How Tongue-Tie Can Worsen Infant Reflux—and How Laser Frenectomy Can Help

Baby cooing in mother's arms

Reflux in infants is a common concern among parents, often marked by frequent spitting up, fussiness, and poor sleep. While many cases are attributed to immature digestion, a less-discussed but significant contributor is aerophagia—the swallowing of excess air during feeding. One major anatomical factor that can exacerbate air-induced reflux is ankyloglossia, or tongue-tie.

Emerging research shows a strong link between tongue-tie, poor latch, air swallowing, and reflux. Even more compelling: releasing the tongue and lip ties, particularly with laser frenectomy, has been shown to significantly reduce reflux symptoms and improve breastfeeding outcomes.

How Tongue-Tie Leads to Reflux

In infants with tongue-tie, the tongue's range of motion is restricted due to a short, tight lingual frenulum (the band of tissue under the tongue). This limitation often leads to a shallow or inefficient latch during breastfeeding. According to Siegel (2016), infants with ankyloglossia and maxillary lip ties are prone to aerophagia-induced reflux, as they swallow more air due to their compromised latch.

Swallowed air distends the stomach and increases intra-abdominal pressure, making it more likely for stomach contents to reflux into the esophagus. The result? Frequent spitting up, irritability, and disrupted feeding and sleep patterns.

The Role of Laser Frenectomy in Reducing Reflux

Improving the latch is key to reducing air intake—and that’s where frenotomy (tongue- and lip-tie release) can make a real difference.

The BRIEF Study: Real-World Results

The BRIEF prospective cohort study (Slagter et al., 2021) followed infants who underwent frenotomy and tracked outcomes related to breastfeeding and reflux. The findings? Post-procedure, infants showed significant reductions in reflux symptoms, including less regurgitation, improved feeding efficiency, and longer periods of settled behavior. These results support the idea that resolving the anatomical restriction can relieve a mechanical cause of reflux.

Primary Research: Measurable Improvements

Multiple studies further bolster these claims. A 2021 randomized trial demonstrated objective improvements in tongue function and feeding efficiency after posterior tongue-tie release. Meanwhile, an earlier 2016 cohort study found that both tongue- and lip-tie releases led to statistically significant improvements in maternal nipple pain, infant latch quality, and feeding duration—all key factors in reducing swallowed air and, in turn, reflux.

Why Laser Frenectomy?

Laser frenectomy offers unique advantages over traditional scissors or scalpel releases:

• Greater precision, especially for posterior ties

• Minimal bleeding and faster healing

• Lower risk of reattachment

• Less trauma for the infant

Because of these benefits, many families and providers prefer laser over conventional methods, especially when treating complex or posterior ties that may go unnoticed during a routine oral exam.

When to Consider Tongue-Tie Evaluation

If your infant shows the following signs along with reflux, a tongue- and lip-tie evaluation may be warranted:

• Clicking or popping sounds while nursing

• Gassiness, frequent spit-ups, or reflux symptoms

• Difficulty latching or staying latched

• Short feeds or very long, inefficient feeds

• Maternal nipple pain or damage

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Final Thoughts

Reflux in infants isn’t always just about digestive immaturity. In many cases, it’s a mechanical problem rooted in a restricted tongue. When poor latch leads to excessive air intake, symptoms can spiral—impacting feeding, growth, and family well-being.

Fortunately, laser frenectomy offers a fast, effective, and research-supported solution. By improving tongue mobility and optimizing latch, we can help infants feed more comfortably—and breathe a little easier, too.

If you're concerned about reflux symptoms and suspect tongue-tie may be involved, consult a provider trained in infant oral function for a comprehensive evaluation.

References:

Ghaheri, B. A., Lincoln, D., Mai, T. N. T., & Mace, J. C. (2021). Objective improvement after frenotomy for posterior tongue-tie: A prospective randomized trial. Otolaryngology–Head and Neck Surgery. https://doi.org/10.1177/01945998211039784

Ghaheri, B., Cole, M., Fausel, S. C., Chuop, M., & Mace, J. C. (2016). Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study. The Laryngoscope, 127(5), 1217–1223. https://doi.org/10.1002/lary.26306

Siegel, S. (2016). Aerophagia induced reflux in breastfeeding infants with ankyloglossia and shortened maxillary labial frenula (tongue and lip tie). International Journal of Clinical Pediatrics, 5(2), 6–8. https://www.theijcp.org/index.php/ijcp/article/view/246

Slagter, K. W., Raghoebar, G. M., Hamming, I., Janssen, J., & Vissink, A. (2021). Effect of frenotomy on breastfeeding and reflux: Results from the BRIEF prospective longitudinal cohort study. Clinical Oral Investigations, 25, 3431–3439. https://doi.org/10.1007/s00784-020-03665-y