Latch · Oral function
Could my baby be tongue-tied?
Tongue tie can cause breastfeeding problems — but it is not always the cause. The four tongue motions we look for, the signs worth an assessment, and why function matters more than appearance.
A tongue tie, lip tie or cheek tie — collectively tethered oral tissues, or TOTs — can absolutely cause breastfeeding problems. It just isn’t always the cause.
Sometimes the struggle is a low supply, an uncoordinated suck, or latch and positioning. And there are other things worth assessing that rarely get mentioned: a high palate, a hyperactive gag reflex, muscle tension, structure.
Which is why the answer isn’t a photo comparison or a checklist verdict. What matters is having both the breastfeeding and your baby’s oral function evaluated — can she drink well, and can she move her tongue properly?
IBCLCs are trained to assess oral function and refer on when it’s warranted. Most often that referral is to a pediatric dentist skilled in TOTs revision, by laser or scissors.
Good tongue motions
These are the four things we look for. A baby who can do all four is using her tongue well.
Extension. Sticks her tongue out.
Lateralization. Moves her tongue side to side.
Elevation. Lifts her tongue to the roof of her mouth.
Suction. Can suck and pull your finger or nipple to the back of her mouth with a real tug.
Signs that may point to a restriction
None of these alone confirms anything — but several together are worth an assessment.
- Pain with breastfeeding despite good latch and positioning
- Low milk supply, from milk not being removed well
- Can’t sustain a deep latch, with or without a nipple shield — leaking milk
- Noises other than swallowing while feeding: clicking, smacking
- An uncoordinated suck — a biting or chewing motion
- Long feedings, over 40 minutes, and not just now and then but most of the time
- Very frequent feedings
- Slow weight gain
- With a bottle: leaking, choking, or clicking and smacking
- Refusing a bottle or pacifier
A helpful resource with photographs: Catherine Watson Genna on identifying tongue tie.
Why the tongue matters
Beyond feeding, your baby’s tongue is doing a lot of work — eating, drinking, coordinating swallows, eventually talking. That’s part of why we assess function rather than appearance.
Our job is to assess oral functioning, build a plan that gets you to your goals, and stay with you while you work it.
The journey isn’t always easy. It is often deeply rewarding, and the outcomes for mothers and babies are frequently very good.
Please reach out.
If you have questions or concerns about this, or simply want to talk it through, we're glad to. Every consult — in-home, clinic or virtual — starts with listening.
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