• Stephanie Gable, RN, IBCLC

An undiagnosed tongue and/or lip tie may be the missing piece to your breastfeeding puzzle.


The Tongue Tie Puzzle

Breastfeeding for any mother and baby is very much like one giant puzzle. Even when most of the pieces fit together, others may not fit at all no matter how hard and long you try. Tongue-tie (ankyloglossia) is just one possible cause for your breastfeeding trouble. Tongue-tie is a condition in which an unusually short, thick or tight band of tissue (frenulum) tethers the bottom of the tongue to the floor of the mouth. If necessary, it can be cut to release the frenulum (frenotomy).


How do you know if a tongue-tie is the cause of your problems? You put together the pieces of the puzzle. And, if you recognize the symptoms and signs below, you just put another part of your puzzle together and have moved closer to meeting your feeding goals for your baby.


Tongue-tie puzzle piece # 1 - Something Doesn't Feel Right When Breastfeeding Did you know something just wasn't right when you nursed your baby for the first time (or 15th) while in the hospital? If you asked for help, were you told; "It looks good to me. See how his ear is moving? Thats a sign he is doing it right." Or "well she is peeing and pooping" or something else that did NOT validate what you were feeling? All said while your toes are curled up and you aren't breathing from the pain?


Tongue-tie puzzle piece #2 - Your Baby's Tongue Appears Stuck or Curls When your baby cries does the tongue stay down on the floor (bottom) of the mouth? Maybe the tongue tries to lift and it curls up like a bowl. Or one side comes up a little but it's obvious something is holding all or maybe just the middle down.

Our tongues are meant to rise during crying to protect our airways. They are also meant to stay in our mouths rested up against the hard palate. If a baby can't do this, there are often airway consequences. There may be future issues with the ear, tonsil, adenoids, or all of the above.


HINT: If anyone says to you, "yeah, there is a tie, but it's little" or "yeah, but I don't think it's causing all the gas, crying, not sleeping...." then they have no idea what it is they are seeing because their brain has not been taught what to look for... If this is beginning to look like your breastfeeding "puzzle" please seek knowledgeable, experienced help.


Tongue-tie puzzle piece #3 - Your Baby is a Noisy Nurser

Does your baby gulp? Click? Clack? Squeak? Or are they an all around loud feeder?

A baby should feed quietly. There should be soft puffs of air when swallowing. Gulping is a warning sign that says, “Beware! Lots of tummy troubles ahead”. Tongues that are restricted (short) underneath do not lift and create suction against the top palate where they can form a tight seal. This can cause a suck/feeding that is noisy.


Do this test to understand what a tongue-tie feels like:

Place the front of your tongue up against the back of your bottom teeth/gum. Leave it there. Do not move it at all. Now swallow water. What did you notice? It’s harder to swallow when you can’t lift your tongue or otherwise use it to help. Now imagine you are having to swallow that way lying under the faucet (breast). You would push, tug, slurp, click, etc…to try to feed and swallow in a defensive position. The tongue tie puzzle pieces here may not apply to all babies with ties. However, if more of the pieces apply than not, further assistance is recommended.


Tongue-tie puzzle piece #4 - You See A Restriction


To the right is a baby I saw last week. Her mother gave me permission to share this. She was having challenges for weeks. Her trusted, respected provider didn’t see anything that needed to be taken care of.


Do you see what I see? It can’t be missed! However, “the eyes can’t see what the mind has not been taught to look for”. So I assess/look in a totally different manner than most providers. Why? Because I was taught to see and how to see, therefore, I can never unsee. Providers know many great things. They may not know about ties and that’s OK. We know lots about them. I really should. I’ve seen 2200 babies with oral restriction in 6.5 years. That’s the vast majority of all babies I’ve seen.



Tongue-tie puzzle piece #5 - You See Something You Think is a Restriction

These are two siblings. Both had “ties” also know as tethered oral tissues or oral restrictions. Each sibling presented differently. One has a tie that appears to be thicker and shorter while the other is thinner and longer. Both can cause breastfeeding challenges (and did). “Ties” are as unique as the infant that has them. There are no two alike even in the same family.


Tongue-tie puzzle piece #6 - Drooling Without Known Cause

Drooling in the absence of teething is not a normal oral pattern.

Due to the open posture of the mouth that tends to stay open at rest, drooling that normally would be swallowed with closed mouth tends to collect/pool and leak outside the mouth.


Tongue-tie puzzle piece #7 - Not a Pacifist!

Does your baby refuse a pacifier, every pacifier? Does your baby refuse most/many bottle nipples? Will your baby only take the shortest pacifiers?

Babies with oral restriction may be able to latch to mom, be it painful, shallow, leaky, etc, but when it comes to any artificial nipple they may have more challenges. They can move mother's soft nipple and breast where he/she/they can manage to suckle. Firmer nipples are harder for many of these babies to manipulate. If they do, it may take them a long time to get a bottle feeding transferred. Of course there are exceptions to this, but if your baby struggles with any nipple, that's your puzzle piece.


I have had more than a few moms say they were told "You need to stop breastfeeding and if your baby gets hungry enough they will eat". Well, 2 of those babies got feeding tubes because they couldn't eat... then they found Gulf Coast Breastfeeding Center (GCBC).


Tongue-tie puzzle piece #8 - Misinformation

Have you heard the following misinformation from well-meaning friends/family...

"It's normal to feel pain. It will go away in a couple of weeks"

"You can pump and bottlefeed until she/he/they figure it out"

"You have a lazy nurser. He probably is using more calories trying to feed than he needs and that's why the weight isn't going up".

(This is one I HATE as an IBCLC) BABIES ARE NOT BORN LAZY!!! A baby may feed and get the easier milk at the front of the breast with letdown and then stop and wait until milk moves to the front of the breast again with another let down. This may be "nippling and napping" nursing. This isn't "lazy". This is compensation feeding. Doing what a baby can with what they have.

"Your nipples are too big for his little mouth"

Babies should be able to open wide. If a baby can only open with a narrow/small gape then something else is going on. Think about a baby bird. Even the tiniest birds open wide for their food.

"You probably don't have enough fat in your milk"

No, you have plenty of fat in your milk. It is usually the inability to transfer milk, NOT the contents of the milk, that some babies are experiencing.

"Some babies just can't breastfeed".

ALL babies should be able to breastfeed (survival of the fittest) and when they can't, there is a puzzle piece.



Mothers that experience several of these "puzzle pieces" are much less likely to meet their feeding goals. It is a fact that women that don't meet their breastfeeding goals will suffer GRIEF. Sometimes it is for life.


If you are struggling with nursing or bottle-feeding your baby, please reach out to someone who is well-versed in oral restrictions such as the International Board Certified Lactation Consultants here at GCBC. Many states, including Mississippi have Facebook Tongue and Lip Tie support groups.



Stephanie Gable, RN, IBCLC and Maranda Nybo, IBCLC at Gulf Coast Breastfeeding Center are here to help! Contact us and together we will put together the pieces of your breastfeeding puzzle!

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