Tongue-tie (ankyloglossia) is a topic that sparks a lot of debate, often making headlines with polarised opinions. Some argue that it’s overdiagnosed, while others believe it’s frequently missed. As with many aspects of infant care, the truth is far more nuanced. A skilled and experienced practitioner understands that tongue-tie is not a one-size-fits-all issue and that each baby deserves an individualised approach based on thorough assessment, careful discussion, and informed decision-making.
Why a Proper Tongue Function Assessment Matters
A tongue-tie diagnosis is not just about whether a baby has a visible frenulum under their tongue it’s about function. Can the baby move their tongue freely? Can they achieve a deep latch? Is their feeding comfortable and efficient? A full assessment by a qualified practitioner someone who has undergone extensive training and understands both tongue function and infant feeding is crucial.
A practitioner who truly understands tongue-tie will not simply look under the tongue and decide to snip without careful thought. Instead, they will take the time to assess how the baby is feeding, how their tongue moves, and whether any restrictions are contributing to feeding difficulties.
Tongue-Tie Affects Both Breastfed and Formula-Fed Babies
Tongue-tie is often discussed in relation to breastfeeding, but it can impact all babies, including those who are formula-fed. While breastfeeding challenges such as pain, difficulty latching, and poor milk transfer are common reasons parents seek a tongue-tie assessment, formula-fed babies can also experience symptoms related to restricted tongue movement.
Some signs that tongue function may be affecting a formula-fed baby include:
Frequent dribbling or leaking milk from the sides of the mouth during bottle feeds.
Taking in excessive air, leading to increased wind, reflux-like symptoms, or discomfort.
Slow, tiring feeds or struggling to finish a bottle.
Choking, coughing, or gagging while feeding.
A preference for certain bottle teats due to difficulty maintaining a good seal.
For some formula-fed babies, addressing a tongue restriction can lead to improved feeding efficiency, reduced discomfort, and a calmer, more settled baby. This is why it is essential that tongue function assessments are available to all families, not just those who are breastfeeding.
What Does a Thorough Assessment Involve?
A proper tongue-tie assessment includes:
A detailed history. Understanding the baby’s feeding journey so far, including signs of difficulty such as pain during feeding, clicking noises, reflux-like symptoms, poor weight gain, or prolonged feeding times.
Functional assessment Looking at how the baby moves their tongue, whether they can extend it past their lower gum, lift it to the roof of the mouth, and create the necessary suction for effective feeding.
Oral examination: Checking the anatomy of the baby’s mouth, including how restrictive their frenulum may be.
Feeding observation Watching a feed (breast or bottle) to assess latch, milk transfer, and how baby’s tongue function is affecting feeding efficiency.
Discussion of options: Not all tongue-ties require division (frenotomy). A robust assessment should include a conversation about the potential benefits and risks of the procedure, as well as alternative approaches such as feeding support and bodywork.
The Role of a Cranial Osteopath
Many babies with tongue restrictions also have tension in their jaw, neck, or body sometimes due to birth positioning, instrumental delivery, or simply how they’ve adapted in the womb. Cranial osteopathy can help to release this tension, allowing the baby to move their tongue and jaw more freely. For some babies, bodywork alone can improve function enough that a frenotomy isn’t needed, while for others, it can support better outcomes if a release is performed.
The Importance of Infant Feeding Support
Because tongue-tie is so closely linked to feeding, it’s essential to see a practitioner with expertise in infant feeding, such as an International Board Certified Lactation Consultant (IBCLC). Even after a tongue-tie release, feeding adjustments are often needed to help the baby relearn how to use their tongue effectively. Without this support, some families may feel that the procedure has not worked when, in reality, baby just needs time and guidance to develop a new feeding pattern.
Nuance Matters: Avoiding Extreme Views
Tongue-tie is a complex issue, and unfortunately, the loudest voices in the media often present extreme viewpoints, either dismissing tongue-tie concerns entirely or advocating for widespread division without thorough assessment. The reality is that each baby is different, and an experienced practitioner will take a balanced approach, considering all factors before recommending a course of action.
What to Expect from an Appointment with Me
When you book an appointment with me, you’re not just getting a quick check and a decision on whether to divide the frenulum. You’re receiving:
A comprehensive assessment of your baby’s feeding and tongue function, whether they are breastfed, bottle-fed, or a combination of both.
A thoughtful discussion about whether a frenotomy is the right choice
Guidance on feeding adjustments and techniques to improve latch, milk transfer, and bottle-feeding efficiency.
Support in exploring cranial osteopathy or other complementary therapies.
Ongoing follow-up to ensure you and your baby receive the support you need in the days and weeks following the assessment.
If you’re concerned about tongue-tie, it’s important to see someone who will take the time to assess your baby fully, consider all the factors at play, and provide ongoing feeding support.
Would you like to chat about your baby’s feeding? Get in touch, and let’s find the best path forward for you and your little one.