What Are Tongue Tie, Lip Tie, and Oral Restrictions?
- PW&Lactation
- Jun 1
- 3 min read
Oral restrictions in infants refer to tight or shortened tissues in the mouth that limit normal movement. The most common types are tongue tie and lip tie, and both can significantly affect infant feeding, at breast and at bottle.
Tongue tie, or ankyloglossia, happens when the tissue under the tongue (lingual frenulum) is too tight or short, making it hard for the tongue to move freely and limiting normal range of motion. Lip tie involves the tissue under the upper lip, which can also restrict normal motion.
These restrictions can cause real problems during feeding—whether breastfeeding or bottle feeding. Symptoms often include pain during latch, development of infant reflux, slow or poor infant weight gain, and the development of low milk supply.
If you're concerned your baby may have an oral restriction, a lactation consultant can help with evaluation and support. Early assessment can make a big difference in your feeding journey.
How Tongue Tie Can Lead to Infant Reflux and Low Milk Supply
Tongue tie isn’t just about limited tongue movement—it can have a ripple effect on infant feeding and maternal milk production and the evidence also points to this! Two common complications that are evidence and science based tied to untreated tongue tie are infant reflux and low milk supply. Here’s how they’re connected:
Air-Induced Reflux in Infants
When a baby has a tongue tie, they often struggle to latch deeply and maintain suction during feeding. The limited tongue mobility can prevent a proper seal at the breast or bottle, causing the baby to swallow air as they try to feed. This trapped air in the stomach can lead to:
Reflux symptoms like spitting up, arching, fussiness, and discomfort
Frequent breaks during feeding, making feeding sessions longer and more tiring
Misdiagnosis of reflux as a digestive issue, when it may actually be caused by poor latch and excess air intake
This is often referred to as air-induced reflux, and in many cases, improving tongue function can reduce or eliminate these symptoms.
Low Milk Supply in Parents
Efficient milk removal is critical for maintaining a healthy milk supply. Babies with tongue tie often cannot create the necessary suction or tongue movement to effectively extract milk. This can lead to:
Poor breast drainage, signaling the body to slow milk production
Short, frequent feeds that don't fully empty the breast
Painful latch or nipple damage, which may discourage frequent nursing
Over time, the baby’s inefficient feeding and the parent’s discomfort can create a cycle of decreased milk supply, leading to the need for supplementation and, in some cases, early weaning.
The Takeaway
Tongue tie can impact both babies and parents in profound ways. If your baby shows signs of reflux, struggles with feeding, or you're noticing a drop in milk supply, it’s worth getting an evaluation from a lactation consultant or pediatric specialist. Identifying and treating oral restrictions early can lead to more comfortable, effective feeding for both baby and parent.
Below are examples of different types of Tongue Tie (short frenulum).
References:
Baeza, C., Douglas, P., Hazelbaker, A., Kaplan, M., Martinelli, R., Marchesan, I., Murphy, J., Smillie, C. & Watson Genna, C. Incidence and Prevalence of Tongue Tie; Assessment ad Classification of Tongue Tie; Treating Tongue Tie; Posterior Tongue Tie; Complementary Techniques to Address Tongue Tie. Clinical Lactation, September Edition, (2017). Pages 89-121.
Berry, J, et al. A Double-Blind, Randomized, Controlled Trial of Tongue-Tie Division and Its Immediate Effect on Breastfeeding. BREASTFEEDING MEDICINE Volume 7, Number 3, 2012
Boutsi, E. (2014). The maxillary labial frenum. J Cranio Max Dis, 3:1-2
Buryk, M, et al. Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial. Pediatrics 2011;128;280
Elad, D, et al. Biomechanics of milk extraction during breast-feeding. PNAS. 2014 Apr 8;111(14):5230-5
Cordray, H., Mahendran, G. N., Tey, C. S., Nemeth, J., Sutcliffe, A., Ingram, J., & Raol, N. (2022). Severity and prevalence of ankyloglossia-associated breastfeeding symptoms: A systematic review and meta-analysis. Acta Paediatrica. https://doi.org/10.1111/apa.16609
Ghaheri BA, Lincoln D, Mai TNT, Mace JC. Objective Improvement After Frenotomy for Posterior Tongue-Tie: A Prospective Randomized Trial. Otolaryngology–Head and Neck Surgery. September 2021. doi:10.1177/01945998211039784
Geddes, D., & Sakalidis, V.S. (2016) Ultrasound imaging of breastfeeding - a window to the inside: Methodology, normal appearances and application. Journal of Human Lactation, 32(2), 320-349.
Geddes, DT, et al. Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effect on Milk Removal and Sucking Mechanism as Imaged by Ultrasound. Pediatrics 2008;122;e188
Genna, C. W. (2017). Supporting sucking skills in breastfeeding infants (3rd ed.). Jones & Bartlett Learning.
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