Lip and Tongue Tie: Answers to Mommas’ Top 9 Frequently Asked Questions

You reading this tells me that you’re concerned about either of these things: you’re in so much pain from nursing (Is it meant to hurt this much?!), your baby is constantly (or hardly) feeding but isn’t gaining weight, and lastly… breastfeeding hurts! Or did I mention that already?

There are several reasons why you could be having breastfeeding problems. But in many cases, these two are the culprits: lip tie and tongue tie.

Lip and tongue tie make it challenging for your baby to latch and suck milk from your breasts. My second baby had both lip and tongue tie, and let me share with you… the pain was excruciating!

I’ll talk some more about my journey later. But more importantly, I’ll also guide you through some of the most frequently asked questions about lip and tongue tie, including:


  • What’s the difference between a lip tie and tongue tie?
  • Can your baby have a lip tie but not a tongue tie?
  • How common are these conditions in babies?
  • What causes these conditions?
  • What are the symptoms?
  • What should you do if your baby has a lip tie and/or a tongue tie?
  • How to fix these conditions?
  • Could lip and tongue tie grow back?
  • If left untreated, could lip and tongue ties have long-term effects on your child?


I’m sure you’re ready for some answers. So keep reading, and let’s get right into it!


1. Lip tie vs. tongue tie: What’s the difference?

Both lip and tongue ties are considered oral soft tissue abnormalities.

A lip tie is an abnormally tight frenulum (a band of connective tissue) that keeps the lip/s tied to the gum line. Lip ties can occur on the upper lip, lower lip, or both. They’re classified based on four classes, with Class 1 being the mildest and Class 4 being the most serious.


Classifications of Lip Ties
Class Description
Class 1 – Mucosal Minimal visible attachment
Class 2 – Gingival The frenulum attaches mostly into the gingival tissue
Class 3 – Papillary The frenulum attaches just in front of the anterior papilla*
Class 4 – Papilla Penetrating The attachment extends into the hard palate
*Papilla – the small bump just behind the area where the upper front teeth are expected to erupt


Source: Lawrence A.Kotlow, DDS, PC


On the other hand, a tongue tie (also known as ankyloglossia) is a congenital condition where a short frenulum limits tongue movement and function.

A baby’s tongue tie could either be an anterior tongue tie or a posterior tongue tie. It could also be classified according to its severity or how limited the baby’s tongue movement is.


Classifications of Tongue Ties
Class Severity Distance of the tip of the tongue to the frenulum*
Class 1 Mild 12 – 16 mm
Class 2 Moderate 8 – 11 mm
Class 3 Severe 3 – 7 mm
Class 4 Complete


(the tongue can hardly move)

< 3 mm
*The clinically normal distance is greater than 16 mm or 1.5 inches 


Source: Archives of Disease in Childhood


When your baby has a lip or tongue tie (or both), they’re working twice as hard to get their much-needed nutrients. And if you have poor breast drainage due to your baby’s inability to latch effectively, there’s a big chance that your milk supply will decrease over time. 

When your baby has a #LipTie or #TongueTie (or both), they’re working twice as hard to get their much-needed nutrients.CLICK TO TWEET


RELATED: Tips on How to Increase Milk Supply


2. Can your baby have a lip tie but not a tongue tie? 

Yes. On rare occasions, some babies can have an isolated case of lip tie while their tongue is functioning normally.

Meanwhile, tongue tie can also appear in tandem with other craniofacial abnormalities, such as a cleft palate and cleft lip.


3. How common are tongue ties and lip ties?

According to studies, tongue ties affect 4% to 10% of babieswhile lip tie in babies is less common. Tongue ties are also more common in boys, with a male to female ratio of 3:1

Meanwhile, it’s worth noting that some lip tie cases, specifically Class 1 and Class 2 lip ties, are typically undiagnosed or untreated since they don’t have serious impacts on babies’ ability to feed. This is also probably one reason why the reported prevalence of lip ties isn’t as high as that of tongue ties.


4. What causes tongue tie and lip tie?

We already know that both conditions are congenital and tend to run in families. Now, let’s try to get to the specifics.

Lip and tongue ties are caused by thick tissues in the mouth. When the connective tissue (aka the lingual frenulum) that connects the tongue to the floor of the mouth is abnormally short, thick, or malformed, then we get a tongue tie. 

The lingual frenulum usually shrinks as your little one grows in your tummy. But for babies affected by tongue ties, this tissue remains thick.

Lip ties are similar, but it’s the connective tissue that binds the upper or lower lip to the gums that are either irregularly too short, thick, or malformed. This abnormality then causes movement issues with either or both the upper and lower lips.


5. What are the symptoms of lip tie and tongue tie? 

So, how can we know if our babies have lip or tongue ties? Here’s a list of symptoms to watch out for in your baby: 


Lip tie symptoms  Tongue tie symptoms 
  • struggles to latch and remain onto the breast 
  • makes a clicking sound during breastfeeding 
  • seems frustrated and tired during and after nursing 
  • flatulence or excessive gassiness (because they tend to swallow air with each suck) 
  • wants to nurse more often (because they’re not getting adequate supply)
  • has difficulty gaining weight 
  • struggles to latch onto the breast 
  • makes a clicking sound during breastfeeding 
  • has a problem poking out the tongue past the lips
  • seems fussy when trying to nurse
  • tends to nurse for long stretches but is still hungry all the time 
  • has difficulty gaining weight 
  • heart-shaped tongue when it’s protruding 


If you’re a breastfeeding momma and your child has lip or tongue tie, you may experience the following:


  • Pain in your breast and nipple during and after breastfeeding 
  • Mastitis or clogged milk ducts 
  • Engorged breasts even after feeding 
  • Exhaustion from having to nurse constantly


But mommas, keep in mind that breastfeeding difficulties can have a range of other causes that could be independent or co-occurring with lip and tongue ties. So, it’s best to consult with a breastfeeding specialist and your child’s pediatrician to pin down the cause of your breastfeeding problems.


6. What do I do when my baby is diagnosed with a lip or tongue tie? 

It’s crucial that you make informed decisions on what steps to take after your child’s diagnosis. Here’s a list of questions that you may need to ask your child’s pediatrician: 


  • Are lip and tongue ties the only cause for my child’s nutrition and breastfeeding problems? Are there other evaluations necessary to rule out other possible causes?
  • What can I do to ensure the nourishment of my child given this condition? 
  • Given the classification of my child’s lip and tongue tie condition, are there non-surgical treatments we can explore?
  • Is my child a candidate for frenectomy
  • What are the post-surgical risks and complications that I should be aware of?


I also recommend getting a second opinion (or even more) before you undergo any serious interventions, like a lip or tongue tie surgery.

The first doctor who diagnosed my son’s lip and tongue tie didn’t recommend treatments, but I knew something was seriously wrong and that I needed to do something because the nursing pain hurt so much. The pain pushed me to consult a number of other health professionals until I found the interventions that worked for me and my son. 

Before considering any serious interventions, like a #LipandTongueTie surgery, it's recommend to get a second (or even more) opinion from trusted doctors.CLICK TO TWEET

You may also try using a nipple shield as a short-term solution. I personally used one, so I could keep breastfeeding my baby while protecting my nipples. Among other things, a nipple shield can also help your baby create suction and hold your nipple in a position that’s ideal for breastfeeding.


Explore your options and trust your momma gut instinct. If something feels off and you’re not getting the treatment you and your baby needs, please consider getting checked by other medical professionals.


7. How to fix lip and tongue ties? 

UNICEF says that most cases of lip and tongue tie can often resolve on their own. But like I said, it’s best to consult medical professionals and have your baby’s lip and tongue properly assessed.

Mild or uncomplicated cases of lip and tongue tie often can be solved by non-surgical measures. Some therapy techniques to help loosen or relax the frenulum can also be done by your child’s pediatrician.

But again, remember that breastfeeding problems can have a range of causes. That’s why a complete assessment for you and your baby is a must! 

Breastfeeding problems can have a range of causes. That’s why a complete assessment for you and your baby is a must!CLICK TO TWEET

Mama Coach Kayla Shea, who is kind enough to contribute to the Milksta blog, shared that it may be helpful to get a referral to a pediatric trained chiropractor, a massage therapist, or a cranial-sacral therapist as non-surgical options. 


RELATED: Why Your Baby Won’t Latch (Expert Advice on Lip & Tongue Ties, Cleft Lip, and High Arched Palate)


But, suppose the condition causes too much discomfort for you and your baby and interferes with day-to-day activities like feeding, speaking, and oral hygiene. In that case, a medical professional may advise that your child goes through a surgical technique like a frenectomy procedure

Procedures done early are usually painless for babies. Want proof? Let me tell you how I got my second son’s lip and tongue tie fixed.

I personally went to two pedia-dentists and a lactation consultant to have my son’s lip and tongue treated via frenectomy. My main motivations back then (aside from the breast pain) were that I didn’t want to stop my breastfeeding journey and didn’t want further complications to happen to my baby. 

My doctor said that the surgery will only take about 15 minutes and won’t be painful for my baby since the nerves in the tied areas weren’t fully developed yet. My son was around 2 months old at this time, and the doctor said that the sooner we do it, the better. Delaying the procedure could pose more pain in my son, so we went on with it. 

After the procedure, my baby’s latch improved and the pain I used to feel during nursing slowly subsided! The doctor also advised me to refrigerate my milk and give it cold to my baby to help speed up his recovery process. He also advised us to do certain exercises to retain mobility in my son’s tongue and keep the tie from reattaching (because it does reattach in some cases). 


8. Could lip and tongue tie grow back?

I often hear this question, but “grow back” isn’t actually the right term. Lip and tongue ties don’t grow back, but they could reattach if you fail to do your doctor’s recommended post-surgery exercises.

Reattachment happens in about 4% of frenectomy procedures. To avoid being part of the 4%, be sure to follow your doctor’s post-op instructions.

I followed the doctor’s advice to the T! I fed my baby cold breast milk for two weeks and regularly followed the exercises. I’m happy to report that my son has been lip and tongue tie-free ever since!


9. What are the long-term effects of untreated lip and tongue ties? 

If the condition won’t budge over time and isn’t treated, moderate to severe cases of lip and tongue-tie can cause the following issues for your little one:


  • Undernourishment and difficulty gaining a healthy weight. This is caused by feeding problems and difficulty in eating certain foods. 
  • Speech impediments. In kids aged two and older, there could be difficulty in pronouncing the tdzsthr, and l sounds.
  • Poor oral hygiene. Because of limited tongue mobility, children with tongue ties can have a hard time clearing food bits from the teeth, contributing to tooth decay.
  • Difficulty in doing oral activities. Licking, kissing, and playing wind instruments can be challenging for kids with tongue ties.


Milksta momma’s takeaways

Lip and tongue tie cases aren’t 100% similar. They vary according to their severity and the exact position of the tie, which is why it’s best to consult your doctor instead of blindly following whatever tips you find online.

Finding the exact causes of your breastfeeding problems (which may or may not be due to lip and tongue tie) can also direct you to the right solutions. So momma, don’t hesitate to seek help, ask questions, and make an informed choice on the treatment or intervention that you or your baby needs.



This mom-powering piece is curated by multiple contributors: Lian Delos Reyes, founder & CEO of Milksta, and research & content specialists Nicole Saldaña and Rose Jane dela Cruz.

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