Understanding Tongue & Lip Tie (Tethered Oral Tissue)

Tongue and lip ties are forms of oral restrictions – tight bands or soft tissue present at birth. While oral restrictions can occur in other areas  of the mouth, tongue tie (ankyloglossia) is the most common. It is often accompanied by a lip tie, and in some cases, buccal ties – tissue connecting the cheeks to the gum-line – may also be present, potentially affecting sucking and mouth opening.

What is a Tongue Tie?

A tongue tie is thought to occur during fetal development when the band of tissue attaching the tongue to the floor of the mouth does not fully dissolve. This leaves a band of tissue or lingual frenulum which is too short, thick or tight, limiting the tongue’s range of motion and strength, resulting in interference with feeding and contributing to increased tension throughout the baby’s body. 

What is a Lip Tie?

A lip tie involves a short or thick band of tissue connecting the upper or lower lip to the gum-line. This can restrict lip movement and, depending on the attachment site, might also affect alignment of the front teeth. 

When To Seek Evaluation

If you suspect your baby has a tongue or lip tie, consult with your pediatrician, an ENT, an IBCLC or experienced lactation consultant, pediatric dentist or a trained therapist who can evaluate your baby and guide you to obtain appropriate care.

Physical therapy can play a valuable role in managing tongue and lip ties. Therapists offer gentle manual techniques, exercises, mobilizations, positioning strategies, and personalized home programs to support your baby’s development and comfort. 

Infant Symptoms of Tongue and Lip Tie

• Sucking blisters on the lips

• Clicking sound during feedings

• Difficulty latching to  breast or bottle.

• Falling asleep during feedings

• Prolonged feeding times 

• Reflux or frequent spitting. 

• Poor weight gain

• Open mouth posture

• Excessive drooling

• Excessive gassiness

• Constipation

• Colic

• Difficulty settling or irritability.

• Body stiffness or tension 

Maternal Symptoms 

• Nipple pain, cracked or bleeding nipples

• Clogged ducts or mastitis

• Low milk supply

Goals of Physical Therapy 

• Reduce body tightness and tension.

• Improve mobility of the tongue, jaw and body.

• Increase tummy time tolerance.

• Support sensory regulation to help baby relax and settle.

• Promote optimal feeding positions.

• Provide care before and after frenectomy.

Whether you are exploring a release procedure or simply seeking support, a physical therapist is a key member of your baby’s care team. They collaborate with other providers to ensure a comprehensive, coordinated approach to your baby’s well-being. 

With early intervention and the right support, you can help your baby overcome the challenges associated with tethered oral tissues and foster healthy growth and development.