Tongue Tie and Breastfeeding: What an IBCLC Wants Every Parent to Know
If your baby has been diagnosed with a tongue tie or lip tie — or if you suspect one might be affecting your breastfeeding — you're not alone. Tethered oral tissues (TOTS) are one of the most common and most misunderstood causes of breastfeeding difficulty, and one of the most frequent reasons families reach out to Lactation Loop for support.
This guide walks you through everything you need to know — what tongue tie and lip tie actually are, how they affect breastfeeding, what the assessment process looks like, and what to expect before and after a frenectomy.
What Is a Tongue Tie?
A tongue tie (ankyloglossia) occurs when the lingual frenulum — the band of tissue connecting the underside of the tongue to the floor of the mouth — is too short, tight, or thick, restricting the tongue's range of motion. A lip tie occurs when the labial frenulum — the tissue connecting the upper lip to the gum — restricts the lip's ability to flange outward.
Both conditions fall under the umbrella term TOTS — Tethered Oral Tissues.
The tongue is the primary driver of effective breastfeeding. For a baby to nurse efficiently, the tongue needs to extend over the lower gum, cup the breast, and create a wave-like motion to draw milk out. When tongue mobility is restricted, all of this is compromised — which leads to a cascade of breastfeeding problems for both mom and baby.
How Tongue Tie Affects Breastfeeding
The effects of a tongue or lip tie on breastfeeding vary widely depending on the severity and type of restriction. Some babies with ties nurse beautifully with no issues at all. Others struggle significantly. Common signs that a tie may be affecting breastfeeding include:
For baby:
Difficulty latching or maintaining a latch
Clicking or smacking sounds during feeding
Frequent slipping off the breast
Gassiness, colic, or reflux symptoms
Poor weight gain or slow transfer of milk
Fatigue during feeds — falling asleep before finishing
Coughing, choking, or gulping at the breast
For mom:
Nipple pain, creasing, or lipstick-shaped nipples after feeds
Nipple damage — blisters, cracking, bleeding
Recurrent clogged ducts or mastitis
Feeling like baby never fully empties the breast
Low milk supply developing over time due to poor drainage
What Is a Frenectomy?
A frenectomy is the release of the restrictive frenulum tissue — either by scissors (frenotomy) or laser. When performed by a skilled provider on an appropriate candidate, frenectomy can significantly improve tongue mobility and breastfeeding function.
Not every tongue tie requires release. The decision to proceed with a frenectomy should be based on a thorough assessment of both the anatomy AND the function — meaning how the tie is actually affecting feeding — not just the appearance of the frenulum. This is why IBCLC evaluation before frenectomy is so important.
Why an IBCLC Evaluation Matters Before Frenectomy
An IBCLC assessment before a frenectomy serves several critical purposes:
It establishes a baseline — documenting latch quality, milk transfer, and feeding function before the procedure
It determines whether the tie is actually causing the feeding problem, or whether other factors (positioning, oversupply, low supply) are the primary issue
It ensures that if a release is performed, there is a plan in place for post-release rehabilitation — which is essential for long-term improvement
It protects families from unnecessary procedures — not every tie needs to be released, and an experienced IBCLC can help identify when watchful waiting or other interventions are more appropriate
What to Expect After a Frenectomy
This is where many families are surprised — a frenectomy is not an instant fix. In the days and weeks after a release, active oral motor rehabilitation is essential to help the baby learn to use their newly mobile tongue effectively.
Post-frenectomy support from an IBCLC typically includes:
Stretching exercises to prevent reattachment during healing
Oral motor exercises to help baby develop new movement patterns
Feeding reassessment to track improvement in latch and milk transfer
Supply management if supply has been affected
Emotional support — this process takes time and patience
Most families see meaningful improvement within 2 to 4 weeks of a release with proper rehabilitation. Some see immediate changes. Others take longer. Having an IBCLC guide you through the post-release period makes a significant difference in outcomes.
How Lactation Loop Supports TOTS Families
Lactation Loop's board-certified IBCLCs work with tongue tie and lip tie families across Florida, Michigan, Texas, New York, North Carolina, and Indiana — offering in-home visits, in-office appointments, and virtual consultations.
Our Ann Arbor, Michigan location inside Blossom Pediatric Dentistry is a dedicated TOTS Center of Excellence — where our IBCLC works alongside the dental team and Blossom requires an IBCLC evaluation before all frenectomy procedures. This coordinated approach gives Ann Arbor families seamless, team-based care from assessment through post-release rehabilitation.
Regardless of where you are, our IBCLCs can assess your baby's latch and oral function, help you understand whether a tie may be contributing to your challenges, and support you through every step of the process — whether that means a referral for evaluation, pre-frenectomy preparation, or post-release rehabilitation.
Does Insurance Cover Tongue Tie Evaluations and IBCLC Visits?
Yes — most likely! Under the Affordable Care Act, most commercial insurance plans are required to cover lactation support services at no cost to you. Lactation Loop accepts Aetna, Cigna, UnitedHealthcare (UHC), UMR, Meritain, Anthem, Wildflower, Lactation Network, and Curative. We bill your insurance directly — no hassle, no paperwork on your end.
Frequently Asked Questions
How do I know if my baby has a tongue tie? Common signs include clicking during feeds, a lipstick-shaped nipple after nursing, poor weight gain, and nipple pain that doesn't improve with positioning adjustments. The only way to know for certain is a hands-on assessment by an experienced IBCLC or TOTS-trained provider.
Does every tongue tie need to be released? No. The decision to release should be based on functional impact — how the tie is actually affecting feeding — not just appearance. An IBCLC assessment helps determine whether release is indicated or whether other approaches would be more appropriate.
My baby was checked at the hospital and they said no tongue tie. Could they still have one? Yes. Tongue ties — particularly posterior tongue ties — are frequently missed by providers who aren't specifically trained in oral assessment. If you're experiencing breastfeeding difficulties that aren't resolving with positioning and latch work, a TOTS-specific evaluation is worth pursuing.
How long does recovery take after a frenectomy? Most families see meaningful improvement within 2 to 4 weeks with proper post-release rehabilitation including stretching exercises and IBCLC follow-up. Some babies improve immediately. Having IBCLC support after the procedure significantly improves outcomes.
Can a tongue tie cause low milk supply? Yes — indirectly. A baby who can't transfer milk effectively due to a tongue tie will drain the breast poorly over time, which signals the body to reduce production. Addressing the tie and rebuilding supply with pumping support can help restore milk production.
Book an Appointment with a Lactation Loop IBCLC
Whether you're wondering if your baby has a tongue tie, preparing for a frenectomy, or navigating the post-release period — our board-certified IBCLCs are here to guide you. We offer in-home, in-office, and virtual visits across Florida, Michigan, Texas, New York, North Carolina, and Indiana. Most major insurance accepted including Aetna, Cigna, UHC, Anthem, UMR, Meritain, Wildflower, Lactation Network, and Curative.
Book an appointment: lactationloop.com/services Call us: 941-254-2502
Related reading: Lactation Consultant in Ann Arbor, Michigan — lactationloop.com/blog/lactation-consultant-in-ann-arbor-michigan-lactation-loop-ibclc Mastitis, Clogged Ducts & Engorgement: An IBCLC's Complete Guide — lactationloop.com/blog/mastitis-clogged-ducts-engorgement-breastfeeding Fussy Baby at the Breast — lactationloop.com/blog/fussy-baby-at-the-breast-why-babies-pull-away-cry-or-fuss-while-nursing