Tethered Oral Tissue Education
What is a tongue-tie? A tongue-tie (ankyloglossia) occurs when the thin band of tissue under the tongue (the lingual frenulum) is too tight, thick, short, or restrictive. This limits the tongue’s natural range of motion and can affect feeding, breathing, speech, oral development, and sleep. Regardless of the method of feeding (Breastfeeding or bottle feeding) the suck/swallow process is a full time job for a baby. A tight frenum can make that job difficult and tiring.
What is a lip-tie? A lip-tie (labial) happens when the tissue connecting the upper lip to the gum is tight or restrictive. Can led to a shallow latch and upper lip dimple while feeding. If the baby is nursing well-enjoy your nursing relationship. In other words, if it’s not causing a problem, there is no need for a procedure at this time.
Cheek and Buccal ties are tight bands of tissue (frenula) that connect the inside of the cheeks (buccal mucosa) to the upper or lower gums. When these bands are too short, thick, or restrictive, they can limit normal cheek movement and function—especially in babies and children.
How do tongue-ties affect babies? Restricted tongue movement can impact how a baby latches, transfers milk, swallows, breathes, and develops oral strength. Common symptoms include:
• Painful breastfeeding (sore and flattened nipples after feeding)
• Poor latch or frequent slipping
• Clicking while nursing or bottle feeding
• Friction blisters or cobblestone appearance still present after the first month of birth
• Gassy, colicky behavior
•Torticolis
•Plagiocephaly
• Slow weight gain
• Frequent and Prolonged feeds
• Reflux-like symptoms
• Milk Tongue (baby can’t lift tongue high enough to rub against the palate)
• Decreased milk transfer
• Proper lip flange
• Plugged ducts/Mastitis
• Fatigue at the breast/Cluster feeding
• Invisible lower lip due to recessed chin
• Baby tongue doesn’t lift while crying
• Tongue cupping or heart-shaped tongue
• High palate
How can tongue-ties affect older children? In toddlers and children, tongue-ties may contribute to:
• Mouth breathing
• Snoring or poor sleep
• Speech delays or articulation challenges
• Dental crowding and mandibular teeth pulled back
• Cavities
• Narrow palate
• Poor oral tongue posture: the tongue should be against the roof of the mouth (palate) with the tip of tongue gently behind the front teeth.
• Picky eating or hypersensitive gag reflex
• Behavioral or attention challenges
• Chronic congestion
• Body tension
• Headaches
Does every tongue-tie need to be released? No. Not every tie needs treatment. At Honeybee, we evaluate:
• Function (how the tongue actually moves and works)
• Symptoms (feeding, breathing, sleep, speech, growth)
• Compensation patterns
• Airway impact
• Whole-body connection
We only recommend release when it is functionally necessary and beneficial for your child’s health and development.
How is a tongue-tie evaluated at Honeybee? We perform a comprehensive functional assessment, which may include:
• Visual and hands-on oral exam
• Range-of-motion testing
• Feeding assessment
• Airway and sleep screening
• Growth and oral posture evaluation
Collaboration with lactation, feeding, or therapy providers when needed
How is the release performed? We use a gentle CO₂ laser (LightScapel) for tongue-tie and lip-tie releases. This allows for:
• Precise tissue release
• Minimal bleeding
• Reduced swelling
• Faster healing
• Lower risk of re-attachment
• Improved comfort
The procedure is quick and typically takes only a few minutes.
Is the procedure painful? Most babies tolerate the procedure very well. Healing in the mouth happens quickly and babies heal faster than adults. The CO₂ laser minimizes trauma, and we use comfort-focused techniques to keep your child calm and supported. Some mild fussiness or soreness for 24-48 hours is normal and temporary. We recommend skin-to-skin time, frozen breast milk, or over the counter pain meds and we have more natural alternative pharmaceuticals for discomfort as well.
How soon will feeding improve? Some families notice immediate improvement, while others see gradual progress over days to weeks as oral muscles learn to move properly. Healing, nervous system integration, and muscle coordination all play a role in timing.
Why are stretches necessary after the release? Stretches help prevent the tissue from re-attaching during the healing phase. While they can feel intimidating at first, they are critical for long-term success and optimal outcomes.The stretches will keep the wound open and allow the fibers to grow with length, resulting in more elasticity post-release.We provide clear, gentle guidance and support throughout the entire process. Healing happens very quickly in infants- they are new and fresh with cells that proliferate at a great speed! Dr. Nez believes it is important to follow-up frequently, because nothing is more frustrating than having to go through the procedure twice.
Do you work with lactation consultants and therapists? Yes. We strongly believe in collaborative care and frequently work alongside:
• Lactation consultants
• Myofunctional therapists
• Bodyworkers (CST, PT, OT)
• Speech therapists
• Pediatricians and ENTs
Optimal outcomes happen when the whole system is supported.
At what age can a tongue-tie be released? Releases can be performed in:
• Newborns
• Infants
• Toddlers
• Children
Each age has unique considerations, which we review carefully with your family.
Is tongue-tie connected to airway and sleep? Yes. The tongue plays a critical role in airway development, oral posture, swallowing, and breathing. Proper tongue posture supports an open airway. Restricted tongue mobility can contribute to:
• Mouth breathing
• Poor sleep quality
• Snoring
• Under-developed jaws
• Narrow arches
• Long-term airway challenges
Early intervention supports healthier airway growth.
How do I know if my child should be evaluated? If your child has challenges with:
• Feeding
• Breathing
• Sleep
• Speech
• Mouth breathing
• Snoring
• Reflux-like symptoms
• Poor latch
• Dental crowding
We use the Fairest-6 (Functional Airway Evaluation Screening tool) framework to asses the Red Flag Exam Findings for Pediatric Sleep-Disordered Breathing (SDB) for example mouth breathing, mentalis strain, tonsillar hypertrophy, and ankyloglossia. We focus on function, rest, posture, tone, and airway patterns,.
Measurements include: Oral Motor Functional assessment (tongue range of motion, lingual palatal seal, maxillary intercaine distance, and facial structural changes). Pediatric Sleep Questionnaire, Imaging (cone beam computed tomography or CBCT), Orthodontic models and expansion. We look at breathing at rest, lip seal, suction, feeding efficiency (breast, bottle, cup), tongue elevation and lateralization, allergies, congestion, tongue-palate awareness, jaw stability, pacifier/thumb use, feeding portions, screen time/posture, palate shape, hypotonia vs. hypertonicity. Neuroplasticity is highest before the age of 4-we are shaping habits before skeletal compensation.
An evaluation may be helpful—if you’re unsure.
Do you accept insurance? Honeybee Pediatric Airway & Tongue-Tie operates as an out-of-network specialty practice. This allows us to provide:
• Longer visits
• Individualized care
• Advanced technology
• Comprehensive evaluations
• True one-on-one attention
We can provide superbills for families who wish to seek insurance reimbursement.
References:
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