Hi there! If you're reading this, chances are you're wondering whether your child has a tongue tie—or maybe you've just found out they do and you're trying to figure out what that means. As a speech-language pathologist (SLP), I work with families navigating this exact situation every day. And let me tell you, you are not alone, and you are not overthinking things.

Tongue ties can be confusing, emotional, and often misunderstood. But with the right information and support, you can feel confident in making decisions that are right for your child. So here’s everything your speech therapist wants you to know—broken down in simple, honest terms.

First Things First: What Is a Tongue Tie?

A tongue tie, or ankyloglossia, is when the strip of tissue under the tongue (called the lingual frenulum) is unusually short, tight, or thick. This can limit the tongue’s range of motion—sometimes just a little, sometimes quite a lot.

A tongue tie is a structural difference a baby is born with, and while some tongue ties are obvious (the classic “heart-shaped” tongue tip), others are not so obvious to the naked eye but are typically suspected through various oral motor challenges (which we will touch on below). In either scenario, a true tongue tie leads to decreased function of the tongue and therefore should not be diagnosed without a trained eye and a functional assessment.

Tongue Ties Don’t Always Work Alone

Oftentimes, tongue ties are accompanied by other oral ties, such as buccal ties (or cheek ties) and lip ties. Together, you may hear these referred to as “Tethered oral tissues”. Similarly to Tongue ties, buccal ties and lip ties are present at birth, difficult to diagnose, and should be assessed by a trained professional through a functional evaluation.

What You Might Notice if Your Child Has a Tongue, Lip, or Buccal Tie

Here are some common signs and symptoms of oral ties, grouped by age:

In Infants:

If not observed immediately at birth or upon your first visit with your child’s pediatrician, your child may demonstrate the following:

Difficulty latching or staying latched during breastfeeding or bottle feeding
Clicking or gulping sounds while feeding
Munching behavior on the breast or bottle (vertical jaw movement to express milk)
Poor weight gain
Gassiness or colic-like symptoms
Milk leaking from the mouth
Long and tiring feedings or very short and ineffective ones (often leading to baby producing a hunger cry immediately after eating)
Frustration during feeds
Open mouth posture while sleeping and/or awake
Unusual tightness within the body
Difficulty opening the mouth wide to latch
Top lip tucking inward during breast and bottle feeding

If breastfeeding, mom might observe the following:

Pain while breastfeeding
Excessive blistering of the nipples
Milk production that never truly “kicks in” (or a low milk supply)

In Toddlers and Children:

Delayed speech or difficulty making certain sounds (like L, R, T, D, N)
Messy or picky eating
Difficulty chewing or swallowing
Frequent choking or gagging
Mouth breathing
Snoring or restless sleep
Frequent and prolonged bedwetting
Drooling past toddler years
Behavioral issues related to sleep deprivation or frustration (can present like ADD or ADHD)
Crowding of teeth
Provider informing you that your child has a high and/or narrow hard palate
Frequent sore throats
Enlarged Tonsils and Adenoids

In Older Children or Teens:

Difficulty with oral hygiene
Tension in the jaw or neck
Speech that sounds “mumbled” or unclear
Fatigue or frustration during speaking
Frequent tossing/turning in the night

Do All Ties Need to Be Released?

No—some ties are tight, but may not cause any functional issues. Some ties can even be treated with a therapeutic approach only. If your child is eating well, speaking clearly, sleeping soundly, and breathing normally, with or without therapeutic intervention, we may simply monitor over time.

If symptoms are present, ties are getting in the way of function, and the therapy approach alone is not enough, a release might be recommended. In that case, we approach care as a team—which may include:

A speech-language pathologist (SLP)
Feeding therapist (SLP or OT)
Lactation consultant (IBCLC)
Pediatric dentist or ENT
Physical or occupational therapist
Bodyworker (e.g. craniosacral therapist, chiropractor)
Myofunctional therapist

Why Speech Therapy Matters Before and After a Release

Releasing a tongue, lip, or buccal tie is only one piece of the puzzle. Without therapy, a child may continue to use the same muscle patterns—or may not fully benefit from their newfound mobility.

Speech and Feeding Therapy can help:

Strengthen oral muscles
Eliminate compensations
Improve speech clarity
Normalize feeding mechanics
Support full recovery and long-term success

In short: structure needs function to follow.

FAQs About Oral Ties

Can a lip or buccal tie affect speech?

Indirectly, yes. While they don’t typically cause speech delays, they can contribute to oral tension, limited mobility, or compensation patterns that affect how sounds are produced. The tongue is usually the bigger speech player, but lip and cheek ties can also affect specific speech sounds.

Do ties cause dental issues?

They can. Lip ties might contribute to spacing between front teeth, while tongue ties can influence palate shape, jaw growth, overcrowding of teeth and potentially lead to orthodontic concerns later on.

Is surgery (or release) the only option?

Nope! Surgery may be helpful in some cases, but it's not always needed—and it's never the first step. We start with assessment, observation, and therapy. If a release is needed, it should be part of a larger treatment plan with proper pre- and post-care.

Who can I go to for a Functional Assessment?

Your local speech, feeding and myofunctional therapists are a great first contact for a functional assessment of possible oral ties. Be sure to ask when scheduling to be placed with a provider that is knowledgeable of oral ties. Though we all learn about ties in school and training, not all providers have experience working directly with oral ties and pre/post releases. Once function is assessed, therapy can begin!

Can a tongue tie “grow back”?

Unfortunately, yes. Oral ties have been known to reconnect after release if therapy is not attended pre and post procedure. Some ties can even become thicker secondary to scar tissue, resulting in decreased function. When deciding on a provider for release (dentist, ENT), be sure that they encourage a team approach with your local therapists. The best outcomes happen with a team approach to tie releases.

Can oral ties affect sleep?

Yes, oral ties have been linked to poor sleep. Oral ties often hold the mouth in an open position leading to mouth breathing throughout the day and during sleep. When we only breathe in and out through our mouths, and not through our noses, we do not obtain as much oxygen. Poor oxygen intake can lead to restless sleep, fatigue throughout the day, behavioral issues, frequent bed wetting and even sleep apnea.

When do oral ties need to be released?

Though there is no true age that ties “need” to be released, like all therapeutic interventions, the earlier you get started the better. It is best to reach out to your local provider as soon as you begin noticing signs of oral ties for a functional assessment to ensure early intervention for your kiddo.

What causes oral ties?

In most cases, ties are likely multifactorial. Things like genetics, development in utero, and environmental exposures can all contribute. While there is a lot left to learn, we do believe a holistic approach to prenatal care is an important piece of the puzzle. You can read more about the link between tongue ties and a proactive approach to genetics in our previous blog HERE.

You Know Your Child Best

If you're reading this and nodding your head—trust your gut. You’ve already taken a huge step by being curious and seeking answers.

Oral ties are not something to panic over, but they are something worth understanding. With the right support, you can give your child the tools they need to eat, speak, and grow with confidence.

Our comprehensive team is a great place to start evaluating your concerns and connecting you with the right specialists.

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Everything Your Child’s Speech Therapist Wants You to Know about Tongue Ties …And then some