My Baby Is Struggling to Breastfeed — Could It Be a Tongue Tie?
If you are reading this at 2am, exhausted and discouraged, with a baby who won't latch, nipples that are more sore than you imagined possible, or a little one who seems to have to work so hard to eat… know that you are not alone (though this doesn’t really make it any better).
We are told that breastfeeding is the most natural way to feed your baby, but when things are not going well, they can feel very unnatural, frustrating, discouraging and upsetting. Unfortunately, natural doesn’t always mean easy. When breastfeeding isn't going well, it is incredibly common to wonder why.
You might be thinking that there is something wrong with you or with your baby. One quick Google search of your symptoms might have you asking: Could it be a tongue tie?
As a pediatric physical therapist and certified breastfeeding specialist who specializes in infants with breastfeeding difficulty, I’m here to tell you YES, or maybe NO. Unfortunately, the honest answer is: it's complicated. Let’s dive in.
What Is a Tongue Tie, Really?
Tongue tie, known medically as ankyloglossia, is a condition where the band of tissue connecting the underside of the tongue to the floor of the mouth (the frenulum, we ALL have one) is too short, too thick, or too tight to allow the tongue to do its important jobs.
In order to feed well, your baby’s tongue needs to move well. When a baby breastfeeds effectively, the tongue does something really beautiful. It moves in a rhythmic, wave-like motion from front to back, while staying elevated to hold and cup the breast, creating the suction needed to draw milk. It is coordinated movement that requires both strength and full range of motion to function optimally.
When your baby’s tongue’s range of motion is restricted by a tongue tie, the whole system is affected. Yet because feeding is so important, babies will find new ways to get milk. They might clamp down with their gums, use their lips differently, or work twice as hard just to get the milk they need. These compensation patterns can be really exhausting for your baby, and really painful for mom.
Signs That a Tongue Tie Might Be Affecting Your Baby's Feeding
Every baby is different, but here are some of the most common signs I see in my practice that suggest tongue tie may be playing a role in feeding dysfunction.
For baby:
Clicking sounds while nursing or bottle feeding
Struggling to maintain a latch
Falling asleep at the breast shortly into a feed
Frequent, short feeds
Poor milk transfer (as noted by weighted feed with an IBCLC)
Excessive gas, reflux, or fussiness after feeds
Poor weight gain
A heart shaped or notched appearance to the tip of the tongue
Tongue stays on floor of mouth when crying
For mom:
Nipple pain during nursing
Nipple damage
Creased or pinched nipple shape after nursing session
Engorgement
Concerns about milk supply
If you are checking off a few of these boxes, it is absolutely worth getting an evaluation from a tongue-tie savvy practitioner. This doesn’t necessarily mean your pediatrician. Most of them do not have specialized education around tongue ties. Hopefully they will instead refer you to a specialist like me! Other providers that may have tongue tie knowledge include IBCLCs, OTs, and SLPs.
A Tongue Tie Diagnosis Is Not the Whole Story
One of the biggest misconceptions I encounter when working with infants with tongue ties is that there is a simple fix. Some believe that if a baby has a tie, you get a release, problem solved. I wish it were that straightforward.
The presence of a tie tells us that there is a restriction in your baby’s tongue’s mobility. What it does not tell us is how that restriction is affecting your specific baby, how your baby has been compensating, or whether a surgical release is actually the right next step for your baby right now.
What matters most is not simply whether a tie exists, but how your baby is feeding, and how their whole body is, or is not, moving. Two babies can have similar appearing ties and have completely different feeding experiences. One may be nursing beautifully with minimal intervention. Another may need therapy before, during, and after any procedure to achieve the best outcome.
I would LOVE to see every baby for at least one therapy visit before their parents decide to take the route of having the tongue tie addressed with a frenectomy. Here is what pre-release physical therapy actually looks like, and why it makes such a meaningful difference.
Why Physical Therapy Before a Release Matters
When a baby has been living with a tongue tie, their body adapts to it. Your baby is always going to take the “easy route.” So if ideal movement patterns aren’t available, they will find another way. Preferred patterns arise, and there is often asymmetry. You may also note that your baby has a head turn preference, or has developed a flat spot on one side of their head.
Pre-release physical therapy does several really important things:
It prepares the body. Before a frenectomy, we work to release tension in the jaw, neck, and body so that when the frenulum is released, the tongue actually has the freedom to move into the space that has been created. Without this preparation, babies sometimes do not show the improvement families hoped for after a release, simply because the surrounding tension was never addressed.
It helps us understand the full picture. Sometimes, by getting your baby moving well in all the ways they weren’t, we see feeding improve! I have learned not to set expectations based on the anatomy I observe as families often see significant improvement in feeding after a few visits of PT. Some are able to avoid a release all together. Every family deserves to know that this kind of improvement is a possibility before making a decision about a procedure.
It gives us a baseline. We get to see how your baby is moving, feeding, and compensating before any intervention — which helps us measure progress and guide next steps.
It prepares the parents. A frenectomy is a short and low-risk procedure. It is important to me that parents are fully informed of what they and their baby will experience on release day. When you work with me before a release, I will explain all of this to you in detail so that there are no surprises. We will also review active wound care, which involves frequent “stretches” or lifts of your baby’s tongue to avoid reattachment (the mouth heals very quickly!) and maintenance of their new mobility. These stretches are quick, but need to be done well, and often, for the best result. We will go over this at length during pre-release therapy visits so that your baby is used to this, and you can feel confident that you are doing things right.
And After a Release?
Post-release therapy is just as important. After a frenectomy, the tongue gains freedom to move in new ways, but it does not automatically know what to do with this freedom. Babies need help learning new movement patterns, building strength, and integrating those changes into functional feeding. Without post-release support, many families find that the improvement they hoped for doesn’t happen. Negative stories around tongue tie often are from families who skipped pre- and/or post-release therapy.
Remember the active wound care I just mentioned? Post-release therapy allows you to practice them again, with my supervision, so you can be confident that you are doing them in the best way. In addition, you will be given individualized exercises to optimize your baby’s active tongue movements. Stretches alone, which are often the only aftercare instruction families receive, are not the same as skilled therapy.
You Deserve This Specialized Support
I became a Certified Breastfeeding Specialist because I kept seeing the same thing over and over in my practice: babies whose feeding struggles were directly connected to how they were moving. The mouth does not exist in isolation. Neither does the tongue. Everything is truly connected.
When I work with a family, I am looking at the whole picture — how your baby moves, how they feed, how they prefer to hold their body, and what they need to do to move their best. Whether that involves a tongue tie release or not, you and your baby deserve specialized support on your journey to improved feeding.
Ready to take the next step?
If you are concerned about your baby's feeding or suspect a tongue tie, I would love to connect with you. You do not have to have it all figured out before you call. That is what I am here for! I offer free discovery calls for this exact reason. I truly believe that every baby deserves to move, feed, and feel well, and every mama deserves to enjoy the start to her motherhood journey.
