birth center, birth team, Breastfeeding, Fear, First Baby, Home Birth, hospital birth, Lactation Consultant, Lip tie, Midwife, Midwife's Assistant, Newborn, Newborn Exam, Normal Newborn Weight Loss, Nurse, OB, Pediatrician, Postpartum, Supplementation, Tongue tie

Testing Tuesdays: Tongue and Lip Ties

Photography: Daniela Rey

Awareness around tongue/lip ties and breastfeeding problems has increased recently, but there’s still confusion.  

In 2015 I shadowed Bobby Ghaheri, ENT on a day of revisions. I learned I’m not qualified to diagnose and treat ties. Many aren’t. I’ve heard midwives, peds, and even some LCs state that baby has no tie on exam, only to see a parent-baby dyad struggle for weeks before visiting a specialist. 

I look for the following problems in the early days and refer to an ENT or pediatric dentist for evaluation:

  • Clicking
  • Poor breast drainage
  • Leaking out the mouth
  • Shallow latch
  • Popping off 
  • Poor weight gain
  • Falling asleep at breast
  • Indigestion
  • Nipple shaping, cracking, bleeding, bruising
  • All of the above may happen even when the latch appears to be great on observation of nursing

If baby is treated, the next step may be to see an LC who knows tie “rehab”.  Some babies won’t need LC help after treatment. 


  • Tongue and lip tie prevent baby from using its mouth to nurse properly
  • It’s not true that a baby who can stick their tongue out has no tie. The tongue may be constricted in other directions
  • Most babies respond well to only tongue release, even if lip-tie is present 
  • A lip will be tied with no tongue-tie 1% of the time 
  • Ties come in different “classes,” but they don’t describe severity
  • Ties may cause tooth decay, speech, or orthodontia problems, but not always. With easy breastfeeding and a tie, some providers say revise now. Others say, wait to treat
  • There is almost always a posterior tie behind an anterior tie. Just clipping the anterior won’t help
  • Laser and scissor releases have about the same effects
  • Most care providers recommend “stretches” after, to keep the wound from healing back to “normal” 
  • Treatment won’t need general anaesthesia but some providers give a local injection

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