Your Baby Has a Tongue Tie but You Are Not Ready for a Release. What Can You Do in the Meantime?
If you have been told your baby has a tongue tie, anterior restriction or a deeper submucosal restriction, you may be trying to make sense of a difficult decision.
Perhaps feeding has felt hard from the beginning. Your baby may click, leak milk, lose their latch, pull off crying, gulp, cough, swallow air, feed for long periods, become stiff through their body or seem uncomfortable after feeds. You may have sore nipples, damaged nipples, low supply, oversupply or concerns about whether your baby is transferring milk efficiently.
You may also have had conflicting opinions. You might have already seen an IBCLC. Perhaps someone has told you feeding looks fine, yet you still feel that your baby is working far too hard to feed. Or maybe a tethered oral restriction has been identified, but you do not feel ready to proceed with a laser or scissor release.
It’s ok to feel unsure. If you are choosing not to release at this stage, there are still ways to support your baby’s feeding, comfort and oral function while you keep reviewing what they need.
Tongue tie is about restriction and function
A tongue tie is not simply a visible piece of tissue under the tongue.
A clinically meaningful tongue tie is a restrictive lingual frenulum that limits tongue movement and affects function. In babies, this may include difficulty lifting the tongue towards the hard palate, creating a stable seal, cupping around the breast or bottle teat, maintaining suction or coordinating sucking, swallowing and breathing.
For effective breastfeeding, the tongue needs to elevate, shape and move rhythmically against the breast. It helps create and maintain a seal, stabilise the breast in the mouth and support milk transfer. When elevation is restricted, a baby may compensate by using more jaw pressure, lip gripping, shallow latching, head extension or whole body tension.
An anterior tongue tie may be easier to see. A posterior or submucosal restriction can be less obvious visually because the restriction may sit beneath the mucosal surface. In these cases, a functional oral assessment may involve observing tongue movement and feeding, as well as gentle palpation of the floor of the mouth by an appropriately trained clinician. Visual inspection alone does not tell the full story.
Not that every baby with a restriction needs a procedure. It’s that a restriction can be clinically relevant when it is limiting tongue movement and contributing to feeding difficulty.
Why parents may choose not to release
There are many reasons a family may decide not to proceed with a release, or may want more time before deciding.
You may be concerned about your baby undergoing a procedure. You may feel anxious about pain, bleeding, wound care, feeding changes afterwards or the possibility that a release will not resolve every symptom.
You may have financial concerns, limited access to an experienced provider or uncertainty after receiving mixed advice. You may also have a baby who is gaining weight, even though feeding is exhausting or uncomfortable, and you may not be sure whether the benefits outweigh the stress of a procedure.
Some parents are simply not ready. That doesn’t mean you’re ignoring your baby’s needs. It means you are choosing to support your baby while continuing to observe, gather information and decide what feels right for your family.
What tongue restriction can look like during feeds
A tethered oral restriction can show up differently in different babies. Some babies compensate very effectively for a period of time, while others become unsettled quickly.
Patterns that may be worth discussing include:
A shallow latch or repeated loss of latch at the breast
Clicking, leaking milk or noisy feeding
Pulling off, coughing, sputtering or becoming upset during feeds
Nipple pain, blanching, compression stripes or nipple damage
Very long feeds, frequent feeds or a baby who seems to tire while feeding
Difficulty maintaining suction on a bottle teat
Dribbling, gulping, coughing or needing frequent pauses during bottle feeds
Excessive air swallowing, burping, hiccups or discomfort after feeds
Jaw clenching, lip gripping, chin tension or strong cheek activity
Head tipping back, arching, stiffening or pushing away during feeds
Concerns about milk transfer, weight gain or maintaining milk supply
These symptoms do not determine that a tongue restriction is the only factor involved. Feeding is influenced by milk flow, supply, breast anatomy, bottle flow, infant maturity, reflux, illness, body tension and many other factors.
However, when these patterns are present alongside limited tongue elevation or poor tongue function, it is reasonable to consider that a tethered oral restriction may be contributing.
If you are not releasing, start with a management plan
Choosing not to release does not need to mean waiting without support.
The goal is to help your baby feed as effectively and comfortably as possible using the movement they currently have, while reducing compensations that can make feeding harder.
Continue lactation support
Even if you have already seen an IBCLC, ongoing support can still be valuable.
Feeding changes as babies grow. Milk supply changes. A baby’s strength, coordination, oral motor patterns and ability to manage flow also change. A follow up assessment may focus less on identifying a tongue tie and more on practical management.
An IBCLC may help with:
Breastfeeding positions that encourage a deeper, more stable latch
Strategies for fast letdown, oversupply or slower milk flow
Supporting milk transfer and protecting supply
Reducing nipple pain and breast trauma
Pacing bottle feeds and matching teat flow to your baby’s coordination
Identifying when feeding is becoming more efficient or when reassessment is needed
For some babies, a more reclined breastfeeding position can reduce the force of milk flow and give them more time to coordinate swallowing. For bottle feeding, paced feeding and a slower, appropriate teat flow can reduce gulping and air intake.
Lactation support cannot remove a restriction. But it can reduce the impact of that restriction on feeding and help you understand whether your baby is managing, compensating or continuing to struggle.
Support body comfort and feeding position
Babies with restricted tongue movement may recruit other parts of their body to help them feed. You may notice jaw tension, neck extension, body arching, shoulder tension, a strong head turning preference or difficulty settling into a comfortable feeding position.
Gentle infant osteopathy or bodywork may be helpful when your baby has clear positional discomfort, tension patterns or limited ease of movement that appear to be adding to feeding difficulty.
The aim is to support your baby’s comfort, head and neck mobility, jaw movement, ability to flex and settle, and capacity to access the tongue movement they do have. This may make it easier for your baby to organise themselves for feeding.
Use gentle oral motor support
When the tongue cannot elevate or move freely, babies often compensate. They may use more jaw compression, a shallow seal, lip gripping or excessive cheek effort to stay attached.
Gentle oral motor support may be used to help a baby organise sucking patterns, improve their available tongue movement, develop a steadier seal and coordinate sucking, swallowing and breathing.
This might include brief, calm and individualised support before a feed, rather than forceful exercises. Depending on the baby, a suitably trained practitioner may support:
Tongue cupping around a clean gloved finger
Rhythmic sucking and sucking endurance
Lip seal and jaw stability
Reduced jaw clenching or biting patterns
More organised sucking before breast or bottle feeds
Gradual practice with an infant MyoMunchee where it is appropriate and guided
These strategies are designed to help your baby work more efficiently within their current movement capacity and reduce unhelpful compensations.
Oral motor support should be gentle and responsive. It should not involve forcefully sweeping beneath the tongue, pushing through distress or continuing if your baby becomes upset, fatigued or begins to resist oral input.
Low tongue posture and development
When tongue elevation is restricted, the tongue may rest lower in the mouth more often. This can matter because the tongue, palate, jaw, nasal breathing and facial growth develop in relationship with one another.
Low tongue posture and reduced tongue elevation can be relevant features to monitor, particularly when they occur alongside feeding difficulty, restricted oral function or persistent mouth open posture.
If you are not releasing at this stage, you can still support the foundations that matter now:
Comfortable nasal breathing
Feeding patterns that reduce strain and air swallowing
Gentle support for body movement and head positioning
Age appropriate oral motor development
Regular review as feeding changes
Further assessment if new concerns arise with solids, breathing, sleep or oral function
Managing air swallowing and reflux like symptoms
A baby who cannot maintain a stable seal may take in more air during feeds. This can contribute to burping, hiccups, tummy discomfort, grunting, frequent possets, pulling off, crying after feeds and reflux like behaviour.
This is sometimes called aerophagia induced reflux (AIR), meaning that swallowed air may be adding to feeding discomfort and reflux like symptoms.
If a restriction is contributing to an inefficient seal, a release may be one option to discuss. But if you are not releasing now, you can still work to reduce the amount of air your baby takes in.
Helpful strategies may include:
Having breast and bottle feeds observed by a feeding professional
Adjusting breastfeeding position to support a deeper latch and more stable seal
Using paced bottle feeding rather than allowing a bottle to flow quickly
Reviewing teat flow and shape with a feeding professional
Keeping your baby well supported, close and aligned during feeds
Offering a gentle pause if your baby starts gulping, leaking or becoming unsettled
Burping responsively when your baby appears uncomfortable
Holding your baby upright against your chest after feeds if this helps them settle
When to revisit the release conversation
You do not need to decide about a release once and never revisit it.
It may be worth seeking further assessment if your baby continues to have significant feeding difficulty despite skilled lactation support, feeding adjustments, body based support or oral motor work.
You may also want to revisit the conversation if there is persistent nipple pain, poor milk transfer, poor weight gain, ongoing bottle feeding difficulty, feeding refusal, increasing stress around feeds or a baby who appears to be working very hard to feed.
A release is generally considered when there is a restrictive frenulum, clear functional impact and feeding difficulties that have not improved with appropriate conservative support.
When to seek medical advice
Please seek prompt advice from your GP, maternal and child health nurse or paediatric clinician if your baby is not gaining weight appropriately, is refusing feeds, is too sleepy to feed effectively, has fewer wet nappies than expected or seems persistently distressed.
Seek urgent medical assessment if your baby has green or yellow green vomit, blood in vomit or stools, repeated forceful or projectile vomiting, breathing difficulty, blue or grey colour changes, fever, signs of dehydration, unusual lethargy or seems significantly unwell.
Takeaway
If your baby has a tethered oral restriction and you are not ready to proceed with a release, you still have options.
A restriction can be functionally relevant, particularly when it limits tongue elevation and contributes to feeding difficulty, poor seal, compensatory jaw and body tension or air swallowing. You do not need to minimise those concerns simply because the restriction is not obvious at first glance.
At the same time, you can choose a supported, practical path. Continue feeding support, reduce feeding strain, support comfort and oral motor coordination, monitor growth and reassess as your baby develops.
You are not required to rush. But you also do not need to wait without a plan.
This article provides general education only and does not replace individual assessment. If you are concerned about your baby’s feeding, weight gain, breathing, vomiting or overall wellbeing, seek advice from your GP, maternal and child health nurse, paediatric clinician or appropriately qualified infant feeding professional.
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If you have been told your baby has a tongue tie, anterior restriction or a deeper submucosal restriction, you may be trying to make sense of a difficult decision.
Perhaps feeding has felt hard from the beginning. Your baby may click, leak milk, lose their latch, pull off crying, gulp, cough, swallow air, feed for long periods, become stiff through their body or seem uncomfortable after feeds. You may have sore nipples, damaged nipples, low supply, oversupply or concerns about whether your baby is transferring milk efficiently.