How to Tell if Baby is Tongue Tied
Have you been having breastfeeding problems? Perhaps you’ve heard of tongue ties in babies.. They are gaining in popularity. Are you staring at the screen after typing into Google “how to tell if baby is tongue tied”?
The good news is that I’ve been there. My first baby was diagnosed with a tongue tie and we had a really difficult time at first. You can check out my whole story about my baby’s tongue tie here. And please do! Then you’ll have a bit of an understanding of where I’m coming from.
So let’s talk about how to tell if your baby is tongue tied… and what you can do about it.
What is a tongue tie?
A tongue tie is a medical term used for a tongue that is tethered too tightly to the bottom of the mouth. The connective tissue that connects your tongue to the bottom of your mouth is called a frenulum. When this tissue is too far forward or causing the tongue not to move properly, it’s called a tongue tie.
There are two different types of tongue ties in medical literature, although controversy surrounds them. They are called anterior tongue ties when they attach at the tip of the tongue and posterior tongue ties when the tongue’s tip is free. Click here to learn more about what anterior and posterior tongue ties are.
Who can diagnose a tongue tie?
First, let’s talk about who can diagnose a tongue tie.
Different medical providers are able to do different things. For example, a doctor has the ability to diagnose people with diseases and conditions, however, a nurse cannot diagnose. Nurses can assess for abnormalities but they cannot difinitively tell someone whether or not they have a condition.
When it comes to a tongue tie, here are the people that can diagnose:
- A doctor (pediatrician or ENT)
- A dentist
- A nurse practitioner
- A midwife
A lactation consultant CANNOT legally diagnose a tongue tie. If a lactation consultant tells you that your baby has a tongue tie, they are acting outside of what they’re legally allowed to do.
There are many reasons for this but mainly people with higher qualifications have a greater understanding of how certain things affect the body as a whole.
That’s why I think the BEST person to diagnose your baby with a tongue tie is your pediatrician. They know your baby’s history and they know how a tongue tie surgery can affect things down the road. They will consider breastfeeding, infections, scar tissue and more.
I see a lof of moms get referred to pediatric dentists. Their specialty is the mouth, and they know what a “perfect” mouth should look like. But people aren’t perfect and unfortunately there seems to be a lot of overdiagnoses happening from these places. Sometimes a variation of normal is deemed a problem – but in reality the tongue works just fine.
Pediatric dentists make a lot of money from tongue tie revisions, and sometimes to a hammer everything looks like a nail. While I believe they truly want what’s best for their patients, I think sometimes they become too focused on the mouth.
They fail to consider the baby and mother as a whole. Tongue tie revisions, especially with a laser, can have disastrous consequences. My first baby had her tongue lasered and what followed was the worst 6 weeks of my (and her) life.
That’s why more needs to be considered when deciding what to do with a tongue tie. It depends on how severe the tie is, whether there is a tie at all, or what else could be causing symptoms.
The benefit of the surgery should outweigh the risk and consequences.
And the tongue tie needs to be deemed severe enough to need revision. Next, I’ll talk about what true signs of a tongue tie are and the best way to diagnose one. (Make sure the provider you go to does this!)
True Tongue Tie Signs
When you’re wondering how to tell if your baby is tongue tied, the first thing to do is find the right provider. My recommendation is to ask a pediatrician, and get a second opinion (or third, or fourth).
When you see someone who knows how to assess for tongue ties and make an accurate diagnosis, they will do these things:
- Test how your baby can move their tongue in different directions.
- Examine your baby’s tongue.
- Determine how your baby sucks.
- Ask about your baby’s medical history.
- Ask about your medical and breastfeeding history.
FUNCTION needs to be assessed as well as APPEARANCE! A diagnosis shouldn’t be made based on either alone. Function and appearance go together.
If you or your baby is truly experiencing extreme difficulty in one of the above areas, then a tongue tie might be diagnosed.
How can you know that the diagnosing provider is accurate though?
There are multiple types of assessment tools available. Some are better than others. The BEST diagnosis tool for tongue ties is the Hazelbaker Assessment Tool for Lingual Frenulum Function. It’s the most comprehensive tool and errs on the side of caution. It assess for both your baby’s tongue function AND what it looks like – so your baby won’t have to go through surgery unnecessarily.
Tongue Tie Signs: Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF)
The ATLFF is the best way for how to tell if baby is tongue tied.
There are other tests out there but none of them test as thoroughly for function and what the tongue should look like.
This assessment is the best because it only recommends surgery if it’s determined necessary. Some babies go through tongue tie surgery and it doesn’t help. The ATLFF will weed out those that don’t need surgery from those that do.
In babies that still function well, there’s no need to clip their tongue. This test for true tongue tie signs will determine if the tongue is really the issue. Sometimes other conditions have similar symptoms as a tongue tie.
Other conditions could include:
- Low tone
- Late term birth
- Other medical problems
Using the Hazelbaker Assessment Tool for Lingual Frenulum Function will either determine that the tongue tie is causing the problems in your baby or it will rule a tongue tie out.
Here is how to tell if baby is tongue tied with the ATLFF:
- Appearance Items: this section explains how the tongue appears. The appearance of the tongue is important but not the only thing a provider should look at. Some tongue ties appear worse than others but can function well. On the other hand some don’t function well but look normal.
- Function Items: this section is for assessing how the tongue moves and functions. It includes moving side to side, lifting, extending, and spreading.
A provider should assess what your baby’s tongue looks like AND the function. The ATLFF only recommends surgery if function is impaired.
The other good thing about this assessment tool is it recommends other management. A score lower than 11 recommends management such as chiropractic, infant massage, craniosacral therapy, or other bodywork. Only if that management fails should surgery be considered.
It only recommends surgery if the total score is less than 8, and those would be severe cases where surgery is indeed warranted.
Dr. Hazelbaker who created this evidence-based assessment is a craniosacral therapist. She’s found in her patients that didn’t score low enough to get surgery, the problems they did have were solved with bodywork and time. Often babies have what’s called torticolis from birth; a tightening of the neck muscles. They show many symptoms of tongue-tied babies. Bodywork will help these babies while cutting the tongue will not help if torticollis is the problem.
What does a tongue tie look like in baby?
A true tongue tie looks like the tongue being attached to the bottom of the baby’s mouth. Severe tongue ties are called anterior tongue ties. They attach the tongue to the bottom of the mouth at the front.
Babies with anterior tongue ties cannot move their tongue forward over their gums. When they try to lift the tongue, the middle front portion stays at the floor of the mouth. It looks like a heart-shape because the sides can come up but the middle stays down.
False Tongue Tied Baby Symptoms
A consensus statement was issued in 2020 after a thorough review of the criteria for diagnosing tongue ties. This study was interesting because there wasn’t a lot that different providers agreed on because diagnosing a tongue tie can vary wildly from one provider to another.
But the consensus did agree upon this:
“a diagnosis of ankyloglossia without limited tongue mobility and/or without a restrictive lingual frenulum should be reconsidered.”
In other words, diagnosing a tongue tie shouldn’t be taken lightly and should only happen if the tongue truly cannot move well and has a restricted connection.
But that’s not always the case. I’ve seen people diagnose babies with a tongue tie based on false symptoms.
Here is a list of false tongue tied baby symptoms:
- Lip blisters. These are a normal finding! Many babies have lip blisters in the newborn phase. They are common and don’t signify a tongue tie.
- Lip creases. Lip creases are common in normal babies. When their lip flanges out while breastfeeding, it may crease.
- Lip tether. Lips are meant to be attached by a frenulum as well. This doesn’t mean your baby has a lip or tongue tie requiring surgery.
- Lip tuck. Babies often tuck their lip while breastfeeding. It should be flanged out for a good latch, but you can just slide your finger under their lip to pull it out after they latch.
- Two-tone (white) tongue. High-fat milk will cause the back of a baby’s tongue to appear white. This is a common and normal fonding in many babies.
- High palate. This is a VERY common false sign. Some babies with tongue ties have a high palette. But some babies with a high palette don;t have a tongue tie at all. It is not a sign of a tongue tie in itself.
- Tongue dents. If there are dents in your baby’s tongue, it could be normal. When babies cry they tense up their tongue and dents may appear. They don’t mean your baby has a tongue tie.
- Tongue curling or cupping. This is actually a normal movement for a tongue. A normal tongue should cup or curl around a finger or bottle- it is certainly not indicative of a tie.
- Frenulum pop. Every single person in the world has a frenulum. Your tongue MUST attach to the bottom of your mouth somehow. When you pull on the frenulum, it will “pop” if you press hard enough (whether or not you have a tie).
- Snoring. This is something that your pediatrician should know about and it could be caused by many things including airway problems. It’s not a sign of a tongue tie.
- Clicking while breastfeeding. Some babies click while they are eating. Usually it can be fixed with positioning or changing the latch, but sometimes it isn’t a problem. Your baby may just swallow some air and need to be burped a bit more. If it doesn’t hurt and baby is gaining weight, clicking isn’t a problem in itself that needs surgery to fix.
- Breastfeeding problems. There are many reasons why breastfeeding is difficult. A tongue tie is sometimes the culprit, but breastfeeding can be hard even without a tongue tie. Sometimes it’s because a mom has flat nipples; it has nothing to do with the baby’s anatomy.
As you can see, there are a lot of things listed as signs of a tongue tie. It would pretty much make anyone think their baby has a tongue tie, especially because many are normal findings.
The most important things to ask yourself when it comes to breastfeeding and tongue ties are:
Is my baby getting enough milk (gaining weight and having poopy diapers)?
Does breastfeeding hurt?
If your baby is getting enough milk and breastfeeding doesn’t hurt, don’t let someone tell you that there’s a problem where there isn’t one!
Putting your baby through surgery should be a last resort. Surgery can result in infections, bleeding, excessive scar tissue, and other unintended consequences. Cutting a baby’s tongue is a risk that should only be done if necessary.
Diagnosing Tongue Tie
I hope you have a better idea about how to tell if your baby is tongue tied. I know it isn’t easy because there isn’t a cohesive list of tongue tied baby symptoms.
Having a list of true tongue tie signs would be nice…
But the fact that there isn’t one means that it should be taken seriously; since tongue tie signs vary depending on who you talk to and cutting a baby has consequences.
People that diagnose many tongue ties often make good money from tongue tie surgery.
If your baby truly has tongue tie signs, a good provider will assess for function and make sure surgery is the best way to go.
I never recommend a laser to any mama. If there really is a tongue tie, a snipping should be enough to solve the problem.
A laser creates a lot of scar tissue and results in painful stretches for the next 4-6 weeks afterward. Sometimes babies go back for another tongue tie revision because things didn’t get better the first time. The most I’ve heard of is 4 times to get the tongue revised.
In some studies, the diagnosis of tongue ties has changed on the same baby. An hour later, the baby may be said to have a tongue tie where they didn’t previously. It could be because they were tired or hungry.
That’s why tongue tie signs are so difficult. It’s hard to know if a tongue tie diagnosis is right but mama knows best.
If someone shows you research supporting tongue ties, know that there is just as much research against it. Trust your gut and do what is best for you and your baby. Get a second, third, or fourth opinion if you have to.
And when you find a provider that is good at diagnosing, you’ll know. They won’t be one that makes money from surgery. They’ll just be one that only recommends revision if it’s absolutely necessary.
How to Tell if Baby is Tongue Tied: In Summery
To sum it up, there really isn’t an easy answer for how to tell if baby is tongue tied. It takes a lot of research, finding the right provider, and using the right diagnosing tools. Above all, medical providers should seek to do no harm first. Only if a tongue tie is diagnosed without a doubt and causing problems should surgery be considered.
Evidence-Based Information on Baby Tongue Ties
Kealy Hawk, BSN, RN, CLC
Kealy is a Registered Nurse, Lactation Counselor, and most importantly a mommy! Her own baby feeding struggles gave her a passion to help moms throughout their feeding journey. She specializes in breastfeeding support and evidence-based formula recommendations. To talk with Kealy or take one of her breastfeeding or formula classes, visit https://littlebearcare.com.