If you've spent any time in breastfeeding communities or mom groups, you've probably encountered the term "tongue tie." And if your baby is struggling to latch, you may have already gone down the rabbit hole of wondering whether it's the culprit, or been told by one provider that there's definitely a tie and by another that everything looks fine.

Navigating tethered oral tissues (TOTS) can feel bewildering. There's a lot of information online, a lot of disagreement among providers, and a lot of emotion involved. Because when feeding is hard, everything feels harder. We want to give you a clear, honest framework for understanding what tongue and lip ties actually are, how they might be affecting your baby's feeding, and what a thorough assessment and care plan actually looks like.

What are tethered oral tissues?
Tethered oral tissues are commonly called tongue ties (aka ankyloglossia), lip ties, and buccal ties (aka cheek ties). These are bands of tissue that restrict the normal range of motion of the tongue, upper lip, or cheeks. They're a spectrum, not a binary. A "tie" doesn't necessarily look the same in every baby, and the functional impact varies widely depending on the degree of restriction, the baby's compensatory patterns, and a number of other factors.

A tongue tie restricts how far and how freely the tongue can move. In breastfeeding, this matters enormously, because effective feeding depends on the tongue being able to extend over the lower gum, cup and compress the breast, and create a peristaltic wave that draws milk forward. When that motion is limited, baby works harder and gets less milk, and mom often feels it.

A lip tie restricts how far the upper lip can flange outward, which affects how baby creates a seal at the breast. Lip ties often get less attention than tongue ties, but they can meaningfully affect latch depth and comfort.

What does a tongue or lip tie actually look like in a breastfeeding baby?
This is where it gets nuanced, because the symptoms of a tie are functional, meaning they show up in what feeding looks and feels like, not just in what you can see in the mouth. Things that might suggest a tethered oral tissue is affecting feeding include:
      - Pain with breastfeeding — nipple pain, cracking, blistering, or a compressed, lipstick-shaped nipple after a feed are classic signs of a shallow or inefficient latch
      - Baby slipping off the breast frequently or unable to maintain suction
      - A clicking sound during feeding — this happens when baby loses suction and has to re-create it mid-feed
      - A baby who feeds for a very long time but seems unsatisfied — because they're working hard but not transferring milk efficiently
      - Slow weight gain or weight loss — insufficient milk transfer affects growth
      - Excessive gas, colic-like fussiness, or reflux symptoms — babies who can't seal properly swallow a lot of air during feeds
      - Mom's supply being affected — the breast operates on supply and demand; if baby isn't draining the breast effectively, supply can drop over time

Not all of these symptoms mean there's a tie. And a tie doesn't always mean these symptoms are present. That's why a skilled assessment and hands-on functional evaluation matters, not just a glance in the mouth.

How we approach TOTS at Simply Well
Our approach to TOTS is what we'd call a whole-baby, whole-dyad model. This means Dr Caroline is not just looking at the oral tissues in isolation, she's looking at baby's full body, the feeding relationship between mom and baby, and the physical and structural factors on both sides that might be contributing to the challenge.

Step 1: A thorough assessment
A TOTS assessment at Simply Well is a part of a full lactation evaluation including feeding history, latch observation, and milk transfer assessment alongside a physical assessment of baby's body. Dr. Caroline is looking at neck range of motion, jaw mobility, body tension patterns, and the oral anatomy itself: not just whether a tie is visible, but how the tongue and lips are actually functioning.

Many babies who come in with feeding challenges related to a tethered oral tissue also present with tension throughout their body that is contributing to how they hold and move their mouth. Many times, what looks like a tie issue is primarily a latch mechanics issue, or a body tension issue, or a positioning issue — and we can make real progress on all of those things without any procedure at all. We would always rather assess your baby and find nothing requiring a release than have you struggle silently for weeks wondering whether this is something that could be helped. Most breastfeeding struggles can be helped, you just need someone to look at the whole picture.

Step 2: Bodywork before any release
If a frenectomy (a procedure to release the tie, most commonly done by a pediatric dentist using a laser) is recommended, bodywork beforehand is a critical part of the preparation. A baby who has been compensating for a restricted tongue has developed muscle patterns and tension throughout the body (especially in the neck, jaw, cranium, and cheeks) that don't disappear the moment the tissue is released. If those patterns aren't addressed, the baby often can't take full advantage of the new range of motion after the procedure.

Chiropractic care and Craniosacral Fascial Therapy, both of which we integrate in our infant adjustments, are the most common forms of pre-release bodywork. Dr. Caroline also teaches parents specific oral exercises to do at home in the weeks leading up to a release, to prepare the oral musculature and improve the outcome.

Step 3: Support after the release
The work doesn't stop at the procedure. The period after a frenectomy is a critical window: the tissue is healing, baby is learning new movement patterns, and feeding can temporarily feel more difficult before it gets easier. Dr. Caroline stays closely involved in the post-release period, providing continued bodywork, lactation support, and home exercise guidance to ensure the new range of motion is integrated into functional feeding.

If you're in Toledo and navigating any of this, please reach out. Feeding your baby shouldn't have to hurt. And you shouldn't have to figure this out alone.

📍 Dr. Caroline Lathrop, DC, IBCLC holds specialized training in tethered oral tissues (TOTS), Craniosacral Fascial Therapy, and pediatric chiropractic care. She provides comprehensive TOTS assessments and a whole-dyad approach to feeding support at Simply Well Family Chiropractic in Toledo, Ohio.