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Tongue Tie in Babies

A tongue tie or ankyloglossia in medical speak is when a piece of tissue under the tongue called the frenulum restricts the movement of the tongue.

Everyone has a frenulum that attaches the tongue to the floor of the mouth, the difference with a tongue tie is the frenulum is tightened, short or closer to the tip of the tongue than it should be.

Tongue tie in babies will present differently to that of a child or adult. We detail this BELOW.

So why is the tongue so important?

The tongue moves several thousands of times per day during:

  • speech
  • eating
  • drinking
  • talking
  • swallowing

Mobile tongue movement is incredibly important from a young age as it’s these movements that sculpts the child’s face. When the tongue is positioned correctly (YES, there is a correct spot) with the tip resting just behind the two front teeth where they join the upper hard palate, it helps mould the hard palate into a broader space in the roof of your mouth which allows for proper dental development, a more open airway and prevents snoring. This can consequently mean less likelihood of upper respiratory infections and tonsillitis than with a higher, narrower shape of the roof of the mouth which typically develops if the tongue is tied.

There is also something called a lip tie when the piece of tissue attaching the lip to the gum attaches too low down to the teeth sockets not allowing free movement of the lip.  

tongue tie | baby with tongue tie

Sometimes baby tongue tie can look like baby cannot protrude tongue forwards

Symptoms of tongue tie in babies:

Tongue tie in babies should be considered if you notice some of the following. You don’t have to experience all of them, and it doesn’t have to be terrible. You just might notice that things seem a little difficult to feed baby. So consider:

  • Poor ability to latch or inability to stay latched (do you have to hold baby just right for latch?)
  • Sliding off the nipple-falling asleep at the breast (a tired tongue puts baby to sleep)
  • Regular clicking during a feed (not getting a closed suction)
  • Poor weight gain (but plenty gain ample weight!)
  • Maternal nipple pain or damage (mastitis, cracks, and bleeding) 
  • Compromised maternal milk supply (baby cannot drain well enough)
  • Dribbling milk at the breast of bottle (think how often you have to wipe)
  • Digestive issues such as increased gassiness or reflux-aerophagia (swallowing air during feeding) 
  • Poor control of the milk during swallowing (lack of coordination)

Symptoms in children or adults might include: 

  • A history of difficulty breastfeeding as an infant 
  • Speech challenges especially with the sounds: S – T – L – R – Ch – Sh – Th – F – Z 
  • Strong gag reflex 
  • Difficulty nose breathing 
  • Recurrent ear, nose, or throat infections 
  • History of bed wetting 
  • Extended pacifier/dummy use 
  • Thumb sucking, hair chewing or eyelash pulling 
  • Tiredness after speaking for extended periods 
  • History of decayed posterior teeth 
  • Frequent bad breath
  • Crowded teeth
  • Difficulty swallowing food or tablets 
  • Difficulty clearing mouth of food 
  • Slow eater
  • Sleep Apnoea 
  • Noisy breathing and/or snoring 
  • TMJ pain or jaw clicking 

What does tongue tie look like?

Not all shortened frenulum’s tie the tongue to the floor of the mouth. Some might stop the tongue moving either side or might stop us from poking our tongue out (how disappointing would it be not be able to stick your tongue out as a kid…or an adult for that matter!)  

You should be able to lift at least the tip of your tongue to the roof of your mouth, a severe tongue tie will hold all the way from the tip of the tongue 

A tongue tie diagnosis is usually picked up in a baby between a few days and weeks after birth, usually most notable during breast feeding.   

If you have a tongue that doesn’t work at full capacity then we start getting compensation from other muscles of the face & neck. Just like everywhere else in the body if something isn’t functioning as much as it should, another part will take up the slack. 

tongue tie in babies | child tongue tie | tongue tie


9 year old boy

Note crowded front & back teeth due to the narrow lower palate

Mouth breather | Slow eater | Food Texture Sensitive | Mumbling


History of chronic neck pain and headaches

Note crowded front teeth due to narrow jaw

Types of tongue tie in babies:

There are 4 main types and some are easily missed.

  1. Anterior to tip (classic heart-shaped tongue)
  2. Anterior but inserts behind the tip of the tongue (no heart shape)
  3. Posterior (or submucosal) with a visible tight frenulum
  4. Posterior but no thin membrane is present, so this type of tie is the most commonly missed. (The front and sides elevate, but the mid-tongue cannot.)

Each type can show severe or mild symptoms with feeding. But remember that even if feeding is not a big issue, the sculpting of the face relies greatly on a mobile tongue!

Anterior Tongue Tie

Anterior is the anatomical word for nearer to the front. An anterior tongue tie therefore has a restrictive membrane that is either close to the front or right at the tip of the tongue. If the tongue tie connects all the way to the tip of the tongue it creates a characteristic shape of a heart because the middle of the tongue is pinned downwards. This heart-shaped tongue is unfortunately sometimes the only characteristic your health professional might weight to diagnose a tongue tie. It couldn’t be further from the truth.

Posterior Tongue Tie

Posterior is the anatomical word for nearer to the back. With regard to tongue tie, this does not mean in your throat. We are still looking under the front of the tongue in the floor of the mouth. A posterior tie is not a great name for the position of this tie, submucosal is another word that is used. Posterior tongue tie can cause considerable issues even though it seems it shouldn’t be as bad as an anterior so don’t be swayed by a common phrase of “it’s not too bad”.

But I’ve been told that baby’s tongue tie is not too bad. What should I do?

Tongue tie can affect more than just breastfeeding. As stated above, when we grow the tongue movement moulds the jaw bones to widen the palate and lower jaw so the teeth have ample room. Without good tongue movement, those bones can remain too narrow. Another important point is that when the tongue muscle does not have good ability to perform it’s functions eg. swallowing, speech, eating, other facial and neck muscles called called upon to do the extra work. Over years this may end up with neck pain and headaches from an inefficient process.

So sometimes a tongue-tie that’s said to be “not too bad” is actually an issue later down the track. Another assessment may be in need!

Tongue Tie Treatment

Treatment from a dentist for a tongue tie will usually include using a laser, surgical scalpel, or scissors to release the tie.

Ideally seeing an Osteopath 1-2 days before the procedure and then 1-2 days after the procedure is optimal.  

Our job is to work closely with the dentist and myofunctional therapists and provide treatment before and then following up after the tongue tie procedure for the soft tissues of the face, neck and mouth. 

We have found that where tension, restrictions and limitation in these other structures are addressed alongside the frenulum release, the results of success are enhanced.

It has been our observation that patients who receive manual therapy from a suitably experienced or osteopath (who works with infants and knows the influence of lip/tongue ties, works with attachment areas of the tongue muscles), present with significantly greater mobility of the tongue, providing better access for surgery and greater potential for rapid improvement of function post-surgery.  

Body work may involve palpating various muscles or the soft bones of the face, head or neck to help with stabilisation of the soft tissue.

It can release the pressure and tension that results from the limited tongue and/or lip movement that occurs due to a tight frenulum. It may also have a flow on effect on the areas of the body that cranial nerves supply such as the Vagus nerve which affects intestinal movement as well as other organs. 

In adults prior to our referring to a reputable dentist, treatment through the mouth, head and neck can even provide improvement in chronic head and neck symptoms (as felt by one of our Osteopaths personally who has received treatment for tongue tie).

Other Osteopathy Services from Boroondara Osteopathy

An established clinic since 2004, our services extend further than tongue tie assessments & treatment. Given the frequency of aches & pains the community experiences, many of our clientele seek our help for neck and back pain, headaches, sports injuries, lifestyle challenges with age or pregnancy and treatment for people of all ages.

Much of our therapy is body work for muscles and joints, rehabilitation for joint, ligament or tendon problems and alongside this we have a strong reference point to consider the body as a whole structure rather the symptoms you attend for.

You can ask us further about what we do from our contact page.

Melbourne Mastitis Clinic

This niche service for breastfeeding women has quite the links to our tongue tie work given recurrent mastitis & tongue tie commonly occur. The Melbourne Mastitis Clinic treats many women daily for breastfeeding issues mainly mastitis, blocked ducts & engorgement with hands-on therapy & ultrasound. Our Osteopaths are also dedicated to teaching women about their breast structure & function to create a situation of self-sufficiency with breast health issues.

Find out more about the Melbourne Mastitis Clinic .

At Boroondara Osteopathy, we love to treat and find the long-term solution for residents in Balwyn, Balwyn North and surrounding suburbs.

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