Understanding Tongue Ties: What Parents Need to Know

Not all tongue ties look the same. Anterior tongue ties are the most recognizable — the frenulum attaches near the tip of the tongue and may cause a visible heart shape when the tongue extends. These are often identified early, sometimes at birth or during initial breastfeeding assessments.

Posterior tongue ties, sometimes called submucosal ties, are more hidden. The restriction is located further back under the tongue and may not be visible without a functional assessment. Despite being less obvious, posterior ties can be just as impactful on function. They are frequently missed by providers who rely on appearance alone rather than evaluating how the tongue actually moves.

In newborns, tongue tie often shows up first as breastfeeding difficulty. A restricted tongue cannot achieve the wide latch needed for efficient nursing, which can lead to poor milk transfer, slow weight gain, excessive gas, and reflux in the baby. For the nursing parent, the result is often nipple pain, cracking, clogged ducts, and a declining milk supply.

Other infant signs include a clicking sound during feeding, milk spilling from the corners of the mouth, falling asleep quickly at the breast without completing a full feed, and a tongue that cannot extend past the lower lip or lift to the roof of the mouth when crying.

As children grow, an unaddressed tongue tie can contribute to speech articulation problems, particularly with sounds that require tongue elevation like L, R, T, D, and N. It can also cause picky eating — especially with textures that require significant chewing — because the tongue cannot lateralize food effectively.

In teens and adults, tongue tie may manifest as chronic jaw tension, TMJ pain, headaches, neck tightness, mouth breathing, snoring, and sleep-disordered breathing. Many adults with undiagnosed tongue ties have compensated for years without realizing that their symptoms are connected to a restricted frenulum.

A frenectomy — the procedure that releases a tongue tie — addresses the structural restriction, but it does not teach the tongue how to function in its new range of motion. This is where orofacial myofunctional therapy is essential.

Pre-release therapy prepares the tongue by building as much strength, coordination, and range of motion as possible before the procedure. This gives the tongue a head start so it can immediately take advantage of its new freedom. Post-release therapy guides the tongue into proper resting posture, retrains swallowing mechanics, and prevents the wound from reattaching due to insufficient movement.

Without therapy, patients often develop scar tissue at the release site, the wound may reattach, and compensatory patterns persist. A frenectomy without therapy is like having knee surgery without physical rehabilitation — the structural fix alone is rarely sufficient.

Tongue tie treatment works best as a collaborative effort. An experienced release provider (often a pediatric dentist or ENT), an orofacial myofunctional therapist, and in some cases a lactation consultant or speech-language pathologist should all be part of the care team.

If you suspect a tongue tie in yourself or your child, starting with a myofunctional therapy assessment is an excellent first step. The therapist can evaluate tongue function, identify related oral posture and breathing issues, and coordinate with the appropriate release provider if a frenectomy is indicated.