What You Need To Know About Oral Restrictions (Tongue-Tie)
How did my baby get a tongue-tie?
Parents often wonder about the origins of tongue tie in babies. While various theories circulate, the key lies in the process of apoptosis—an embryological phenomenon of programmed cell death. At around the 12th week in utero, if this process falters, the tissue beneath the tongue may not fully resorb, resulting in a tight band under the tongue known as a tongue tie. Tethered oral restrictions (TOTS) include anterior tongue tie, posterior tongue tie (submucosal), lip tie (labial), and buccal (cheek ties). Frenums, identified as thin lines between gums and lips (labial) or the floor of the mouth and the base of the tongue (lingual frenum), can become tight or restricted, impeding normal oral tissue function.
More than one tie
Understanding that there is more than one type of oral restriction is key. If a health provider is only trained to identify anterior tongue ties and overlooks other types, it may lead to the misconception that there is "no tongue tie." This oversight is common and can result in ongoing issues for both parent and baby. If your baby experiences problems like reflux/colic symptoms, poor latch, poor weight gain, fatigue while feeding, or is very unsettled, a second opinion from a provider with additional training in oral restriction assessment is imperative.
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5 things to look for: oral restrictions and mother’s symptoms
Recognising oral restrictions in your baby may also involve acknowledging your breastfeeding symptoms. The severity of these symptoms plays an important role in deciding whether a frenectomy, the release of oral restrictions, is necessary. Here are five signs to look out for:
Pain with breastfeeding: Persistent pain during feeding, unaffected by latch adjustments.
Cracked or bleeding nipples: Nipples may appear flattened or lipstick-shaped, with continuous irritation leading to cracks and wounds.
Poor latch or inability to maintain latch: Shallow latch, clicking sounds, and an inability to maintain a proper seal.
Endless Feeds: Prolonged feeding sessions, triple feeding, or comfort feeding to settle the baby.
Poor milk transfer: Baby appears to suck a lot but swallows minimally, displaying signs of fatigue during feeding.
Additional symptoms may include the use of a nipple shield, a history of mastitis, poor weight gain without supplementation, nipple thrush, and breast engorgement. An experienced IBCLC (International Board Certified Lactation Consultant) should be part of your team to help recognize whether your symptoms are related to your baby’s oral restrictions. If your health provider has not conducted a thorough functional oral assessment, it is essential to seek a second opinion for the well-being of both you and your baby.
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Hi I’m Michelle, I teach parents how to calm their unsettled newborn with simple exercises and strategies. I can help you support your baby through issues such as colic, infant reflux, oral restrictions and birth strain. I’m an osteopath with over 20 years experience and a mum of 2 boys.
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