Tongue ties are one of the most talked-about topics in breastfeeding community right now, and the advice out there swings between two extremes. Some say every feeding problem is a tie. Others say ties are over-diagnosed and revisions are rarely needed.
The truth is a bit more nuanced. Tongue ties are real, and some babies genuinely need a revision. But a tie is rarely the only piece of the puzzle, and plenty of feeding struggles have other causes entirely.
What is a tongue tie?
Everyone has a frenulum, the band of tissue under the tongue. A tongue tie (ankyloglossia) is when that tissue is tight, short or thick enough to restrict how the tongue moves.
The key word is restrict. Seeing a frenulum doesn't mean a baby is tied. What matters is whether the tongue can lift, extend and move side to side well enough to feed effectively.
How a tie can affect feeding
When the tongue can't move freely, a baby may struggle to stay deeply latched and remove milk well. Signs can include:
Painful latch, nipple damage, or nipples that look flattened or creased after feeds (lipstick shaped)
Clicking, losing suction or slipping off the breast
Long, frequent feeds with a baby who still seems hungry
Slow weight gain
Low supply, since milk isn't being removed effectively (note this usually happens later, not in the first two weeks)
Gassiness or reflux-like symptoms from swallowing air (excessive hickups)
These signs are real and worth taking seriously. But none of them is unique to tongue tie.
Other causes that can look like a tie
Many babies with these exact symptoms have no tie at all, or have a tie plus something else going on. Common contributors include:
Torticollis. Tightness in the neck muscles makes it hard for a baby to turn their head comfortably, which often shows up as a strong side preference and a shallow latch on one breast.
Body tension. Birth position, a long or fast labour, or interventions like vacuum or forceps can leave tension in the jaw, neck and shoulders that limits how wide a baby opens.
Oral dysfunction. Some babies have a disorganized or weak suck, a high palate, or low or high oral tone, which affects feeding regardless of the frenulum.
Latch and positioning. Sometimes small changes to how baby is held and brought to the breast make a big difference.
Supply and flow. A fast let-down or low supply can cause fussing, clicking and pulling off.
Prematurity or a sleepy baby. Early or jaundiced babies may simply not have the stamina yet.
This is why a revision on its own doesn't always fix things. If tension or oral dysfunction is part of the picture, it needs addressing too.
Assessment: function over appearance
A good assessment looks at how the tongue works, not just how the frenulum looks. In my practice, that means:
Taking a full feeding history for you and your baby
Watching a full feed
Assessing tongue lift, extension, side-to-side movement and suck
Checking jaw, neck and body for tension or asymmetry
Looking at milk transfer, weight gain and your supply
This assessment is not:
A quick sweep under the tongue without looking visually or feeling how the tongue moves (a suck assessment is critical to assess function)
No exam at all and history/questions only
Often the first step is working on positioning, latch and any body tension. If function is still restricted after that, a revision may be the right next step.
When a revision makes sense
Some ties do need to be released. When a tie is clearly restricting function and feeding isn't improving with other support, a revision can make a real difference for both baby and mom.
Revisions can be done with scissors or laser by a trained provider. Laser revision is a common choice because it allows a precise release with minimal bleeding.
What matters most is the plan around it:
Before: address body tension and set up feeding support, so baby is ready to use their new range of motion. (I like to start with infant physio and osteopathy by an RMT so it can be covered under benefits)
After: follow your provider's aftercare, including any recommended stretches, and keep working with your lactation consultant. Bodywork can also help after.
Expect a learning curve. Feeding often improves over days to weeks as baby learns to use their tongue in a new way.
When to get support
If feeding hurts, your baby isn't gaining well, or you suspect a tie, a full feeding assessment is the best place to start. It can sort out whether a tie is the issue, part of the issue, or not the issue at all, and what to do next.
At Village Lactation in Victoria, BC, I assess the whole picture and help you decide whether a revision makes sense for your family.
