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A Step-By-Step Guide To Diagnosing Tongue/Lip Ties

on January 31 | in Everything Else | by | with 113 Comments

Colic? Reflux? Baby that won't sleep? It may be an undiagnosed tongue/lip tie. Heres a step-by-step-guide to identifying them at home.

I ♥ Kindergarten Rules

. .  but sometimes I really want to break the one that says “Keep your hands, feet, and objects to yourself.”

“Oh, your baby has reflux?” My hand twitches a bit as I force it to stay by my side.

“You’re struggling with low milk supply?” I put my hand in my pocket . . . it can’t be trusted.

“Your baby is waking every two hours to nurse at six months old?” At this point the urge is so strong I use my other hand to slap myself. 

What do I want to do? Check for a tongue / lip tie, of course!  They can be such a source of SO. MUCH. MISERY. for nursing mamas and their sweet babes, including me.

Unfortunately, the symptoms are often misdiagnosed as other conditions like colic, reflux, and failure to thrive because many pediatricians and lactation do not know how to properly identify them. Since writing about this subject three years ago I cannot count the number of messages I have received that said, “My pedi said there was nothing wrong so we suffered for months, then we got a second opinion and discovered a severe tie!”

Fortunately, Word Is Getting Out

While I was in New York getting Levi’s ties revised last month, Dr. Kotlow informed me that he gets at least one family per week who heard about him here. (If you’re not familiar with him, Dr. Kotlow is considered the foremost expert on tongue/lip ties in the United States.)

Where are all these people hearing about my story? From YOU.  Thank you for sharing my posts and helping get the word out – you have changed more lives than you know!

In this post I’m going to share with you some new tips Dr. K showed me for identifying tongue and lip ties at home, plus I’ll share the #1 critical mistake they make when assessing a tie.

Bottom line: If you’re a mama and you suspect a problem there probably is one. Tongue ties are not just about structure, they’re about function, and there is no one more qualified than you to determine if a baby’s latch feels “off.” Now let’s get started!

Colic? Reflux? Baby that won't sleep? It may be an undiagnosed tongue/lip tie. Heres a step-by-step-guide to identifying them at home.

Step 1: Focus on the symptoms first

“The most important diagnostic tool is not looking at the lip, or looking at the tongue. Although it’s important to clinically evaluate them… it’s mother’s symptoms,” Dr. Kotlow told me.

Why? Because a mother’s breast can come in many different sizes and shapes, as can a baby’s mouth. The crucial factor is how the two function together. Here are some things to look for when determining whether there is a concern:

Mama’s symptoms

  • Creased/flat/blanched nipple after feedings
  • Cracked/blistered/bleeding nipples
  • Discomfort while nursing
  • Plugged ducts
  • Thrush/mastitis
  • Sleep deprivation (Because baby is not able to nurse efficiently they compensate by nursing more often, leading to frequent night feedings. My first son was still nursing every 2 hours at 8 months old)

Baby’s symptoms

  • Difficulty latching on or falls off the breast easily
  • Gumming our chewing the nipple while nursing
  • Unable to hold a paci or bottle
  • Gassy (babies with ties often swallow a lot of air because they cannot maintain suction properly)
  • Poor weight gain
  • Excessive drooling
  • Baby is not able to fully drain breast
  • Choking on milk or popping off to gasp for air while nursing
  • Falling asleep during feedings, then waking a short while later to nurse again
  • Sleep deprivation (due to the need for frequent feedings)
  • Extended nursing episodes  – aka marathon nursing sessions
  • Clicking noises while sucking
  • Popping on and off breast often
  • Biting – Babies who have trouble grasping the nipple sometimes try to use their teeth to hold on. (Once they come in, of course)
  • Gap between teeth/jaw issues

Problems Associated With Tongue and Lip Ties

  • Babies may not be able to stimulate milk production through vigorous nursing, leading to low milk supply
  • Painful nursing/early weaning because child gets too frustrated
  • Improper tongue mobility may prevent babies from clearing milk from their mouth, causing tooth decay (especially in the front teeth)
  • Colic
  • Reflux
  • Sleep deprivation for mama and baby (due to the need for frequent feedings)
  • Speech difficulties
  • Gap between teeth/jaw issues

If some of these issues are present, move on to step 2.

Step 2: Examine the baby

What is the #1 mistake pediatricians and lactation consultants make when diagnosing tongue ties? According to Dr. Kotlow, it’s how they position baby for the exam.

“Correct examination of infants requires the infant be placed on the examiners lap with the infant’s head facing the same direction as the person evaluating the infant and the infant’s feet facing away from them. Just looking at the frenum in the mother’s lap will most likely lead to an incorrect or missed diagnosis.” (Source: Tongue-Tie Fact Sheet provided by Dr. Kotlow)

Colic? Reflux? Baby that won't sleep? It may be an undiagnosed tongue/lip tie. Heres a step-by-step-guide to identifying them at home.

Image courtesy of Dr. Kotlow

Now that you know how to position baby, here’s how to check for a tie:

Look at the tongue

Colic? Reflux? Baby that won't sleep? It may be an undiagnosed tongue/lip tie. Heres a step-by-step-guide to identifying them at home.

Photo courtesy of Dr. Kotlow

Here is a step-by-step exam guide from lactation consultant Catherine Genna.

Though anterior ties (at the front of the mouth) are pretty straightforward, posterior ties may be a bit tricky to identify. Here’s a video in which Dr. Kotlow demonstrates how to get a sneaky posterior tie to reveal itself:

Look at the lip

See that bulbous section in this baby’s lip? ↓

Colic? Reflux? Baby that won't sleep? It may be an undiagnosed tongue/lip tie. Heres a step-by-step-guide to identifying them at home.

It’s called a lip callus, and it forms when babies can’t flange their lip out properly when nursing. Here’s what a latch should look like:

Colic? Reflux? Baby that won't sleep? It may be an undiagnosed tongue/lip tie. Heres a step-by-step-guide to identifying them at home.

When the lip is not able to flange or “flip out” properly  – as is the case with a lip tie – a friction-induced callus can form. Is baby free from a lip tie if you don’t discover a callus? Not necessarily, but if you find one chances are pretty good a tie is present.

Now let’s look for the source of many nursing problems – including the lip callus – a maxillary tie (aka lip tie). Once you lift the lip, look for a band of tissue that connects the lip to the gum area. If the frenulum (aka the band of tissue) is tight, a lip tie is likely.

Colic? Reflux? Baby that won't sleep? It may be an undiagnosed tongue/lip tie. Heres a step-by-step-guide to identifying them at home.

Some of the complications associated with a lip tie are:

  • restricted function which leads to discomfort while nursing
  • gassiness/reflux/colic due to an improper seal that causes baby to swallow excess air
  • tooth decay

Tooth decay occurs because baby may not be able to clear their mouth properly, causing pockets of milk to collect near the upper lip. As the top four teeth come in the milk may rest on them and cause decay.

Check baby’s sucking pattern

Reach in to your mouth with your thumb and feel the roof of your mouth. Toward the back you’ll notice a spot where the hard palate meets the soft palate. Now, using your index finger find this same spot in your baby’s mouth. If you feel compression along the entire length of your finger – like a gentle massage – this is good function.

Colic? Reflux? Baby that won't sleep? It may be an undiagnosed tongue/lip tie. Heres a step-by-step-guide to identifying them at home.

Image courtesy of Dr. Kotlow

If most of the compression is at the front of the mouth, this is an indication that your baby is actually grabbing the nipple to hold on instead of compressing the whole breast. This kind of latch often results in discomfort and poor milk stimulation.

Step 3: Confirm Your Diagnosis & Explore Treatment Options

In this post I share how to get a FREE expert opinion from Dr. Kotlow, who is the leading expert on tongue/lip ties in the United States. I also discuss different treatment options and link to providers around the country. You can also join the tongue tie babies support group on Facebook to talk with and learn from other moms.

Questions, insights, doctor recommendations?

Please share them in the comments!

Sources:

Tongue Tie Fact Sheet by Dr. Lawrence Kotlow

American Academy of Pediatrics

Photo credits:

Main photo – Mae Burke Photography. Find her on Facebook.

Diathesis, BruceBlaus

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113 Responses to A Step-By-Step Guide To Diagnosing Tongue/Lip Ties

    • Sarah says:

      This has been very helpful. I just found out yesterday that my 5 month old has a lip and tongue tie. Very frustrating that drs didn’t catch this after my complaint of nursing her exclusively and her still being underweight.

    • lenah says:

      Hi I have a omost 4 year old and 5 year old they both had bad teeth for no reason. I live in Athens county Ohio and trying to find a dentist or doctor who knows what there doing and can check for slight tongue and mouth tie. I’m pretty sure they both have them and me too;(

      • Katrina S says:

        Dr Notestine DDS in Beavercreek (nearby Dayton) is one of the best, and probably the nearest for you.Took my children to him, he is great.

      • Emily says:

        Are they getting fluoride? I know it’s not related to a tongue/lip tie, but I’m from Athens too, and I know that even the city water supply has no fluoride in it. If your children aren’t getting it regularly from the dentist, it could be helpful. It actually corrects tooth decay.

        • Gemma says:

          I’m sorry but fluoride does not correct decay and is certainly not the answer to preventing or healing tooth decay. I’d do a bit more research on that one. Fluoride has so many negative health implications you would not believe!

        • Meme says:

          I only wash my daughter’s teeth with non fluoride toothpaste, and at almost 4 all her teeth are fine. My teeth however are horrid. Since I stopped fluoride toothpaste for the Greenpeople’s one I use for my child, my visits to my dentist got more pleasant. :)

    • Michelle says:

      Hi Heather! Thanks for this! Have you heard of Dr Julie Martinez in The Woodlands?

    • Eve says:

      Thank you for your article! I was having great difficultly with my son and nursing (not to mention I was a zombie because he would not sleep longer than an hour and a half at a time for 8 weeks!!! Luckily, some late night googling between the every 30-90 minute feeds led me to your website.

      Based on your article, I knew tongue tie was the issue. When I took my 3 week old to a general practitioner who completes the procedure in his office, he said it was too mild and the procedure would do nothing, therefore refusing to do it. I visited a Lactation Consultant who confirmed my son had tongue tie and advised me to have the procedure completed. I went to a walk-in clinic and demanded a referral to an ENT. The ENT reiterated what the GP stated, but allowed us to make the decision as to whether or not to go ahead with the procedure. When my son was 8 weeks old (I was wanting it done at 3 weeks old), the procedure was completed and immediately following, everything was better.

      Without your article, I would have never gone with my gut instincts and looked into tongue tie. Thank you, thank you, thank you!!!

    • Meme says:

      I want to say Thank You! for this article. My daughter is now almost 4 yo and has lip tie that extends into the hard palate. I haven’t checked for a tongue tie, but I have both (my mom could only nurse me for 3 months and doctors put the blame on her). I somehow managed to nurse her for 18months, but the memories are not pleasant. She would nurse for an hour each time, sleeping during from the effort. I had blocked milk ducts all the time and the pain was so bad sometimes I had to bite on a belt to feed her. I had to take her to the health visitor and the doctor once a week and often feed in front of them as her weight gain was too slow. They made me feel like I was starving my baby. :( She never used a paci, now I know why. I self diagnosed her when she was two and a half and took her to the doctor. They sent me to the dentist (we live in the UK) and she said that it should have been sorted when she was a newborn and now we have to wait until her baby teeth had fallen out and her adult ones are in (around age 6-7). They will have to put her under for surgery which makes me uneasy.
      The most annoying thing about lip tie is that not many people (even lactation consultants!) know about it. In her nursery they kept dismissing me as a helicopter parent for grating her apple or chopping it into small pieces. Even after explaining to them a thousand times, they still tried to make her bite into whole apples. Even biting into ripe bananas give her pain. Luckily her speech is not affected. Rant over. ;)

    • Anastasia says:

      Thank you! I stumbled across your page recently (during yet another late night marathon nursing session) and my jaw literally dropped. Everything I was reading perfectly described my current nursing situation and what I went through with my first child! I couldn’t believe it. Sure enough, I looked in both of my daughters’ mouths and they are both lip tied! Finally, an answer and a light at the end of the no sleeping, sore nipple tunnel! I went to my pediatrician today and left in tears. She said that there is no evidence that a lip tie causes any problems and treated me like a was crazy. She said my daughter probably has acid reflux and prescribed zantac. I was furious and feeling defeated. I thought she would help me and she definitely did not. Luckily, I found the number to the lactation ladies from the hospital where I gave birth and she couldn’t believe my doctor said that. It was so great to get that validation. I have an appointment on Wednesday for my daughter to get checked and get a referral to a pediatric dentist. If I hadn’t found this site I might not have gone after a second opinion. Thanks to you I had enough information to fight for my child and our breastfeeding relationship.

  1. Emily says:

    I’m pretty sure my first 2 kids were tongue tied. I had all the symptoms listed. It was so bad that I pumped and bottle feed as my oldest refused to nurse after a few days.
    My second had the same issues as did I and we suffered through it for several months till she refused to nurse and I turned again to the pump.
    She has speech issues. Could this be causing it? Or at least affecting it?
    She is 3 now, can a tie be fixed this late?
    I have 2 more kiddos and we all had a month of hell nursing starting off but thankfully things got better and I was able to nurse them normally.
    It’s sad but I’ve asked the doctors to check them for ties and they alway look at me like I’m crazy and say they are perfectly normal. :/ (I’d like them have the nipples of fire and death for a while and see how normal that is)

    • Andrea M says:

      Fire and death sounds about right.

    • Susana says:

      Many healthcare professionals still don’t know about posterior tongue-ties and even less how to clip them. The good news is, if your 3 year old is indeed tongue tied, it can totally be corrected. Try and find a professional in your area who will know how to diagnose and treat it. :)

      • Heather says:

        Emily, I am so sorry for what you went through! Yes, tongue ties can sometimes be a source of speech problems. You might want to email Dr. Kotlow to get his opinion on your little ones – he may even be able to suggest a provider near you.

    • Mallissa says:

      Emily, it can totally be corrected and the sooner the better. I grew up with tongue tie and it was not corrected until I was 18. My mom was a trooper for 6 months breastfeeding my twin and pumping for me! My tongue tie was not diagnosed until I was 15. Teachers were always trying to put me in special ed because of the way I spoke when they first met me. They couldn’t though, because I didn’t qualify…… I guess I just sounded like I did. I had trouble being understood and always felt like I wasn’t smart because of it. I didn’t want to talk to people. My tongue is still deformed from developing with a severe tie but at least I have not trouble speaking now. If you believe your child is tongue tied definitely consult an authority on the subject (which doesn’t mean any old doctor) and see what your options are.

  2. Krystal Nelson says:

    This confirmed for me what I already believed to be true for my daughter. Her lip tie extends all the way to her Papilla. I am in Washington State, is there a doctor in my area that can help is? When she was born she had very loud clicking, she still spits up a lot. I only wish I would have found out earlier.

    • Sarah D says:

      I am in your same situation! My daughter has a lip tie that also goes to her papilla touching her two front teeth. She is 21 months. I wish these health practitioners were more informed :( Wondering if there is a doctor in the Houston/Austin/Dallas/San Antonio area of Texas that would do the procedure under local anesthetic?

    • Bobby Ghaheri MD says:

      Hi Krystal

      Dr Maryann Ohara in Seattle is great. I’m in Portland. Both of my daughters have this I treat about 600 babies/year so contact me if you have questions.

      Bobby Ghaheri MD

    • Amanda @ Mommypotamus Support says:

      Krystal, I am so sorry for what you went through! You might want to email Dr. Kotlow to get his opinion on your little one – he may even be able to suggest a provider near you.

    • Cassiopeia says:

      There is one in Portland and one in Seattle that specializes in it. I am looking into it as well because my 6 moth old has a severe lip tie and is tongue ties as well and my ped says she is fine…well at 6 months old im pretty sure she should be more than 12lbs!

      http://drghaheri.squarespace.com/#nav
      This is the one in Portland

  3. Laura says:

    Even though I don’t have any children, I read this post with utter interest.. So interesting and really necessary knowledge to have. I’m lucky to read all those posts before having a baby.. I’m so sure that I know more about babies from this blog than from anywhere else (how to swaddle for example, this one was also very interesting and good thing to know..i mean, who would have guessed). Thanks for educating us:)

  4. Rosanna says:

    My kiddos are almost 2 and 5 and after reading this, it seems like they had this. Should I still be worried about getting a tie fixed?

    Thank you for posting this, I will be forwarding it to all my preggo friends…

    • Heather says:

      According to Dr. Kotlow, NYU and a few other institutions are looking at the effect of tongue ties in adults. There may be some correlation between a tight frenulum and TMJ, plus other issues. It may be worthwhile to send him an email and discuss your concerns.

  5. Andrea M says:

    I am one of those fortunate mamas whose nursing relationship was saved by you and Dr. Kotlow! After so much pain and so many tears (on my end…. baby was gassy but happy) it was such a relief to read your initial post and realize that I would be able to continue breastfeeding with no pain. We took him to Albany when he was 4 months (so lucky to live only 3 hours away) and we have an awesome nursing relationship now at 7 months. Two lactation consultants and the pediatrician did not have this issue on their radars at all. So THANK YOU THANK YOU THANK YOU. <3

    My question is, when we are ready for the next one, how soon can you identify and correct a lip or tongue tie in a newborn? Is it obvious immediately? How old does the baby need to be for the procedure? I'm assuming I'll need to plow through at least a few weeks of painful feeding… but it would be so much easier this time around, knowing that it won't be 4 months of the same.

    • Heather says:

      Andrea, this makes me SO HAPPY to read! I’m glad you found my previous posts helpful. To answer your question, if you know what to look for you can often identify a tie immediately. I knew my son Levi was tied within the first few hours after he was born. The procedure can be done anytime depending on your ability to travel to the doctor/dentist. We had my son’s revision done when he was two weeks old.

  6. Kierstan says:

    I had started a local breastfeeding support group when my son was 9 months old (he’s 2 now) and this is one of the biggest issues I kept hearing about. So out of curiosity and so I could help other moms spot it, I inspected my son and LO an behold he had a stage 4 liptie! No wonder we had such issues nursing- if it wasnt for my determination to breastfeed and teach him how to suck properly using a pacifier to hold his tongue down we would have never succeeded. I took him to Dr. James Jesse in Loma Linda, CA while we were on vacation and had it lasered at 22 months just to prevent future dentistry issues (he has a huge gap in his front teeth from it) Dr. James is one of the few that will do it and do it properly (local anesthetic and not general). He’s amazing and it was so not a big deal during and after! I just held my son on my lap while the assistants and my mother helped hold him still- my son was more agitated about being held that tightly but it was so fast the tears only lasted a few minutes. We were in and out in 10 minutes :) Thank you for spreading the word on this devastating condition that so many moms are unknowingly heartbroken from not being able to successfully breastfeed. Now I just wish there were more dentists that can do this- our local dentist said there wasn’t anything he could do until my son was older, because they want to put them totally under. I’m lucky I have family in California that I was able to get this done- I’m currently pregnant again and told Dr. James if this one had the same issue I’m road tripping out there asap (I’m in Colorado). He said his youngest patient was 2 days old! Good for that mama :)

  7. Danielle says:

    No kids yet, but I’m currently training to be a birth doula and lactation consultant, and I will most definitely implement this information into my practice!

  8. Sarah D says:

    My 21 month old daughter has a lip tie that also goes to her papilla touching her two front teeth. I wish these health practitioners were more informed :( Wondering if there is a doctor in the Houston/Austin/Dallas/San Antonio area of Texas that would do the procedure under local anesthetic?

  9. Sara R. says:

    Thanks for this great summary! We also went to Dr. Kotlow for our second child’s ULT and posterior tongue tie. I’m really glad that we did, and I see SO many missed diagnoses for ties.

  10. Kathleen says:

    This article is excellent. I am a doula that offers lactation support and I am a mom who has 2 children that need lip and tongue ties corrected by Dr. Kotlow a year ago.

  11. What about those who cannot afford to go to NY to see Dr. Kotlow? Even if he does a free “email consult” will they be able to afford to go to NY to have the laser revision? Seems like it would make more sense to refer them to a LOCAL IBCLC who can assess and refer to a qualified physician then assist them through the lengthy recovery process. There are IBCLC’s like myself who have been trained by Kotlow and are very competent.
    Mom’s can find a local IBCLC on ILCA.org

  12. J says:

    It might be helpful to add that a cleft in the tongue can be a sign of tongue tie. (Speaking from experience.)

  13. Thanks for this. As a mom who struggled with a tongue and lip tied baby, I can relate. We also went to Dr. Jesse. Our story is here: http://www.staciebingham.com/2/post/2013/06/hes-just-a-bad-nurser-part-1.html It is my understanding that only doctors can diagnose, though — not even IBCLCs diagnose ties. Thanks for spreading awareness. Here is an info sheet that parents and professionals may find useful — feel free to share, it is for public use created by me and others in ATTE (www.tongue-tie-education.com). <3

  14. En says:

    My 7 month old doesn’t flange and has the bulbous upper lip but feeds ok. Will this be a problem later in life? Speech?

  15. Lindsey says:

    I had read your previous post and thought my daughter probably had a lip tie, although the only symptoms were that she spit up a bit and made a clicking noise sometimes while she ate, and night waking. Other than that we were getting along fine. I had an appointment set up with a ped. dentist who does laser correction, but a few days before we were at her well child check and the pediatrician took a look and said it looked fine. He was worried the pediatric dentists were performing unnecessary procedures, so I cancelled the appointment, not wanting her to have to go through the pain if it was unnecessary. She is 9 months now, growing very well but still not sleeping great (waking once per night), so I’m not sure if I should have gone ahead with it. It’s so hard to know!

  16. As far as issues later, there is a list of potential problems that may arise (and then again, they may not). Speech issues, delayed eating of solids or gagging on solids, GERD or reflux, apnea, snoring, and many others. The link I shared above has a thorough list of evidence-based symptoms that could come with ties: http://www.tongue-tie-education.com/uploads/2/9/9/0/2990748/atte_quickguide_2013.pdf

    I have a posterior tongue tie myself, which I plan to have Dr. Jesse treat, and I get debilitating tension headaches from my neck; I also clench and grind my teeth and have mandibular tori (bony growths) — which can all be associated with ties. I have had a handful of friends with regular migraines who, upon inspection, also have PTTs — it’s a good thing to check out if you have migraine or headache issues with no seeming cause.

  17. shelly says:

    It is wise to note that any claims offered to a lip/posterior tongue affecting breastfeeding have NO empirical evidence and only “borrow” the incredible research that has been completed regarding an Anterior tongue tie. In our clinic in Toronto we see babies daily who have had the procedures done (sometimes more than once) with little to no improvement in pain, latching, supply, etc. A word to wisdom to all practitioners…like many tools in lactation, this is not a silver bullet to fix all problems. Please see the most recent issue of Breastfeeding Medicine for some good information on this by a leading pioneer in the field of Lactation.

    • Heather says:

      Thanks for your comments, Shelly. I don’t know that I would say there is no empirical evidence, though. Dr. Kotlow keeps before/after records on his patients and there seems to be a strong indication that it does benefit nursing pairs in many cases.

    • Bobby Ghaheri, MD says:

      Actually Shelly, there are good studies that have shown improvement, most recently Cliff O’Callahan’s study of almost 300 kids who showed significant improvement.

      As an example of why this argument shouldn’t dissuade moms from seeking help, there are NO empirical studies saying that jumping out of an airplane without a parachute can be harmful to your health. So should we jump just because data aren’t present?

      I think many lactation consultants and providers are threatened by the concept that others can actually fix a problem. And while I agree that this procedure is not a silver bullet, I think you’re doing a disservice to moms and babies everywhere when you say these sorts of things.

    • Karen Metzler says:

      Shelly, I see Dr. Bobby addressed your comment, and likely more thoroughly. Your comment was brought to my attention. I, too, was going to cite the O’Callahan article from last year. If my memory serves me, he treated 299 babies with tongue tie, in an office setting with topical anesthesia (which he no longer uses). 85% had PTT and the remaining 15% had ATT. Procedure was done in an office setting and there was statistically significant improvement after the procedure. Can’t remember the exact measures, but I think it might have been an increase in breastfeeding and decrease in pain? I’ve read so many studies I get mixed up of what studies used which measures, but I’m sure you will find the article very interesting. Perhaps your physicians are not fully releasing the PTT????? Just a thought. Thanks for your interest in helping moms and babies. It is my goal that the emotional distress (and physical exhaustion) I went through for 2 months with my older daughter will be minimized in the future.

  18. Jen Z says:

    Thanks for sharing this information! Are you part of the Tongue Tie Babies Support group on Facebook? I don’t remember seeing their group linked in your blog, but if you wouldn’t mind sharing it so other moms can get help wherever they may be, that would be really cool :)

    https://www.facebook.com/groups/tonguetiebabies/

  19. virginia says:

    Thank you for sharing more of your insightful research, Heather! I would love to be your neighbor, even if the closest is a mile away. Question for you: are there reasons to correct lip tie if you are past breastfeeding? My daughter is almost 4 and nursed for 2 1/2 years. I now see those symptoms were present and also some speech obstacles, which I think she will overcome. If you have any thoughts, I’d value them!

    • Heather says:

      Hi Virginia! According to Dr. Kotlow, NYU and a few other institutions are looking at the effect of tongue ties in adults. There may be some correlation between a tight frenulum and TMJ, plus other issues. It may be worthwhile to send him an email and discuss your concerns.

  20. Sierra says:

    I realized, through your posts, that not only did my youngest have lip/tongue tie, but so did my oldest and my husband! I nursed for 27 months total before realizing this and it made me want to cry in relief that I was NOT CRAZY!
    We had our youngest son’s tongue tie corrected in December of last year and then his lip tie corrected yesterday….the issue I see now is that he has nursed improperly for a year! How can I correct his latch?
    Also, for anyone in the phoenix area – dr Agarwal of agave pediatrics or dr Briggs are both highly recommended. I personally saw the former and was very impressed with the care and the method.

  21. I do accept all of the concepts you could have provided on your publish. They’re persuading and definately will undoubtedly work. Still, the particular blogposts are way too brief for freshies. May perhaps you want lengthen all of them somewhat by the next occasion? Many thanks for the actual write-up.

  22. Erin says:

    This is so helpful. Can anyone recommend a doctor in the Cincinnati or Louisville areas?

  23. Emily says:

    thank you for this wonderful article! My 5 1/2 month old son and I have many of the symptoms listed above. Can you tell me if it is normal for an EBF 5 1/2 month old to still be nursing every 2 hours? the evening peak Western feed every hour. At bedtime he will go for about 4 sometimes 5 hours without a feed. But during the day its every two hours, in the evening every hour. I am wondering if a tongue tied could be the cause for such frequent nursing. Or at his age should be nursing sessions be further apart?

    • Heather says:

      Emily, both of my older children had tongue/lip ties that were not corrected by five months so I honestly can’t say what’s considered normal. I do know that my son’s feedings increased in frequency as he grew due to his increased need for calories and his inefficient latch. By 8 months he was nursing every two hours at night again despite sleeping stretches of 5 hours prior to that. For us, having the tie corrected did increase the length of time between nursing sessions. Long story short, I would check with a lactation consultant on what’s normal. If something seems off it might be worth exploring the possibility that a tongue/lip tie is present. (And depending on what symptoms you’re having it might be worth looking into anyway!)

  24. […] Unfortunately, the symptoms are often misdiagnosed as other conditions like colic, reflux, and failure to thrive because many pediatricians and lactation do not know how to properly identify them. Since writing about this subject three years ago I cannot count the number of messages I have received that said, “My pedi said there was nothing wrong so we suffered for months, then we got a second opinion and discovered a severe tie!” http://www.mommypotamus.com/a-step-by-step-guide-to-diagnosing-tonguelip-ties/ […]

  25. Bobby Ghaheri MD says:

    Greg Notestine DDS in Dayton is one of the best in the country.

  26. […] hang out with moms of infants, or if you ever babysit… you might be interested in knowing how to identify a tongue-tie. This one little issue can certainly cause trouble in the eating and thriving department! This blog […]

  27. kate says:

    Hi Heather,

    My 8 month old actually just had his lip and tongue tie revision done last week. I noticed in a previous posted that Micah was the same age when you had his done. Just wondering if he ended up having any residual feeding/swallowing/speech issues because of the ties. Did you seek out any therapy for him? I’d love to know how it worked out for your little one! Thank you!

    • Heather says:

      Hi Kate, after his procedure he FINALLY started sleeping better. It was an amazing difference! He already had some pretty bad habits with his latch that I was never fully able to re-train, but things did improve and he continued nursing until he was 2+ with no problems. We did cranio-sacral therapy following the procedure and found it helpful. No speech issues :)

  28. Carissa says:

    Thanks for posting this! My son (now 14 months) had some of these symptoms as an infant, while I had zero symptoms. He now has no trouble nursing, however, he has a gap between his two front teeth. Are gaps like this normal in children? When should you be concerned? Thank you!

    • Heather says:

      Hi Carissa! You might want to join the Tongue Tie Support Group linked to at the bottom of the post. There are a lot of mamas in there that can direct you to good info on your questions.

  29. Jennifer says:

    never thought to look for this with either of my two kids even though i did have slight difficulties nursing. fortunately i was blessed with a more than ample milk supply, so even though i occasionally had sore nipples, i didn’t notice any of the other issues, and was able to nurse both children past the age of 1. Just now checked my now 3.5yo and 2 year old and both of them have class III lip ties. my 2yo actually still has a visible lip callus (probably from sippy cups at this point). i was willing to nurse them both much longer than i actually did, but stopped because of what seemed to be lack of interest on their part. i imagine now that my diminishing supply combined with their poor latches was the more likely cause. here’s hoping to better results with baby#3, now on the way!

  30. Darla McLain says:

    Love this article. I so appreciate the time it takes to write these articles and they are so very helpful. I am certain my daughter had this and wish I’d known then. She just had her son 4 months ago and he also has the lip-tie. She had it repaired last week.

  31. […] he no longer had issues with gassiness and was able to fill his belly better and sleep better. (Here’s how to diagnose tongue and lip ties at home. If your baby seems to have reflux or colic it’s worth looking […]

  32. Heather S. says:

    Hi Heather,
    Thank you so much for this information. After I read this I asked my sister to check her 1 week old son for a tie because he was having so many issues eating and was gulping air with every drink. He has a tie and they are on their way now to have it taken care of. So hoping that this will help the little fella, and she can get back to breast feeding-he hated the breast because he couldn’t get what he needed and they have been on formula since 4 days old- He will be 2 weeks tomorrow and I am so happy they are getting it fixed. So again Thank you Thank you for your post!

  33. Barbara says:

    I’m a little concerned about the lip callus as a sign of a tie. So many absolutely normal babies get these in the first two months. Some get one or two that fall off naturally, just because they are using their lips so frequently. All my five had lip calluses, and I’ve had great nursing (almost ideal) experiences with each.

  34. Melissa says:

    Thank you so much for posting this. I’d like to share my personal story since yours and others have helped me so much.

    My daughter is now 13.5 months old. We just had her severe lip tie and mild tongue diagnosed and corrected via laser yesterday. Yesterday, after 13.5 months of inconsistent latch, very little sleep, discomfort nursing, and resistance to any non-finger food.

    I was told by her pediatrician at one month old that my concerns about a tongue tie were unfounded. Even though dad and grandpa have them, even though she has a shallow latch, even though she vomits after feeding.

    I got a second opinion from a periatrician at a different practice and got the same answer. So i countinued nursing through it all. It was usually uncomfortable and occasionally painful. I thought the all-night feedings was just reverse cycling. I began to read more due to a recent increase in biting (serious, clamp down and refuse to open up kind of biting) and was reminded of my early concern by your post. I knew once I saw the images that the lip tie was present. I searched for and made an appointment with a pediatic dentist the next day.

    I am pleased with the work of Dr. Tanios-Rafla in East Brunswick, NJ. She has a nursing room in her office and I found the staff to be professional. I was hesitant because I read of a previous sanction (related basically to allowing assistants to adjust braces) but after reading the report and talking to my husband, we agreed that everyone makes mistakes and if we felt uncomfortable we could leave. I briefly worked for a dentist in high school and knew to look closely for cleanliness, etc. I am so glad we gave her a chance. She even waited until after we nursed to talk with us and get a high five so my daughter wouldn’t be afraid to come back. I have never had a doctor take time like that.

    Again, thank you so much. I hope this information helps to inform more parents to trust their instincts and understand how uninformed pediatricians can be about these issues. I only wish I went sooner because the procedure was more difficult due to the more developed, thicker muscle. I noticed an immediate change in the appearance of her lips and her latch.

  35. Summer says:

    My son was diagnosed with lip tie and posterior tongue tie after we’d been working with a lactation consultant for 5 weeks, and she ran out of other suggestions. We had him treated at six weeks old (the soonest he could be seen) by Dr. Branton Richter, a pediatric dental specialist in Utah. Dr. Richter was trained by Dr. Kotlow and uses a laser for treatment. Dr. Richter was great and definitely knows what he’s doing. We were finally able to breastfeed exclusively (with no pumping or SNS) when my son was about two months old. It was a hard decision to have the procedure done when there were no guarantees that it would help, but he’s six months old now and we’re still nursing, which seemed an impossible goal in the beginning. Good luck!

  36. Phoebe says:

    Thank you thank you thank you. I was googling my six-week-old daughter’s weird sleep patterns (at least once a night she’ll go for four or five hours straight nursing and seem totally unsatisfied) and came across this blog post. Even though her weight gain is great, we have SO many of the symptoms here–pain (me) and popping off the breast and clicking sounds and gas (her!). I asked my midwives about it at our postpartum visit today and they confirmed that she has both a lip and posterior tongue tie. Since we’re in NY state, they work closely with Dr. Kotlow and gave us his card. I can’t wait to call and make an appointment and get me and my baby some relief!

  37. Morgan says:

    I just started research on this due to my 5 week old. I am pretty sure he has stage 4 lip tie and a tongue tie. Then I checked my 3 yr old And I think she has both as well she also has speech issues so I am anxious to get both of them in to see if I am correct. I plan on talking to our pediatrician… but just in case they aren’t familiar with this does anyone know of a Dr who is around Boise Idaho? Thank you so much for all this information.

    • Andrea says:

      Did you find a dentist in Boise to correct the lip tie? After major nursing issues with all of my kids, I’m just discovering that it looks like all three have lip ties. The symptoms line up exactly and no pediatrician, dentist, lactation consultant, nurse, or occupational therapist (I counted 18 specialists I’ve seen for BF issues over the years) has ever picked it up.

    • Emily says:

      I’m also curious if you found someone in boise.

  38. T says:

    Thank you so much for getting out info about tongue ties. I am now just finding out my 8 yr old has a posterior tongue tie. I could just cry for all the nights he’d wake up screaming and be inconsolable and this went on for 2 yrs. The stress of no sleep for 2 yrs, severe reflux, my own PPD, and other health problems lead us to have him as an only child. To add insult to injury, we had a lactation consultant come and proclaim that there was no tongue tie. Oh, if only we knew! More mothers need to read your opening remarks.

  39. Katrina S says:

    Heather, thank you so much for these wonderfully informative posts on tongue and lip ties! Long story short, I thought my newborn daughter was having trouble with my “overactive letdown” (shallow latch, popping on and off, choking, gagging, refux, among other problems) when instead she is struggling due to a posterior tongue and a lip tie! Have an exam and (if I’m right) a laser revison with Dr Notestine in Dayton scheduled next week. *Praying this is the answer to our breastfeeding struggles!* Never would have proactively researched and questioned without these posts!!! I feel like there is hope for our breastfeeding relationship now. I found this blog post and a WAPF article- could an awesome Mommypotamus-style post be in order on the Dr Price-narrow palate-tongue tie- dietary- environmental toxins connection? Found it very interesting, and you have a way with condensing info and making it totally understandable. Just a suggestion from an avid follower :-) Blessings!
    http://www.pennilessparenting.com/2012/02/tongue-tie-and-lip-tie-snipping-for.html?m=1
    http://www.westonaprice.org/dentistry/from-attention-deficit-to-sleep-apnea

  40. Kathy says:

    I’m so glad I found this!!! My 4 month old and I have both been miserable since she was born and now I think I found the answer! Does anyone know of a doctor in Wisconsin??

    • Emily says:

      Hi kathy, I recently figured out my 11 month old has a lip tie causing her upper front teeth to come in with quite a space between! I will be taking her to a pediatric dentist clinic called Smiles In Motion, which is in chippewa falls wisconsin. You could look them up online. They are very friendly and helpful and can do the Lazer procedure to reverse tongue and lip ties! We are very excited to have this done, just wish we had it done a lot earlier as I had lots of trouble and difficulty nursing her!

  41. […] Babies who are hungry don’t sleep well. And babies who have nursing issues are often hungry. Read this post and thank me […]

  42. […] breast isn’t stimulated enough. It can be a simple as correcting a bad latch or addressing any anatomical issues that are preventing a good latch from a baby being lip tied, tongue tied or mama having inverted […]

  43. L says:

    I want to cry (happy tears) after finding this blog and article. I just took my LO to his third weight check in because he hasn’t been gaining fast enough. After his 8 week appt, they suggested I supplement with formula. After going from bottle to breast he was having a rough time, so we did bottle only. Then my milk supply drastically started to dry up and now he’s formula only. When we were still bf, he was nursing for over an hour at a time and still not gaining, in addition to having 90% of the other symptoms listed above. I feel so angry that no one ever checked for this – we could still be nursing right now *and* he would be gaining the necessary weight! Thank you SO much for putting this information out there to hopefully help other mamas having issues – hopefully more doctors will start checking for/diagnosing ties!

  44. Kathy says:

    Hi all. This information is so great but I just thought I would share my experience. I was thrilled to discover this and made an appointment with Dr. Margolis near Chicago who charges $1200. My daughter was, gagging, choking air, refluxing like crazy and had extreme pain with a lot of gas. She screamed like bees were stinging her constantly etc. etc. etc. My pediatrician finally had me try Nutramigen for babies with cow’s milk allergy and all of her problems disappeared the same day and have not come back in over a week. We still may do the lip tie later for dental or speech reasons but bless her heart this is a completely different child.

  45. Kathy says:

    Hi all. This information is great but I just had to share my story briefly. My baby suffered miserably from birth until just over a week ago.(4-1/2 months). She gagged and choked during feedings and refluxed like crazy. She screamed like bees were stinging her constantly, had a lot of gas and was in severe pain. I was excited to find this information and booked an appointment with Dr Margolis near Chicago to release her lip tie. He charges $1200. THEN…the pediatrician had us try Nutramigen for babies with cows milk allergies. Her problems disappeared the same day and have been gone for over a week!! She is a completely different child! We may end up lasering the lip tie for dental or speech reasons later but it turned out that a milk allergy was the immediate problem. Best to everyone.

  46. Kathy says:

    Oops. I thought my first post disappeared. Now I see it twice. Sorry about that…

  47. Han says:

    Wow, I’m pretty sure I have a tongue tie and a lip tie- I wonder what my mother went through to breast feed me! I never even knew it was a problem…

  48. […] 0 Post(s) Tagged: 0 Thread(s) Quoted: 0 Post(s) This site helped me immensely! http://www.mommypotamus.com/a-step-b…onguelip-ties/ My midwife caught my daughters lip tie at birth and we chose to wait and see how she nursed and we […]

  49. […] in the game, we would likely have had it clipped). Here’s a good blog post I recently found: http://www.mommypotamus.com/a-step-by-step-guide-to-diagnosing-tonguelip-ties/ Dr. Newman is also known as a great resource. You can even email him directly and he will […]

  50. […] tie and can be diagnosed by a lactation consultant, pediatrician or pediatric dentist. Please read here for further […]

  51. Amanda says:

    I had heard of a tongue tie but not a lip tie! My 4 mon old has been diagnosed with sagittal craniosynostosis and I heard that tongue/lip ties were common with his diagnosis. Sure enough, he has a pretty severe lip tie from what I can determine : / He nurses, but struggles staying latched on. I don’t experience much pain but he does seem to get extra gassy and falls asleep a lot while nursing. I’m also concerned with teeth decay and placement so the sooner this gets treated the better! I live near Las Vegas. Are there any Drs you can refer me to?

  52. […] be helpful in establishing a good breastfeeding relationship. Moms also might want to check for a tongue or lip tie to increase nursing […]

  53. […] A Step-by-step Guide to Diagnosing Tongue/Lip Ties Here’s a great article to read if you are thinking ties are an issue for you or someone you know. […]

  54. Stephanie says:

    Help please! I am in desperate need of a dental surgeon or Dr. that will take our sons Severe posterior tongue as well as lip tie seriously! We have received a class 4 diagnosis on both from an orofacial myofunctional therapist but when we visited the dental surgeon he said he only saw a lip tie not tongue (he didn’t look at him from the correct position!), and he scheduled surgery for 6 weeks from now, b/c that’s when he gets a surgery block at the hospital. We have every single symptom…we have been to drs., lactation consultants, a breast feeding specialist Pediatrician, and an ENT, and gotten tubes in ears all just trying to figure this out….we live in Central Nebraska but will drive for help of course! Our son is now 8 mo. old and, although still somewhat chubby, has gone from the 75% for weight down to the 16%. Our family doc said that it’s just normal at this age b/c they get easily distracted while nursing…..I tried to hold back the mama bear inside. Does anyone know of someone at least in the Midwest to help us? We would happily drive to any city within 8hrs., Maybe even farther. I wish NY was closer. Thank you for any help! It’s getting very hard to keep up the pumping required to keep up my supply and our little guy can’t take a bottle without gagging and throwing up often…we desperately want to keep nursing.

  55. Bobby Ghaheri MD says:

    You have several options but you’ll need to drive.
    1) Fitzik dentistry in Wichita Kansas. http://fetzikdentistry.com/

    2) Mindy Hochgesang in Bettendorf Iowa. mindyhochgesang@gmail.com – she’s very open to emails.

    You can email me if you need more direction – drghaheri@gmail.com

  56. […] He still wouldn’t pee. And I recalled, dimly, something about lip and tongue ties. […]

  57. […] Make sure you find the support you need to be successful with breastfeeding. Join a breastfeeding class or support group, get connected with a lactation consultant, read great breastfeeding books like Breastfeeding Made Simple, The Nursing Mothers Companion, The Womanly Art of Breastfeeding, The Breastfeeding Book by Dr. Sears or check out kellymom.com (a great resource for nursing mamas). Many pediatricians are not trained in lactation support and unfortunately, many will give advice as if they are – so please speak with a lactation consultant, postpartum doula or breastfeeding professional if you have any issues, especially when it comes to latch and milk supply. If you are experiencing a chronic latch issue, please make sure that your breastfeeding professional checks for a tongue tie. […]

  58. […] LC would have to look at a number of different things  to determine if there might be a TT/ULT. This is probably the best article I’ve found online that help moms in diagnosing a baby’s […]

  59. karen hoffman says:

    I believe I just discovered both my children – 3yo and 9mo – have lip ties, which explains SO much of my troubles over the past 3 years. I know Dr. Kotlow is in Albany, but can anyone recommend a doctor who uses lasers in the NYC metro area? We live in Brooklyn, so don’t have a car, and I’ve found the following names in my research:
    Scott Siegel in Long Island
    Gina Tanios-Rafla in New Jersey
    Leonard Kundel in Connecticut

  60. Leann says:

    I am pretty sure my son has a mxillary lip tie. He is 10 weeks and has completely fallen off the growth curve. Do you know of any good docs in the gulf coast area (anywhere from New Orleans to south Florida?

  61. ashley23 says:

    Thank you!! I was about to give up BF cuz my baby is 4 weeks and my nipples still hurt and I can’t figure out how to get him to latch any better. I have had to supplement with formula cuz his weight gain was so low. My LC noticed that his top lip wasn’t popped up like it should be during a feeding just yesterday and she looked and said she thought it was lip tie. My ped looked at me like I was crazy and thought my concern was painful nipples vs lip tie cuz he said it was fine. I can handle the painful latching/feeding but he doesn’t stay awake for more than 2 min. He doesn’t feed long enough and needs to eat every hr or less. I have a 4 yr old and a husband who works out of town and that BF schedule is not manageable. I’m calling a dentist that someone recommended tomorrow in hopes to get this fixed and have a happy ever after also. I wasn’t convinced on calling until I read your article though so thank you so much for sharing!!

  62. […] my son has some brown spots in between his front four teeth. I had already discovered he had an undiagnosed lip tie (which I am sure was the culprit for our zillion breastfeeding troubles) and this seemed to be […]

  63. Mishell says:

    Thank you for the info like you said we mom can tell if something wrong I think my one week old has lip tie and or tounge tie. Can any one recommend a doc In California I Live in Los Angeles

  64. MR says:

    My son was diagnosed with failure to thrive and admitted to the hospital at 3 months old. He weighed in at 8 pounds and change. It was confusing because he was the happiest baby and never cried, but was skin and bones. He struggled both with breastfeeding and bottle feeding. (Breast milk and formula.) We saw the lactation consultant and went in for weighings. The pediatrician who ordered that he be admitted accused me of neglect, and of purposefully starving my baby. It was the most horrifying day/week of my life.

    Once admitted, he was in the hospital for 5 days. During this time they watched me during feedings to “make sure I was actually feeding him.” They ran every test they could think of, and after 5 days–he weighed LESS than when we came in–they said they didn’t know what was wrong with him, but that they needed our room for somebody else and that we had to go home, and they sent me home with my little 3 month old, 8 pound baby. I reluctantly started him on pureed avocado and sweet potato because I didn’t know what else to do to keep him from starving, and he started gaining weight.

    Fast forward 4 years. Just got home from the dentist today, where I found out he has a SIGNIFICANT tongue tie. I asked if this could contribute to failure to thrive and she said “Oh if he had failure to thrive this is absolutely why, no question.” She also said there is no reason the doctors and lactation consultants shouldn’t have caught this, especially after almost a WEEK in the hospital and THOUSANDS and THOUSANDS of dollars in hospital bills. Because of my son’s extended bout of failure to thrive, he now has developmental delays that effect his–and our family’s–everyday lives. Language delay has caused communication to be extremely difficult, resulting in all sorts of emotional and social problems for him. Sensory Processing Disorder causes seemingly small irritations to bring his world crashing down, multiple times a day. Frustration abounds. Because NONE of these MANY medical professionals could diagnose a simple tongue tie? Am I wrong to be livid??

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