majority of pediatric offices across the U.S. do not routinely perform corrective procedures for the ties that can  enhance and prolong the breastfeeding experience. Agave is one of the very few pediatric clinics in the USA that has been providing such care and has treated thousands of patients for over a decade. We have developed a very comprehensive, evidence based and multi-disciplinary program to manage tongue ties over the years and we call it the Agave Approach.  We will discuss some of the scenarios where tongue and / or lip tie should be considered as a cause of variety of symptoms in a child. 

Symptoms associated with tongue and / or lip ties:

Tongue tie can cause a number of problems with feeding, speech and sleep. The following sections provide more information on the various symptoms that can be associated with tongue tie at various ages. 

Tongue Tie and Breastfeeding

Because the life-long health of your baby is our utmost concern, breastfeeding is valued as the gold standard of infant nutrition by our providers. Breastfeeding is:

  • normal, natural, and a beautiful biological process

  • a skill that commonly takes a bit of time for each mom and baby to master

  • known to improve a child’s immunity

  • a contributor to a higher I.Q.

  • a protective mechanism that lowers a child’s risk of contracting illnesses and developing allergies

  • it has been proven to reduce the risk of breast, ovarian & uterine cancer in mothers

  • rarely as easy as we assume it will be

Breastfeeding can be compromised and become unsustainable when the presence of a tongue tie limits the tongue’s normal range of motion. An upper lip tie can limit the ability of the baby’s upper lip to form an adequate seal while breastfeeding. This can cause discomfort, difficult feedings, poor weight gain, and stress for parents, baby, and the whole family.

Symptoms of tongue tie in breastfeeding infants 

Infant Symptoms:

  • Difficulty latching and/or maintaining a deep latch

  • Frequent unlatching and re-latching

  • Clicking sounds on the breast

  • Leaking/dribbling on the breast

  • Gumming the nipple

  • Tucked upper/lower lip when on the breast

  • Persistent suck blisters

  • Spitting up frequently

  • Frustration and/or breast refusal

  • Poor weight gain

  • Fussiness at breast and in between feedings

  • Gassiness

  • Difficulty bottle-feeding when breastfeeding is being supplemented

 

Maternal Symptoms:

  • Nipple “flattening”/ whitish compression stripes post-breastfeeding

  • Bleeding, cracked, scabbed or blanched nipples

  • Vasospasms

  • Severe nipple pain while breastfeeding

  • Plugged milk ducts

  • Low milk supply

  • Mastitis

  • Thrush

  • Frustration and anxiety associated with breastfeeding

  • Difficulty bonding with the baby

Tongue Tie and Bottlefeeding

Feeding your little one should be a wholesome experience. We understand that there are many choices for bottle feeding available and at times the process can be difficult and frustrating.

At Agave, we believe that bottle feeding is a healthy way to provide nutrition to your baby.

We want to help you whether you are providing formula, breastmilk or both.

At times, the difficulty and discomfort a baby is experiencing during and after a feeding can be related to restriction in the tongue caused by a tongue tie.  An upper lip tie can limit the ability of the baby’s upper lip to form an adequate seal while feeding, causing gas pain and fussiness. This can cause discomfort, difficult feedings, poor weight gain, and stress for parents, baby and the whole family. 

Symptoms of Tongue Tie Related to Bottle Feeding

While these symptoms may be red flags to evaluate for tongue function, some of these may be caused by other factors like a fast flow rate, swallowing difficulties or dysphagia, gastro-esophageal reflux, etc.

 

  • Difficulty latching to the bottle

  • Needing to trial SEVERAL bottle systems to find one the child will take

  • Gagging when bottle nipple is presented

  • Chewing/gumming the bottle nipple

  • Clicking sounds while sucking

  • Collapsing the nipple

  • Pulling away from the bottle frequently

  • Dribbling while feeding

  • Coughing during feeds

  • Prolonged feeding times (over 30 minutes to complete age appropriate volumes)

  • Falling asleep/fatigue during bottle feeds

  • Gassiness, air intake, frequent spit ups

  • Upper lip curling inwards when sealed on the bottle

  • Bottom lip moving back and forth, on and off the nipple when feeding

Tongue Tie and Solid Foods

Feeding your little one should be a beautiful experience. We understand that there are many choices for solids available and at times the process can be difficult and frustrating. We want to help you whether you are just starting the transition to solids, already on your way to stage 3 foods, or more.

At times, the difficulty and discomfort a baby is experiencing during and after a feeding can be related to restriction in the tongue caused by a tongue tie.  An upper lip tie can limit the ability of the baby’s upper lip to form an adequate seal while feeding, causing gas pain and fussiness. This can cause discomfort, & stress for parents, baby and the whole family.  

Symptoms of Tongue Tie Related to Solid Feeding 

While these symptoms may be red flags to evaluate for tongue function, some of them may be caused by other factors like low muscle tone, sensory processing difficulties, gastro-esophageal reflux, etc.

 

  • Gagging with purees/ spoon feeding

  • Tongue thrusting when foods are presented

  • Excessive spillage of food from the mouth

  • Pocketing of foods in cheeks and/or the roof of the mouth

  • Difficulty managing mixed textures (ie: chunks of meat in sauce, pieces of pasta in soup)

  • Avoiding certain foods

  • Difficulty with textured foods – chunky, thicker purees, oatmeal, etc

  • Difficulty with complex solids like meats, breads, raw vegetables, etc that require more efficient chewing patterns

  • Prolonged mealtimes and frequent reminders to chew, to take another bite, to not pocket foods

  • Extremely small bites of food, and prolonged times to clear this

  • Needing to drink a liquid between bites to clear the food

  • Dipping foods excessively to moisten it

Tongue Tie and Speech

An undiagnosed or untreated tongue tie may negatively effect speech. If your child is struggling with certain sounds and words and has been assessed by a speech therapist we encourage you look further into the possibility of tongue tie causing issues with speech. Reflect on your child's past feeding habits and possible history of colic and reflux to see if any of those symptoms could point to a tongue tie that has been left undiagnosed. We don't encourage treating a tongue tie to prevent speech issues. We believe that there can be a number of causes for speech problems and tongue tie is just one of the many possible reasons 

 

Speech symptoms with tongue tie:

While these symptoms may be red flags to evaluate for tongue function, some of them may be caused by other factors like developmental delays, hearing difficulties, etc.

 

  • Difficulty with sounds like L, T, D, N, SH, TH, R, or S once a child is past the age when these sounds are mastered

  • Delayed speech milestones

  • Prolonged need for speech therapy with slow progress

  • Speech that sounds “slushy” or unclear

  • Lisps

  • Unclear speech when sentences are longer and conversations are more complex

Tongue Tie & Sleeping / Breathing Problems

An undiagnosed or untreated tongue tie may negatively influence overall health and well-being, leading to an increased risk for physiologic alterations resulting in poor breathing and sleep quality. Evidence suggests that normal development of the cranial, facial, and neck structures is positively impacted by long-term breastfeeding. The natural jaw movements and suck motions that take place during breastfeeding assist in creating optimal shape and function of the head, neck, mouth, and sinus cavities. How we “suck” and what we “suck” on as infants may influence our ability to function properly as we grow. Having a free-moving, high-lifting tongue helps to promote optimal feeding (breast and bottle), swallowing, breathing, and sleeping. In short, we need to feed, breathe, and sleep WELL to function WELL.

Symptoms of Tongue Tie Related to Breathing/Sleeping Disorders

  • Gagging, coughing, or choking during feeding, sleeping, or when swallowing oral secretions

  • Breathing through the mouth instead of the nose during feeding, play, or rest

  • Dry, cracked lips

  • Excessive drooling

  • Persistent nasal congestion and sinus symptoms

  • Snoring

  • Waking frequently at night

  • Frequent sore throat

  • Obstructive or apneic periods during sleep (Obstructive Sleep Apnea)

  • Daytime fatigue

  • Behavior and concentration changes