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Tongue/Lip Tie Identification

and Functional Impacts

Tongue ties (ankyloglossia) and lip ties are restricted tissue underneath the upper and lower lips and beneath the tongue. They can have significant impact on the ability to close lips or move the tongue tip up, down, left, right or the middle back of the tongue up for correct and efficient swallowing. We offer consults to assess feeding for infants up to one year, including identification in tongue and lip ties and the impact they may have. Please view our Tongue and Lip Tie Symptoms section.

Infant Signs/Symptoms:

  • Fussy/gassy/colicky/frequently spitting up/excessive hiccups

  • Falls asleep during feeds

  • Poor or shallow latch at breast or bottle

  • Gagging, sputtering, or coughing during feeds

  • Slides on/off the nipple during feeds

  • Reflux

  • Lip blisters

  • Difficulty flanging lips out

  • Loss of milk from mouth during feeds

  • Feeds extend past 20 minutes after infant is approximately 4 weeks of age

  • Frequent feeds (more than once every 2-3 hours)

  • Clicking or smacking noises during feeds

  • Biting/chewing nipple

  • Noisy breathing or snoring

  • Breathing through mouth (tongue may protrude forward)

  • Frustration during feeds

  • Short sleep duration

  • Nasal congestion

  • Poor weight gain

  • Pacifier falls out easily


Mother’s symptoms of a tongue/lip tied infant:

  • Pain during nursing

  • Cracked, creased, flattened, bleeding, or lipstick shaped nipples

  • Plugged milk ducts and/or mastitis

  • Oversupply or under supply of milk

  • Needing to use a nipple shield


Signs/Symptoms in Children and Adults:

  • Speech difficulties or distortions (poor speech intelligibility)

  • Mouth breathing; lip closure may be difficult; nasal congestion may be persistent

  • Noisy breathing; poor respiration patterns

  • Slow, slurred speech

  • Feeding difficulties (picky, messy, avoiding certain food types or textures, difficulty chewing)

  • Poor lip rounding (i.e. difficulty using a straw or giving a kiss with puckered lips)

  • Coughing with thin liquids when drinking from a cup or straw

  • Drooling; drooling should never be excessive and cease by 2 years of age

  • Poor sleep quality

  • Poor oral health; increased number of cavities

  • TMJ dysfunction


These signs may not only be caused by tongue and lip ties, making it important to have an assessment to determine the cause of the symptoms for the infant, child, or adult to create a therapy plan specifically for that individual.

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