Signs & Symptoms

Tongue & Lip Ties - Signs & Symptoms

Tongue tie in infant
Lip tie in infant


Breastfeeding: Infant Symptoms

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 known to improve a child’s immune system, is a contributor to a higher I.Q., is a protective mechanism that lowers a child’s risk of contracting illnesses and developing allergies, and has been proven to reduce the risk of breast, ovarian, and uterine cancer in mothers.[1-3] Breastfeeding is normal, natural, and a beautiful biological process. It is a skill that commonly takes a bit of time for each mother and infant to master, and is 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[4-6]. An upper lip tie can limit the ability of the baby’s upper lip to form an adequate seal while breastfeeding.[6-8] ● 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

Breastfeeding: 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 infant


Bottlefeeding Infant's Symptoms

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

Solid Foods

Eating Solids

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. 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. Symptoms: ● 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 (chunks of meat in sauce, pieces of pasta in soup, etc.) ● Avoiding certain foods ● Difficulty with textured foods (chunky/thicker purees, oatmeal, etc.) ● Difficulty with complex solids that require more efficient chewing patterns (meats, breads, raw vegetables, etc.) ● Prolonged mealtimes and frequent reminders to chew, to take another bite, to not pocket foods, etc. ● Extremely small bites of food, and prolonged times to clear them ● Needing to drink between bites to clear food ● Dipping food excessively to moisten it


Speech Problems

An undiagnosed or untreated tongue tie may negatively affect speech.[9-11] 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. 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. Symptoms: ● 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


Sleep/Breathing Problems

An undiagnosed or untreated oral tie may lead to an increased risk for physiologic alterations resulting in poor breathing and sleep quality, and evidence suggests that normal development of the cranial, facial, and neck structures is positively impacted by long-term breastfeeding.[11-13] 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. 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: ● 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


Dental Problems

There are many dental problems that can arise with undiagnosed or untreated tongue/lip ties.[13-15] Some dental symptoms are due to the inability to clear food adequately, while others are due to the physical restriction of tight oral tissues. Symptoms: ● Gap/diastema between two front teeth ● Tongue getting stuck between front teeth ● Gum disease ● Gum recession ● High palate ● Cavities/dental caries ● Overbite ● Open bite ● Crooked teeth


1. Bartick MC, Schwarz EB, Green BD, et al. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr. 2017;13(1):e12366. doi:10.1111/mcn.12366

2. Brahm P, Valdés V. Benefits of breastfeeding and risks associated with not breastfeeding. Rev Chil Pediatr. 2017;88(1):15-21.

3. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490. doi:10.1016/S0140-6736(15)01024-7

4. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110(5):e63. doi:10.1542/peds.110.5.e63

5. Berry J, Griffiths M, Westcott C. A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding. Breastfeed Med. 2012;7(3):189-193. doi:10.1089/bfm.2011.0030

6. Benoiton L, Morgan M, Baguley K. Management of posterior ankyloglossia and upper lip ties in a tertiary otolaryngology outpatient clinic. Int J Pediatr Otorhinolaryngol. 2016;88:13-16. doi:10.1016/j.ijporl.2016.06.037

7. Patel PS, Wu DB, Schwartz Z, Rosenfeld RM. Upper lip frenotomy for neonatal breastfeeding problems. Int J Pediatr Otorhinolaryngol. 2019;124:190-192. doi:10.1016/j.ijporl.2019.06.008.

8. Wiessinger D, Miller M. Breastfeeding Difficulties as a Result of Tight Lingual and Labial Frena: A Case Report. J Hum Lact. 1995;11(4):313-316. doi:10.1177/089033449501100419.

9. Ito Y, Shimizu T, Nakamura T, Takatama C. Effectiveness of tongue-tie division for speech disorder in children. Pediatr Int. 2015;57(2):222-226. doi:10.1111/ped.12474

10. Messner AH, Lalakea ML. The effect of ankyloglossia on speech in children. Otolaryngol Head Neck Surg. 2002;127(6):539-545. doi:10.1067/mhn.2002.129731

11. Baxter R, Merkel-Walsh R, Baxter BS, Lashley A, Rendell NR. Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study. Clin Pediatr (Phila). 2020;59(9-10):885-892. doi:10.1177/0009922820928055

12. Govardhan C, Murdock J, Norouz-Knutsen L, Valcu-Pinkerton S, Zaghi S. Lingual and Maxillary Labial Frenuloplasty with Myofunctional Therapy as a Treatment for Mouth Breathing and Snoring. Case Rep Otolaryngol. 2019;2019:3408053. doi:10.1155/2019/3408053

13. Chen X, Xia B, Ge L. Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition. BMC Pediatr. 2015;15:46. doi:10.1186/s12887-015-0364-1

14. Meenakshi S, Jagannathan N. Assessment of lingual frenulum lengths in skeletal malocclusion. J Clin Diagn Res. 2014;8(3):202-204. doi:10.7860/JCDR/2014/7079.4162

15. Vaz AC, Bai PM. Lingual frenulum and malocclusion: An overlooked tissue or a minor issue. Indian J Dent Res. 2015;26(5):488-492. doi:10.4103/0970-9290.172044