Tongue Tie and Lip Tie in Babies: Signs, Causes, and Treatment

Feeding difficulties are common during the first few weeks of a baby’s life. Problems with latching, long feeding sessions, nipple pain, or slow weight gain may have several causes, including positioning, milk supply, oral coordination, or restricted tongue movement.

Tongue tie may contribute to feeding problems when it limits how the tongue moves. Lip tie is less clearly linked to feeding difficulties, and the appearance of the upper lip tissue alone does not mean treatment is needed. A professional evaluation focuses on how the baby feeds and functions rather than how the tissue looks.

What Is Tongue Tie in Babies?

Tongue tie, medically known as ankyloglossia, occurs when the tissue beneath the tongue restricts its movement. This tissue is called the lingual frenulum and normally connects the tongue to the floor of the mouth.

A restrictive frenulum may make it difficult for a baby to:

• Lift the tongue toward the roof of the mouth
• Extend the tongue over the lower gum
• Move the tongue from side to side
• Maintain the tongue movements needed for feeding

Some tongue ties are easy to see, while others are less noticeable. The appearance of the frenulum does not show whether it is affecting feeding. According to the American Academy of Pediatrics, a baby can have a visible tongue tie and feed without difficulty. 

What Is Lip Tie in Babies?

The upper lip frenulum is the band of tissue connecting the inside of the upper lip to the gum above the front teeth. Every baby has this tissue, and its shape, size, and attachment can vary.

The term lip tie is sometimes used when the frenulum appears thick or attaches close to the gumline. However, a prominent upper lip frenulum is common in babies and does not automatically cause a feeding problem.

Current evidence does not show that releasing an upper lip frenulum routinely improves breastfeeding. Treatment should not be recommended based only on a photograph or the location of the tissue.

What Is the Difference Between Tongue Tie and Lip Tie? 

Tongue tie and lip tie affect different tissues, and their significance depends on function rather than appearance alone.

Note: A baby may have either finding or both. An in-person examination should focus on movement, feeding function, and growth rather than appearance alone.

What Causes Tongue Tie and Lip Tie in Babies? 

Tongue tie and variations in the upper lip frenulum develop before birth as the mouth forms.

• Development before birth: The tissues connecting the tongue and upper lip change during fetal development. In some babies, the frenulum beneath the tongue remains short, thick, or restrictive.
• Genetic influence: Tongue tie may run in families, suggesting that genetics can play a role.
• No single confirmed cause: The exact reason these tissue variations develop is not always known.
• Not caused by the parent: Tongue tie and lip tie are not caused by anything a parent ate, did, or avoided during pregnancy.
• No known prevention: There is currently no proven way to prevent tongue tie or variations in the upper lip frenulum.

What Are the Signs of Tongue Tie and Lip Tie in Babies? 

Possible signs include:

• Difficulty latching: The baby may struggle to achieve or maintain a deep latch.
• Slipping during feeds: The baby may repeatedly come off the breast or bottle.
• Clicking sounds: Clicking may occur when the baby cannot maintain suction.
• Milk leakage: Milk may escape from the sides of the mouth.
• Long feeding sessions: Feeds may take longer than expected or occur very frequently.
• Feeding fatigue: The baby may become tired before finishing a feed.
• Poor milk transfer: The baby may feed often but still not receive enough milk.
• Slow weight gain: Inadequate milk intake may affect expected growth.
• Parent discomfort: Breastfeeding may cause nipple pain, cracking, blocked ducts, or incomplete breast emptying.

These signs may also occur because of feeding position, milk supply, bottle flow, reflux, prematurity, or oral coordination. An evaluation is needed to identify the cause.

How Do Tongue Tie and Lip Tie Affect Feeding? 

The tongue and upper lip support different parts of the feeding process.

• Tongue movement: The tongue helps create suction, control milk, and move it toward the back of the mouth.
• Restricted tongue motion: A tongue tie may make it harder to maintain a latch or transfer milk effectively.
• Upper-lip movement: The upper lip helps form a seal around the breast or bottle nipple.
• Lip-tie evidence: A thick or low-attaching upper lip frenulum does not always interfere with feeding.
• Functional assessment: Oral movement, milk transfer, feeding patterns, and weight gain matter more than appearance alone.

Feeding difficulties should not be linked to a frenulum without examining how the baby feeds.

How Are Tongue Tie and Lip Tie Diagnosed in Babies?

Diagnosis requires an in-person examination focused on movement and feeding function.

A pediatric dentist in Arlington, VA may assess: 

• Tongue mobility: How well the baby can lift, extend, and move the tongue.
• Upper-lip flexibility: Whether the lip moves comfortably during feeding.
• Frenulum structure: The location, thickness, and flexibility of the tissue.
• Sucking pattern: How the baby creates and maintains suction.
• Feeding duration: Whether feeds are unusually long or frequent.
• Milk transfer: Whether the baby receives enough milk during each feed.
• Weight history: Whether the baby is gaining weight as expected.
• Parent symptoms: Whether breastfeeding causes ongoing pain or nipple damage.
• Previous support: Whether latch, positioning, or feeding guidance has already been tried.

Photographs may show the tissue, but they cannot confirm whether it is causing a functional problem.

What Are the Treatment Options for Tongue Tie and Lip Tie in Babies? 

Treatment depends on the baby’s oral movement, feeding ability, growth, and overall health. The care plan may include feeding support, monitoring, or a procedure when a clear functional problem is present.

Feeding and Lactation Support

A lactation consultant or feeding specialist may help improve positioning, latch, bottle nipple selection, milk transfer, and sucking coordination. Many feeding concerns improve with these changes without requiring a procedure. Support often begins around your child’s first visit.

Monitoring Feeding and Growth

When symptoms are mild, the pediatrician may monitor weight gain, hydration, and feeding progress. The pediatric dentist can reassess tongue or lip movement if difficulties continue.

Tongue-Tie Release

A tongue-tie release may be considered when restricted tongue movement continues to affect feeding despite appropriate support. Depending on the tissue and technique used, the procedure may be called a frenotomy, frenulotomy, or frenectomy. When needed, sedation options help keep young patients comfortable. 

The dentist should explain the recommended approach, expected outcome, and aftercare before treatment. Improvement varies because other factors may also contribute to feeding difficulties.

Is Lip-Tie Release Necessary?

Most babies with a prominent upper lip frenulum do not need treatment. Based on current clinical guidance, lip-tie release may only be considered when restricted lip movement is clearly affecting function and other possible causes of feeding difficulty have been assessed. 

When Should You See a Pediatric Dentist for Tongue Tie or Lip Tie? 

A pediatric dental evaluation may be helpful when feeding concerns persist despite appropriate support.

Consider scheduling an appointment if your baby has: 

• Restricted tongue movement: The tongue cannot lift, extend, or move freely.
• Persistent latch difficulty: The baby repeatedly struggles to stay attached.
• Poor milk transfer: The baby feeds often but may not receive enough milk.
• Long feeding sessions: Feeds regularly take an unusually long time.
• Feeding fatigue: The baby becomes tired before finishing.
• Parent discomfort: Breastfeeding continues to cause significant pain or nipple damage.
• Unclear oral findings: You are unsure whether the tongue or lip tissue is affecting function.

An evaluation does not automatically lead to treatment. Observation, feeding support, or coordination with another healthcare professional may be recommended.

Contact your baby’s pediatrician promptly if feeding problems occur with poor weight gain, fewer wet diapers, unusual sleepiness, refusal to feed, or signs of dehydration.

Schedule a Tongue-Tie and Lip-Tie Evaluation in Arlington, VA

Concerned about your baby’s feeding or oral movement? Schedule an evaluation with Dr. Dina Ghaly-Habib at Little Diamonds Pediatric Dentistry, located at 3803 Fairfax Drive, Suite 100, Arlington, VA 22203. 

Call (571) 281-8714 to book an appointment.

FAQs 

Does every baby with tongue tie or lip tie need treatment?

No. Many babies with visible tongue or lip frenula feed well and grow normally without treatment. A procedure is usually considered only when restricted movement causes a clear feeding problem that continues despite appropriate lactation or feeding support.

Is laser treatment used for tongue tie and lip tie?

Both lasers and surgical instruments can be used for frenulum procedures. Dr. Dina Ghaly-Habib may use a LightScalpel CO₂ laser when appropriate, but the method depends on clinical findings, with alternatives, expected outcomes, and aftercare explained.

Will feeding improve after a tongue-tie or lip-tie release?

Improvement varies. Some babies respond quickly, while others need time and continued feeding support. Results depend on whether the restricted tissue was the main cause of the feeding problem.