Tongue Tie Feeding Problems: A Parent’s Guide to Early Intervention

Dr. Dina Chehab
Sep 16, 2025
13 min read

When Emma brought her three-week-old son, Noah, to Urbana Pediatric Dentistry, she was at her breaking point. "I thought something was wrong with me," she admitted, her voice trembling. "Everyone kept saying breastfeeding is natural, that it should just work. But every feeding was a battle."

Noah would latch for a few seconds, then slip off crying. Each feeding session stretched to over an hour, leaving both mother and baby exhausted and frustrated. Despite nursing constantly, Noah had lost weight since birth. Emma's nipples were cracked and bleeding, and the pediatrician had started suggesting formula supplementation.

What Emma didn't realize was that Noah's struggles weren't about her abilities as a mother or his willingness to eat. Hidden beneath his tiny tongue was a tight band of tissue that was preventing him from feeding effectively—a condition called ankyloglossia, more commonly known as tongue tie.

As a board-certified pediatric dentist who specializes in infant oral function, I see families like Emma and Noah every week. Their story is heartbreakingly common, but it's also one filled with hope. Because when tongue ties are identified early and treated with collaborative, comprehensive care, we can prevent not just feeding struggles, but a cascade of developmental challenges that can affect a child's speech, sleep, breathing, and overall quality of life.

Understanding Tongue Tie Feeding Problems

Ankyloglossia occurs when the lingual frenulum—the band of tissue connecting the underside of the tongue to the floor of the mouth—is unusually short, thick, or tight. This restricts the tongue's natural range of motion, preventing it from performing the complex movements necessary for effective feeding, proper speech development, and healthy oral function.

Recent research indicates that tongue tie affects approximately 8% of infants under one year old, though the actual prevalence may be higher due to underdiagnosis. The condition is more common in boys than girls and often runs in families, suggesting a genetic component.

But here's what many parents don't realize: a tongue tie isn't just about anatomy. It's about function. Two babies can have similar-looking frenulums, but only one may experience functional limitations. This is why comprehensive evaluation by professionals trained in assessing infant oral function is so critical.

The Four Types of Tongue Tie

Not all tongue ties look the same or cause the same degree of difficulty. Healthcare professionals often classify tongue ties using systems like the Coryllos grading scale:

Type I and II ties are anterior ties, visible near the tip of the tongue. These are easiest to identify during routine exams and often create the classic "heart-shaped" appearance when a baby tries to extend their tongue.
Type III ties involve thicker, less elastic tissue connecting from the middle of the tongue to the floor of the mouth. These can be more restrictive despite being less obvious visually.
Type IV ties are posterior ties, sometimes called "hidden" tongue ties. The restrictive tissue isn't always visible, but you can feel tight fibers when gently palpating under the tongue. These are frequently missed during routine newborn exams but can cause significant functional impairment.

The Immediate Crisis: How Tongue Tie Sabotages Infant Feeding

When Noah tried to breastfeed, his restricted tongue couldn't create the wave-like motion needed to extract milk efficiently from the breast. This led to a perfect storm of problems:

For the baby:

Inadequate milk transfer despite lengthy feeding sessions
Poor weight gain and failure to thrive
Excessive gas and reflux from swallowing air
Frustration, crying, and feeding refusal
Clicking or popping sounds during feeding
Frequent unlatching and re-latching attempts

For the mother:

Severe nipple pain and damage
Decreased milk supply from inadequate breast stimulation
Engorgement and risk of mastitis
Emotional distress and questioning of parenting abilities
Early cessation of breastfeeding

Studies published in Pediatrics demonstrate that when tongue tie causes significant feeding difficulties, early intervention with frenotomy combined with lactation support can dramatically improve breastfeeding outcomes for both mother and baby.

Beyond the Bottle: The Long-Term Consequences of Untreated Tongue Ties

Tongue tie feeding problems--yes, it's a thing. While feeding struggles are often what bring families to seek help, untreated tongue ties can cast a long shadow over a child's development. What starts as difficulty latching can evolve into a cascade of issues affecting multiple body systems.

Speech Development Challenges

As children grow, tongue mobility becomes crucial for clear speech articulation. Kids with unresolved tongue ties often struggle with sounds that require tongue elevation or complex tongue movements—particularly "L," "T," "D," "N," "S," and "Z" sounds. Many develop a frontal lisp or other articulation errors that persist despite traditional speech therapy because the underlying physical restriction hasn't been addressed.

Orofacial Myofunctional Disorders (OMDs)

A restricted tongue often develops compensatory movement patterns that become habitual over time. These orofacial myofunctional disorders include:

Tongue thrusting: Pushing the tongue forward against or between teeth during swallowing, speaking, or at rest
Low tongue posture: When the tongue rests on the floor of the mouth instead of against the palate
Mouth breathing: Breathing predominantly through the mouth rather than the nose
Messy eating: Difficulty chewing or managing food textures due to limited tongue coordination

As I discussed in our article about myofunctional therapy for children, these muscle dysfunction patterns don't just go away on their own. They require intentional retraining through specialized therapy.

Dental and Orthodontic Complications

Proper tongue posture plays a crucial role in shaping the dental arch and guiding jaw development. When a tongue tie forces the tongue into a low, forward position, it can lead to:

High, narrow palate formation
Crowded teeth and malocclusion
Open bite or crossbite
Need for extensive orthodontic intervention

The tongue should naturally rest against the roof of the mouth, providing gentle, constant pressure that promotes proper palatal width and forward facial growth. When this doesn't happen, the face literally develops differently.

Sleep-Disordered Breathing and Behavioral Issues

Perhaps the most surprising consequence of tongue ties is their impact on sleep and daytime behavior. Children with tongue ties are at higher risk for developing:

Chronic mouth breathing, even during sleep
Obstructed airway passages
Sleep-disordered breathing and pediatric sleep apnea
Restless, fragmented sleep
Daytime fatigue and difficulty concentrating

As I've written about in my article on how mouth breathing affects behavior, these sleep disturbances can manifest as hyperactivity, impulsivity, difficulty focusing, and mood dysregulation—symptoms that are sometimes mistakenly attributed to ADHD or other behavioral disorders.

The connection is clear: when children can't breathe properly through their nose, especially during sleep, their entire body suffers. And tongue ties are one of the physical restrictions that can set this cascade in motion.

The Power of Early Detection: What Parents Should Watch For

Trust your parental instincts. If feeding feels impossibly difficult or your child shows concerning symptoms, seek evaluation sooner rather than later. Here are the signs that should prompt a comprehensive tongue tie assessment:

In Newborns and Infants:

Difficulty latching or maintaining latch during feeding
Frequent clicking, smacking, or popping sounds while nursing
Sliding off the breast or bottle repeatedly
Excessive drooling or milk spillage from the corners of the mouth
Extended feeding sessions (over 45 minutes) with poor weight gain
Fussiness and frustration during feeds
Signs of reflux or excessive gas
Maternal nipple pain, damage, or distortion
Heart-shaped or restricted tongue movement when crying

In Toddlers and Young Children:

Persistent mouth breathing, especially during sleep
Snoring or restless sleep patterns
Difficulty with solid food textures or messy eating
Speech delays or articulation difficulties
Gap between upper front teeth
High, narrow palate
Forward tongue posture with mouth open at rest

In Older Children:

Speech sound errors despite speech therapy
TMJ pain or tension headaches
Orthodontic issues like crowding or open bite
Behavioral issues or difficulty concentrating at school
Signs of sleep-disordered breathing

The earlier these signs are recognized and addressed, the better the outcomes for your child's long-term health and development.

The Diagnostic Journey: Comprehensive Evaluation Makes All the Difference

When Emma brought Noah to our practice, I didn't just look at his tongue. I evaluated his entire feeding system—how his jaw moved, how his cheeks compressed, how his tongue coordinated with swallowing, and how the whole process functioned together.

A thorough tongue tie evaluation includes:

Functional Assessment:

Observing actual feeding, not just examining anatomy at rest
Assessing tongue range of motion and strength
Evaluating latch quality and suction pressure
Watching for compensatory movements
Checking for lip ties or buccal ties that can compound the problem

Maternal History:

Previous breastfeeding experiences
Nature and severity of nipple pain
Milk supply concerns
Family history of tongue ties or feeding difficulties

Physical Examination:

Visual inspection of the frenulum
Palpation to detect posterior ties
Assessment of tongue lift, lateralization, and extension
Evaluation of palate shape and oral cavity structure

According to the American Academy of Pediatrics, proper diagnosis requires both anatomical restriction of the frenulum and functional feeding difficulties. This is why collaboration between pediatric dentists, lactation consultants, and other specialists is so important.

The Village Approach: Collaborative Care for Best Outcomes

Noah's journey to successful feeding didn't involve just one provider—it took a team. At Urbana Pediatric Dentistry, we believe that the best outcomes happen when healthcare providers work together, each contributing their unique expertise.

Before Noah's procedure, we connected Emma with:

A Certified Lactation Consultant (IBCLC): These specialists are invaluable for optimizing positioning, latch technique, and post-procedure feeding strategies. They can identify subtle feeding issues and provide hands-on support that makes all the difference.
A Bodywork Specialist: Many babies with tongue ties develop compensatory tension in their neck, jaw, and shoulders. Gentle bodywork from a pediatric chiropractor or craniosacral therapist can release this tension and help the baby's whole body reset for better feeding.
The Pediatrician: Monitoring weight gain, overall health, and developmental milestones ensures that we're addressing all aspects of your baby's wellbeing.
Speech-Language Pathologists: For older children, SLPs trained in orofacial myofunctional therapy can retrain muscle patterns and address speech or swallowing difficulties.
This interprofessional approach aligns with current clinical consensus statements emphasizing that tongue tie management works best as a team effort, not a one-provider solution.

Treatment That Transforms: Modern Frenectomy Procedures

When conservative measures like improved positioning and lactation support aren't sufficient to resolve feeding difficulties, a surgical release called a frenectomy or frenotomy may be recommended.

At Urbana Pediatric Dentistry, we use state-of-the-art soft tissue laser technology for these procedures, offering significant advantages over traditional scissors or scalpel techniques:

Benefits of Laser Frenectomy:

Precise tissue removal with minimal trauma
Significantly reduced bleeding during and after the procedure
Lower risk of infection
Faster healing with less scar tissue formation
Can be performed without general anesthesia
Most babies can feed immediately afterward

The procedure itself typically takes less than five minutes. Noah cried briefly during the release but settled immediately when placed skin-to-skin with Emma. Within hours, she texted me photos of him nursing peacefully—the first truly comfortable feeding of his life.

Post-Procedure Care: The Critical Follow-Through

The frenectomy itself is just the beginning of the healing journey. To prevent reattachment and ensure optimal functional outcomes, we provide families with:

Active Wound Care:

Gentle stretching exercises performed 4-6 times daily for several weeks
Techniques to keep the release site open during healing
Pain management strategies (typically minimal discomfort is involved)

Feeding Support:

Continued lactation consultation to optimize new feeding patterns
Patience as baby learns to use their newly mobile tongue
Realistic expectations for improvement timeline

Functional Retraining:

For older babies and children who developed compensatory habits, myofunctional therapy may be necessary to retrain proper muscle patterns
Speech therapy if articulation issues have already developed
Ongoing monitoring of oral development

Studies show that improvement in breastfeeding typically begins within the first 24-48 hours after frenectomy, with continued progress over the following weeks as healing completes and new motor patterns develop.

Emma and Noah's Happy Ending—and New Beginning

Three months after Noah's procedure, Emma returned for a follow-up visit. The transformation was remarkable—not just in Noah, but in their entire family dynamic.

Noah was thriving: gaining weight beautifully, nursing efficiently in 15-minute sessions, and sleeping in longer stretches. He had even started babbling, his tongue moving freely to explore all the sounds a baby should make.

Emma had regained her confidence and joy in motherhood. "I finally feel like I can do this," she said, tears of relief in her eyes. "I don't dread feeding him anymore. It's actually become our favorite part of the day."

But perhaps most importantly, by addressing Noah's tongue tie early, we had prevented a cascade of future complications. He wouldn't need speech therapy for articulation disorders that never developed. He wouldn't struggle with crowded teeth or a narrow jaw because his tongue was already resting in the proper position, guiding healthy facial growth. He wouldn't become a chronic mouth breather with all the associated sleep and behavioral challenges.

Early intervention had changed the trajectory of his development—and his life.

The Critical Window: Why Timing Matters

While tongue ties can be treated at any age, there are compelling reasons to address them early:

In Infancy:

Establishes successful feeding patterns
Supports maternal breastfeeding goals
Prevents failure to thrive
Avoids compensatory habits that become ingrained
Simpler procedure with faster recovery

In Early Childhood (6 months - 3 years):

Before speech patterns solidify
During critical periods of jaw and palate development
While habits are still relatively easy to modify
Before dental misalignment becomes severe

In Older Children and Adults:

Can still provide significant benefits
May require more extensive myofunctional therapy to retrain established patterns
Often addresses chronic issues that have persisted for years
May prevent or improve TMJ dysfunction, orthodontic relapse, and sleep issues

The bottom line: it's never too late to address a tongue tie, but earlier is almost always easier—for both the procedure itself and the functional rehabilitation afterward.

When Your Child Needs Help: Taking the First Step

If you're reading this while struggling with feeding difficulties, speech delays, or any of the other signs we've discussed, please know that you're not alone. Thousands of families face these challenges every year, and there is effective help available.

Don't wait for problems to resolve on their own or for your child to "grow out of" symptoms. Tongue ties don't stretch themselves enough to restore normal function, and the compensatory patterns that develop while waiting can create their own complications.

At Urbana Pediatric Dentistry, we offer comprehensive tongue tie evaluations that assess both anatomy and function. We look at the whole child—not just their frenulum—to develop personalized treatment plans that address their unique needs.

Our collaborative approach may include:

Detailed functional assessment of feeding or speech
Coordination with lactation consultants and other specialists
Laser frenectomy when appropriate
Post-procedure care and monitoring
Referrals for myofunctional therapy when needed
Long-term follow-up to ensure optimal outcomes

The Bigger Picture: Oral Function as the Foundation for Whole-Body Health

Noah's story—and the hundreds of others like his that we see each year—illustrates a fundamental truth: oral function matters far beyond just teeth and mouth. The way a child breathes, swallows, speaks, and rests their tongue affects their facial development, sleep quality, cognitive function, behavior, and overall quality of life.

Tongue ties are just one piece of this puzzle, but they're often a critical piece. By addressing them early with comprehensive, collaborative care, we can prevent problems from cascading through multiple body systems. We can support children in developing to their full potential, with clear speech, restful sleep, proper facial growth, and the confident smile they deserve.

This is why I'm so passionate about education and early intervention. Every parent should know the signs of tongue tie. Every healthcare provider should understand the importance of functional assessment, not just anatomical appearance. And every family should have access to the coordinated, evidence-based care that makes such a profound difference.

Your Child's Journey Starts with Recognition

Whether you're a new parent struggling with feeding difficulties or the parent of an older child with speech delays or sleep issues, recognizing tongue tie as a potential contributor is the first step toward solutions.

Your story doesn't have to be one of continued struggle and frustration. Like Emma and Noah, it can be one of hope, healing, and transformation—where feeding becomes peaceful, speech develops clearly, sleep is restorative, and your child can thrive.

At Urbana Pediatric Dentistry, we've helped countless families navigate the journey from tongue tie diagnosis through treatment and into lasting oral health and function. We understand the challenges you're facing, and we're committed to providing the compassionate, comprehensive care your child deserves.

Dr. Dina Chehab is a board-certified pediatric dentist with advanced training in infant oral function, laser frenectomy procedures, and airway-focused dentistry. She leads Urbana Pediatric Dentistry with a commitment to evidence-based, collaborative care that addresses the whole child. Dr. Chehab has helped hundreds of families overcome the challenges of tongue tie and related orofacial disorders.

Ready to explore whether tongue tie might be affecting your child's feeding, speech, or development? Contact Urbana Pediatric Dentistry today to schedule a comprehensive evaluation. Early intervention can change your child's developmental trajectory—and your family's quality of life.

Frequently Asked Questions

How do I know if my baby has a tongue tie?

Signs of tongue tie in infants include difficulty latching during breastfeeding, clicking sounds while feeding, poor weight gain despite frequent nursing, maternal nipple pain, and limited tongue movement. During crying or when attempting to stick out the tongue, you may notice a heart-shaped appearance or that the tongue tip can't extend past the lower gum line. However, the most reliable way to diagnose tongue tie is through comprehensive evaluation by a healthcare professional trained in assessing infant oral function, as not all tongue ties are easily visible.

Can tongue tie cause problems beyond feeding?

Yes, untreated tongue ties can lead to a cascade of developmental issues beyond infancy. These include speech articulation difficulties (particularly with sounds like L, T, D, S, and Z), orofacial myofunctional disorders like tongue thrusting and mouth breathing, dental problems including high narrow palate and crowded teeth, and even sleep-disordered breathing that can affect behavior and cognition. The tongue plays a crucial role in facial development, proper breathing patterns, and oral function throughout childhood and into adulthood.

At what age should tongue tie be treated?

While tongue ties can be treated at any age, earlier intervention typically provides the best outcomes with the simplest recovery. For infants with feeding difficulties, treatment within the first few weeks or months can establish successful breastfeeding and prevent failure to thrive. For older children, addressing tongue tie before age three—during critical periods of speech and jaw development—can prevent many downstream complications. However, even older children and adults can benefit from tongue tie release, though they may require more extensive myofunctional therapy to retrain established compensatory patterns.

Is tongue tie surgery painful for babies?

Modern laser frenectomy procedures are designed to minimize discomfort for infants. The procedure itself typically takes less than five minutes, and babies usually cry briefly during the release but settle quickly afterward. Most babies can nurse immediately following the procedure, which provides comfort and pain relief. Post-procedure discomfort is generally minimal and can be managed with gentle pain relief measures if needed. The stretching exercises required during healing may cause brief fussiness, but this is temporary and crucial for preventing reattachment.

Will my child need speech therapy after tongue tie release?

Whether speech therapy is needed depends on your child's age at the time of release and whether they've already developed compensatory speech patterns. Infants and very young children treated before speech development typically don't need speech therapy. However, older children who've been speaking with a tongue tie may have learned incorrect tongue placement for certain sounds. These children often benefit from working with a speech-language pathologist, particularly one trained in orofacial myofunctional therapy, to retrain proper tongue positioning and movement patterns for clear speech production.

How successful is tongue tie treatment?

When tongue tie is properly diagnosed based on functional impairment (not just anatomical variation) and treatment includes comprehensive care with lactation support and appropriate follow-up, success rates are very high. Studies show significant improvement in breastfeeding outcomes for most mother-infant pairs within 24-48 hours, with continued progress over the following weeks. For older children, success depends on proper post-procedure care including stretching exercises and, when needed, myofunctional therapy to retrain muscle patterns. The key to success is the combination of skilled procedural technique, diligent post-procedure care, and collaborative support from multiple specialists.