Tongue Tie Isn't Black and White. And That's Exactly the Problem.

Written By Emily Spaeth

You Googled "tongue tie."

And now you have seventeen browser tabs open, a list of conflicting opinions, and more anxiety than you started with.

One provider says it's obvious. Another says it's overdiagnosed. A third says wait and see.

In this episode, Dr. Emily Spaeth sits down with Melissa Cole — IBCLC, neonatal oral motor specialist, clinical herbalist, and published researcher — to untangle one of the most controversial topics in infant feeding.

Tongue tie isn't a simple yes or no. And the nuance is everything.

What a Tongue Tie Actually Is

A tongue tie — or ankyloglossia — happens when the lingual frenulum, the connective tissue beneath the tongue, hasn't fully regressed during embryonic development.

In a typical embryo around 8–10 weeks of pregnancy, that tissue is supposed to pull back, allowing the tongue to move freely from the floor of the mouth. When it doesn't fully regress, the tongue's mobility and function can be restricted.

It's not about tightness alone. It's also about where the frenulum inserts — and how much each baby can compensate.

That's why two babies with the same anatomy can have completely different feeding experiences.

Why There's So Much Confusion Right Now

Tongue tie has gone from a footnote in a textbook to a heated debate — online, in pediatrician offices, and in feeding clinics.

The research started catching up around 2014–2017, with an explosion of literature. Awareness grew. Parents wanted answers. And providers, trained through very different lenses, started disagreeing publicly.

Here's the reality:

  • Some babies have a tie that's affecting feeding significantly

  • Some babies have visible anatomy that isn't causing any problems

  • Some babies have feeding problems that look like a tie but are caused by something else entirely

What families need isn't a yes or a no. They need a clinician who can tell them how much of the problem is the tie — and what else might be going on.

Signs That Might Point to a Tongue Tie

There's no perfect checklist. But Melissa shares what she commonly sees:

  • Poor latch or seal

  • Inefficient milk transfer

  • Baby tiring quickly during feeds

  • Increased air intake and gassiness

  • Low weight gain despite frequent nursing

  • Jaw or lip compensation during feeding

The critical distinction? Every single one of these symptoms can also be caused by something that has nothing to do with a tongue tie.

That's why good differential diagnosis matters so much.

What a Mindful Approach to Tongue Tie Care Actually Looks Like

Melissa uses the phrase "mindful approach" — and it means something specific:

Before any procedure:

  • Understand how much of the feeding problem is actually the tie

  • Address musculoskeletal tension, GI issues, or strength concerns that may be contributing

  • Help the family set realistic expectations

  • Decide together: is now the right time?

Some babies need prep work first. Some don't. A good clinician helps a family figure out which situation they're in — rather than handing them a pre-set protocol.

After a frenectomy:

  • Wound care matters, but less is often more

  • Melissa typically recommends simple oral motor activities and wound care about three times daily

  • She checks in with photos weekly to monitor healing

  • Full tissue remodeling can take up to 12 months — families need to know this

The goal is healing without adding more stress to an already overwhelmed baby — and an already exhausted parent.

When It Isn't the Tie

This might be the most important part of the conversation.

Many babies who present with feeding challenges don't have a tongue tie at all — or the tie isn't the primary driver.

Common culprits that can mimic a tongue tie:

GI and digestive issues. A baby who's clamping, pulling, or frequently fussing at the breast may be dealing with reflux, bowel motility issues, or food protein sensitivities — not a structural problem in the mouth.

Cardiorespiratory factors. A baby working harder to coordinate suck-swallow-breathe may look like a tongue-tied baby simply because they're fatigued or compensating.

Tone and strength concerns. Babies with lower muscle tone or sensory differences feed differently — and may need occupational therapy or PT support, not a surgical procedure.

Tension from birth. Residual tension from delivery can affect how a baby uses their jaw, neck, and oral muscles — and may need to be addressed before feeding can improve.

A skilled clinician isn't just looking at the frenulum. They're looking at the whole baby.

The Team Around the Baby

Tongue tie care is never a solo act.

Melissa talks about who might be on a baby's team:

  • IBCLC for feeding assessment and support

  • Pediatric PT or OT for tone, tension, and developmental concerns

  • Manual therapist (PT, specialized chiropractor, CST) for body-based work

  • Pediatric dentist or ENT for the frenectomy procedure itself

  • Pediatrician for medical oversight

And a red flag? Any provider who says they're all you need.

What This Experience Does to Families

Melissa holds a Certified Perinatal Mental Health credential for good reason. Feeding challenges don't just affect babies.

Parents dealing with unresolved feeding issues are often carrying:

  • Significant anxiety (situational or pre-existing)

  • Exhaustion

  • Grief around feeding goals that feel out of reach

  • Guilt from receiving conflicting advice

She reminds every clinician working in this space: check in on the parent. Ask how the days are going. You might be the first person who has.

If postpartum mood concerns are present — in either parent — that's part of the picture that needs support.

Questions to Ask When You're Looking for a Provider

Not near Portland? Not able to access Melissa or Emily directly? Here's what to ask:

  • Who else would you consider referring us to if you saw something else going on?

  • What would we do if my goals aren't being met in four weeks?

  • How much of the feeding problem do you think is the tie?

If a provider gets defensive, dismisses your concerns, or insists they have all the answers — that's your signal to keep looking.

Melissa also recommends ICAP (the International Consortium of Ankylofrenula Professionals) as a starting point for finding providers with a vetted interest in tongue tie care.

For Pregnant Families: You Don't Have to Be Afraid

Here's the reframe Melissa offers at the end of this episode:

Most families don't end up in her office. Most feeding experiences, with a little support, go well.

What helps isn't fear — it's preparation.

  • Know who your IBCLC is before your baby arrives

  • Consider even one prenatal lactation visit to get comfortable

  • Have a short list of names to call if something feels off

You can't plan for everything. But you can make sure you're not alone.

About Melissa Cole

Melissa Cole is an IBCLC, Neonatal Oral Motor Assessment Professional, Clinical Herbalist, and Certified Perinatal Mental Health Provider. She is the founder ofLuna Lactation and Wellness in Portland, Oregon, a published researcher, and an international speaker.

With over two decades of clinical experience and a master's degree in therapeutic herbalism, she brings one of the most comprehensive lenses in the field to infant feeding and tongue tie care.

Learn more at Luna Lactation and Wellness.

Mentioned in This Episode

More About Dr. Emily

Dr. Emily Spaeth is a Doctor of Physical Therapy and International Board Certified Lactation Consultant specializing in pregnancy, postpartum recovery, and babies. She is the founder of Be Well Baby, a home-visit practice in Portland, Oregon, and the creator of the Beyond Birth Blueprint — an online membership supporting parents through birth, recovery, babies, relationships, and nervous system health.

Everything discussed in this episode is for educational purposes only and is not a substitute for care from your own healthcare team.

If you've been spinning in confusion about tongue tie, this conversation is an invitation to stop.

Find a provider who looks at the whole picture. Ask hard questions. Trust that answers exist.

You deserve clarity — not just a checklist.

Emily Spaeth https://www.bewellbabypdx.com
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