Tongue Tie Explained: Signs, Diagnosis & Support for Babies and Children
by Dr Vanessa Fisher, Osteopath (The Willow Clinic)
What Is Tongue Tie?
Tongue tie is a condition present at birth where the lingual frenulum is shorter, thicker or tighter than usual. This the tissue connecting the underside of the tongue to the floor of the mouth.
It can limit tongue movement and affect how the tongue functions. Not everyone with a visible frenulum has a problematic tongue tie and this needs to be properly assessed. The key, is whether tongue movement impacts function, especially feeding in infants.
How Do I Know If My Child Has a Tongue Tie? What Are the Symptoms?
Signs in Babies
Tongue tie may present with functional issues, particularly during feeding:
• Difficulty latching to the breast or staying on the nipple
• Painful breastfeeding for the parent, including nipple damage
• Clicking sounds while feeding
• Poor milk transfer or slow feeds
• Inadequate weight gain despite frequent feeds
• Excessive gas or feeding fatigue in the baby
Physical Signs to Look For
When encouraged to extend their tongue, a baby with restricted mobility may show:
• Limited tongue extension beyond the lips
• A heart-shaped or notched tongue tip
• Difficulty lifting the tongue up or moving it side-to-side
Signs in Older Children
In toddlers or older kids, signs can include:
• Difficulties with certain speech sounds
• Challenges with swallowing certain foods
• Mouth breathing or poor tongue posture
• Slow or inefficient eating patterns
How does it compare with what’s normal?
A lingual frenulum is normal anatomy — only when it significantly restricts tongue function do clinicians consider it a problematic tongue tie. This functional approach (not just appearance) is emphasised in clinical consensus guidelines.
In a clinical context, professionals assess:
• Range of tongue motion
• Functional patterns like suck-swallow-breathe coordination
• Feeding biomechanics and overall oral posture
Key Takeaways
✔ A tongue tie is clinically significant when it limits function, not just based on appearance.
✔ Early signs are most notable in feeding patterns and oral mechanics.
✔ Diagnosis is best made through a multidisciplinary approach involving medical and functional
specialists.
✔ Osteopaths and chiropractors with expertise in oral function can play a complementary role in
assessment and supportive care.
✔ Collaborative care and careful assessment ensure the most appropriate path forward for your
child’s feeding and development.
If you're unsure if your baby has tongue tie, Dr Vanessa Fisher is an experienced Osteopath based in Brookvale on Sydney's Northern Beaches. Make contact here and she can help you assess and advise you on the next steps forward for your baby's optimal feeding and health. To read more, I have continued the discussion about Tongue Tie with Vanessa in a Part 2 post here.
References
https://pmc.ncbi.nlm.nih.gov/articles/PMC6850428
https://pubmed.ncbi.nlm.nih.gov/35337536/
https://online.tonguetieinstitute.com
osteopathy.org.au
https://aapd.org.au/wp-content/uploads/2021/01/Ankyloglossia-and-Oral-Frena-Consensus-
Statement_June-2020.pdf
