Tongue Tie Facts 

Frequently asked questions

General FAQ's

  1. What symptoms are related to a tongue tie?

1. For babies: most moms will complain of difficulty in breast feeding. These difficulties include painful feeding sessions, cracked and possibly bleeding nipples, baby being fussy at the breast, baby is unable to drain the breast due to a lack of transferring milk, baby eats frequently for long periods of time (30-45minutes), lack of weight gain, reflux symptoms, overly gassy and uncomfortable from gas, swallowing difficulties and possible torticollis.
2. For older infants: you might see issues with developmental milestones regarding feeding. Babies might have a hard time transitioning to solids, they may gag on pureed foods, gag and choke on puffs or wafers, and a lack of wanting to try new textures of foods. Some babies can still experience reflux, lack of good sleeping habits by waking frequently at night, and difficulty transitioning to sippy cups.
3. For toddlers: you might start to notice that all the above symptoms were present, and now your child is experiencing difficulty articulating certain sounds. Toddlers will also continue to be hesitant on trying new textures of foods. Kids at this age can start to show symptoms of hyperactivity due to lack of proper sleep cycles. Some toddlers or young kids will be very noisy breathers as well 4. For additional details check out the signs & symptoms page

  1. How do I know if my baby needs a lip tie release?

  1. Lip releases are not always needed. Signs that a baby still needs a lip release include continued reflux symptoms, excessive gas and baby is uncomfortable from gas, continued clicking, gulping, baby popping on and off the breast, fussy at the breast, slides off the breast easily, frequent spit ups or vomiting. A lip tie causes the mouth to be tight and therefore unable to properly create a seal around the breast or bottle and therefore air is swallowed with each feeding.
  2. On a side note, babies can have worsening of these symptoms after the tongue release because as their suck gets better they end up swallowing even more air.

How is the lip tie release different than the tongue tie release?

The procedure itself is very much similar, and local anesthetic (lidocaine) is still used. Majority of babies do better after the lip release because it is a piece of skin that is opened versus muscle tissue. Also, the stretches are a bit easier since you are not opening their mouth, and not messing with muscles.

  1. What grade is my baby’s tongue tie and when is it bad enough to be released?

The degree or grade of a tongue tie is not the deciding factor in whether a procedure is indicated. If you are experiencing symptoms related to the ties, that is when a procedure is warranted. Doing a procedure when symptoms or complications are not present only to prevent potential issues later, is not a cause for a procedure at this time.

  1. What will I experience on the day of the appointment of the procedure?

  1. On the day of the appointment, please arrive at your designated time. You can feed your baby upto 30 minutes (or earlier) prior to your appointment, but please do not in the office. You can feed the baby immediately after the procedure.
  2. Dr. Agarwal will come in and see you and the baby, the medical staff that assists with the procedures will take the baby into the treatment room and get the baby swaddled.
  3. Dr. Agarwal will inject a small amount of numbing medicine (lidocaine) into the area being treated for release by laser. The laser is used for ~10-20 seconds and then the same medical staff brings your baby right back to you.
  4. Dr. Agarwal will come back to see you and answer any questions. He will show you how the tongue moves and let you know how the procedure went.
  5. You will be encouraged to feed the baby immediately after the procedur

Why is Dr. Agarwal hesitant about doing both the lip and tongue release together?

Many babies do have a tight lip tie that goes along with their tongue tie, although not all babies will need the upper lip released, so why have an added procedure done if it is not needed. Many of the symptoms that are causing the difficulty feeding can be eliminated by just performing the tongue release. So, allowing one procedure to be done and see how things improve before adding another to the recovery process. Also, some babies are sensitive and do sometimes have a difficult time relearning to eat after the tongue release, adding two painful areas can slightly increase the chances of oral aversion, reattachment, and longer difficulties breast feeding, so if we can avoid that by spacing things out, in most cases this has provided the best feeding success. Although every case is different, and Dr. Agarwal will weigh the risks for each patient and decide with the family the best approach.

Why does Agave Pediatrics have us come for a consult and then a procedure and subsequently a follow up?

Agave Pediatrics, under the direction of Dr Agarwal, is one of the leading specialists in the country in management of tongue and lip ties. We have developed a standard of practice that is now followed by other practitioners too. Tongue / lip tie releases are considered surgical procedures, and while the procedure itself is very quick, there still needs to be a full assessment of your baby or child prior to performing any surgical procedure. This standard of practice of having a consult done by one of our very knowledgeable practitioners to fully assess your child, assess their symptoms related to the tie is necessary to fully assess the function of the tongue and lip, and to discuss the entire procedure and the after care. We want all of our parents to be completely informed of why or why not the procedure is indicated, risks and benefits, and take the time to answer any questions. You then have the ability to go home and make sure you are comfortable proceeding with a surgical procedure and your appointment is scheduled. You then come back for a follow up, just like you would any surgical procedure to make sure things have healed well, and to make sure symptoms have improved. While we know it can be a very stressful time having a baby who is struggling to breast feed, or feed in general, we want to make sure we are providing procedures safely and each baby or child is looked at from all angles, not just their tie.

Exercises Related FAQ's

When and how often do we do the exercises / stretches, and how do I know I am doing them correctly?

  1. The stretches post procedure are extremely important as this is what is allowing the wound to heal in an open position versus in a closed position that can lead to “reattaching”. The process of getting the tip of the tongue up and back and then going across the wound will help to detach the fibers that are trying to close the wound, and that is not what we want. Getting the tongue to move side to side is helping the tight oral muscles to stretch and to move in the natural way the tongue should move. The stretching exercises are shown in this video
  2. The recommended amount of times per day is about 6. Try them at all different times of the day. If your baby is under 2 months, some babies might sleep through them. If you can only do them with one finger, that is ok as long as you are getting the movements done.

When I do stretches my baby pulls his tongue down and back and I can’t get under there.

a. There are wonderful videos of how to do the stretches. Although these babies are very cooperative, your baby will probably not be as cooperative and that is very normal. All we can ask if that you do your best, finding times when your baby is the most relaxed is the best. Some it’s right before diaper changes, some its right after a feeding, some it’s while sleeping. You decide what time you feel is right but try and switch it up. Before feedings is not always recommended because it can cause discomfort which might not be the best for feedings.
b. If your baby is clamping down on your fingers, try this technique. Lay your little one down, use one hand and place your palm on the side of their face and put your thumb in between their gums so they bite down on your thumb, then use your pinky finger on the other hand to do the stretches, then switch sides. Sometimes this can be helpful.

My baby wont suck on a pacifier or my finger, how do I do the suck training?

Many babies do not perform “nonnutritive sucking”. A baby wont suck on something they do not find comforting. While some babies wont function without a pacifier in their mouths. If you can try a drop of breast milk on your finger and see if they will suck that way and then try a little tug here and there, it will be beneficial. If your baby wont suck or just gives up when you start to tug, that is ok, just keep trying.

Can my baby sleep through the night without stretches or should I wake him / her up?

Preferably the stretches should be done around the clock in spaced out intervals, but we do not want to wake a sleeping baby if we can let them go an extra hour or two. If your baby sleeps 6-7 hours at night, just do a good session prior to sleeping, and as soon as they wake up. Keep in mind that also without waking up for stretches they are not having any pain control at night and might be in a bit more pain when you do the stretches first thing in the morning.

Post Procedure Related FAQ's

When do I start pain medication at home?

Each baby metabolizes the numbing medicine (lidocaine) differently so starting pain control before your little one is in a lot of pain is very important. Starting Tylenol (or Ibuprofen or Arnica) within the first few hours of being at home is recommended. Also, keeping on top of dosing will be very beneficial to making sure this transition goes as smoothly as it can. If your baby is at the peak of pain before control medication is started, it can become very difficult to get him / her calmed down enough to eat. So, staying on top of pain is very important.

When should I see a Lactation Consultant (IBCLC)?

It varies. Some parents see a Lactation Consultant (LC) on the day of the procedure even though your baby may be in pain or very sleepy after the procedure. The 3-5 days after the procedure can be some of the roughest days for your little one, so trying new positioning and new feeding techniques might be overwhelming. Discussing this with a LC on the day of your visit and / or with your provider would be the optimal way to identify the best time to see a LC for a follow up and for trying new feeding techniques.

How can I tell if there is reattachment?

a. Reattachment is a scary word and the thought that a baby may need to go through another release procedure can be very stressful. Reattachment is a risk after the surgery but it is a minimal one. All wounds heal, and we just ask that you do your best when it comes to stretches to hopefully prevent the healing process from doing its job. If your baby has improved in feeding, and symptoms have decreased, and you have been doing the stretches, the risk of reattachment is very minimal.
b. If you start to feel a bump in the area, the wound has significantly closed before day 7 post procedure, or you feel a tightening of the tongue movement during stretches please call the office for a follow up to check for re-attachment.
c. Also, if you were told that your baby had a very tight tongue tie, sometimes what may happen is that the deeper muscles may have come forward after the more surface ones were released. It is not the same as reattachment and can be a potential problem but a very minimal one.

What is all the talk about Chiropractic therapy or CST and do I need to do it?

When a baby develops in utero with tongue and / or lip ties, it’s not just those areas that are tight, the muscles of the head, neck, face, and back can also be tight. Releasing the tongue tie addresses just one of the muscle structures that is loosened. But many other muscular areas are still very tight, even after the tongue release, and chiropractic therapy performed by someone who specializes in children using Cranial Sacral Therapy (CST) may be what would be needed if you chose to explore this option.

What is that white patch of skin under the tongue/lip and do I try and scrape it off?

a. The white area is the mouth’s way of putting a scab on the wound. Do the stretches by rubbing the wound vertically and horizontally.
b. The wound usually developed around days 2-3 and last until about day 10-14.

What is the white stuff on the tongue and is it thrush?

This is a normal layer that develops in babies with tongue ties. However, babies who do not have ties are able to rub their tongue up against the roof of the mouth which wipes that layer off. Babies with a tongue tie and high palate are unable to do so, so the white layer is normal and will eventually be scraped off as the tongue movement improves.

Is Tylenol safe to give if I suspect my child has the MTHFR genetic mutation?

Many parents are now suspecting this genetic mutation in their babies and concern is starting to spread with the wide variety of social media information. If you have concerns, please address them with your provider and also your pediatrician prior to this appointment.


Tongue Tie can be familial. If one child has it; other children may also have it. Agave is studying the genetics of tongue tie


Tongue Tie can present in many ways and may need a health care professional to diagnose it


Tongue Tie can be successfully treated in a majority of children


Agave has has developed a compassionate and evidence based approach to tongue tie care that is provided by a multi-disciplinary team


Tongue tie care is very easy to obtain at Agave. Just contact us

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