Tongue Tie and Breastfeeding

An evidence-based, thoughtful approach in a noisy space

What Tongue Tie Really Means

Tongue tie is a topic many parents hear about early and often—through friends, family, social media, and online forums. It is frequently discussed alongside other so-called “ties” and can be framed as a simple explanation for a wide range of feeding challenges.

At FLOW, we understand how confusing and emotionally charged this topic can be. Our approach is grounded in current medical evidence, professional guidelines, and careful evaluation of both parent and baby.

What People Mean When They Say “Ties”

Tongue tie is often discussed together with other oral frenula and referred to broadly as:

“Tethered oral tissues”
“Oral ties”
“Lip and tongue ties”

These terms are commonly used online but are not standardized medical diagnoses.

It is important to distinguish between:

The lingual frenulum (under the tongue)
The labial frenulum (upper lip)
Buccal frenula (cheeks)

What the Evidence and Guidelines Say

Both the Academy of Breastfeeding Medicine and the American Academy of Otolaryngology–Head and Neck Surgery emphasize several key points:

There is no universally accepted definition or diagnostic criteria for tongue tie
Tongue tie should not be diagnosed based on appearance alone
Procedures should not be performed prior to a skilled lactation evaluation
Decision-making should focus on feeding function and outcomes, not anatomy in isolation

These recommendations exist to protect families from unnecessary procedures and to ensure that feeding challenges are evaluated comprehensively.

Tongue Tie as a Functional Diagnosis

At FLOW, we view tongue tie as a functional diagnosis, not a visual one.

This means we assess:

How the tongue moves through the range of motion required for breastfeeding
Whether the tongue can elevate, extend, and coordinate effectively
Infant milk transfer at the breast
Maternal comfort, including nipple pain or tissue damage
The overall feeding relationship between parent and baby

A visible frenulum alone does not determine whether treatment is indicated.

What FLOW Does Not Recommend

Based on current medical literature and professional guidance:
- We do not perform or recommend buccal (cheek) frenotomy or labial (lip) frenotomy for breastfeeding concerns
These positions reflect the absence of high quality evidence that they improve feeding challenges—not dismissal of parental concerns.

When Tongue Tie Treatment May Be Considered

In some infants, a tight lingual frenulum is associated with clear functional feeding difficulties that persist despite appropriate lactation support.

In these cases:

A comprehensive breastfeeding evaluation is completed first
Risks, benefits, and alternatives are discussed in detail
Scissory frenotomy may be offered when clinically appropriate

This is done only after informed consent and shared decision-making, with the understanding that frenotomy is not a guaranteed solution and is not appropriate for every feeding challenge.

Why Evaluation Comes First

Feeding difficulties are often multifactorial. Pain, poor milk transfer, or poor weight gain can arise from:

Positioning and latch challenges
Oral motor immaturity
Prematurity or medical complexity
Milk supply or flow issues
Maternal factors

Professional organizations recommend against performing frenotomy without first addressing these possibilities, because doing so can delay appropriate care and create false expectations.

A Balanced, Respectful Approach

At FLOW, our goal is not to dismiss tongue tie concerns—or to rush to procedures.

Our goal is to:

Listen carefully to families
Acknowledge the information parents are encountering
Evaluate feeding thoughtfully and thoroughly
Use evidence to guide recommendations
Support breastfeeding without unnecessary intervention

Tongue tie is one possible piece of a much larger feeding picture.

A Measured, Evidence-Based Approach

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