Over the past decade, I have had the privilege of working with thousands of infants and children with tongue-ties and lip-ties. During that time, I have also had the opportunity to collaborate with many outstanding pediatricians.
This article isn’t meant to criticize pediatricians. Quite the opposite.
Pediatricians are asked to recognize and manage an incredible number of conditions during well-child visits, and most receive very little formal education about tongue-ties during medical school or residency.
If I could share a few things from my own experience with every pediatrician, these would be at the top of the list.
Quick Answer
Tongue-ties are not always easy to recognize, especially when tongue function appears more restricted than tongue anatomy suggests. Evaluating feeding function and listening to parents can help identify infants who may benefit from additional assessment.
A Normal-Looking Tongue Doesn’t Always Function Normally
One of the biggest misconceptions about tongue-ties is that they should be obvious.
Sometimes they are.
Many times they are not.
Posterior tongue-ties, in particular, can be difficult to recognize because the restriction is often hidden beneath the mucosa rather than appearing as the classic band attached near the tongue tip.
I’ve evaluated many infants who had multiple newborn examinations before anyone recognized that tongue mobility was actually restricted.
That isn’t because someone wasn’t paying attention.
It’s because these restrictions can be surprisingly subtle if you haven’t been trained to look for them.
Feeding Function Deserves as Much Attention as Anatomy
One lesson I’ve learned after watching thousands of babies feed is that function almost always tells a more complete story than appearance.
A baby may have a visible tongue-tie and feed beautifully.
Another baby with a much less obvious restriction may struggle tremendously.
Rather than asking only, “Is there a tongue-tie?” I think one of the most valuable questions we can ask is:
“How is this baby actually feeding?”
Watching a feeding – or listening carefully to parents describe one – often provides more useful information than anatomy alone. The baby and family struggling with colic, gas, reflux, nipple pain (but not always!), spit up, poor weight gain (but not always!!), and other feeding struggles often has a less obvious tongue-tie present.
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Parents Usually Know When Something Isn’t Right
One thing I have learned over the years is to pay close attention when parents say:
- “Something just doesn’t seem right.”
- “Feeding shouldn’t be this hard.”
- “We’ve tried everything.”
Most parents don’t arrive looking for a tongue-tie diagnosis.
They are simply looking for an explanation for why feeding feels so difficult.
Sometimes the answer is a tongue-tie.
Sometimes it isn’t.
But those concerns deserve to be taken seriously.
Also Read: Preventing Reattachment After a Tongue-Tie Release: What Parents Need to Know About Stretches
Tongue-Ties Can Look Like Other Conditions
Many infants referred to our office have previously been treated for:
- Reflux
- Colic
- Poor weight gain
- Excessive gas
- Painful breastfeeding
- Prolonged feeding sessions
Do tongue-ties cause all of these problems?
Of course not.
But feeding dysfunction caused by restricted tongue movement can contribute to many of these symptoms.
When babies repeatedly lose suction, swallow excessive air, or work much harder to feed, they often become uncomfortable and understandably fussy.
We Need Each Other
One of the biggest changes I’ve seen over the last decade is increased collaboration between providers. We had over 50 pediatricians refer patients directly to us at the Alabama Tongue-Tie Center last year. We also send letters to pediatricians informing them of the care the child received and any aftercare instructions.
The best outcomes rarely happen because of one provider working alone.
They happen when pediatricians, lactation consultants, speech-language pathologists, occupational therapists, physical therapists, dentists, and physicians communicate well and approach the patient as a team.
Every discipline contributes a different perspective.
That collaboration benefits families tremendously.
Sometimes the Best Recommendation Is “Not Yet”
People are occasionally surprised when I tell them I don’t believe every tongue-tie should be released. I don’t.
Some babies feed well despite a restriction.
Some simply need additional lactation support.
Others benefit from bodywork or therapy before considering a procedure.
The decision should always be based on function, not anatomy alone.
Knowing when not to recommend treatment is every bit as important as knowing how to perform it.
Why I Enjoy Teaching Providers
One of the reasons I created Tongue-Tied Academy was to shorten the learning curve for other providers.
Many of the lessons I’ve learned came from thousands of patient encounters, collaboration with therapists and lactation consultants, and continually asking myself how I could better serve families.
If those experiences can help another provider recognize a struggling infant sooner, or give a parent answers they might not otherwise receive, then teaching has been worthwhile.
I also ask the moms to share with their primary care provider about their experience and how having the tongue or lip-tie treated has helped their infant. Often the changes are remarkable for even a less obvious tongue-tie.
Frequently Asked Questions
01. Why are some tongue-ties missed?
Ans. Many posterior tongue-ties are subtle, and most healthcare providers receive limited formal education about tongue-ties during their original training.
02. Can pediatricians diagnose tongue-ties?
Ans. Absolutely. Pediatricians play an incredibly important role in recognizing feeding concerns and identifying infants who may benefit from further evaluation.
03. Should every baby with a tongue-tie have surgery?
Ans. No. Treatment decisions should be based on function, symptoms, and a comprehensive clinical evaluation.
04. How can providers learn more?
Ans. Ongoing education and collaboration with experienced providers can greatly improve confidence in evaluating tongue-ties and oral function.
Final Thoughts
If I could leave pediatricians with one message, it would simply be this:
Thank you.
You are often the very first professional families turn to when something doesn’t seem right with their baby. That places you in a unique position to recognize feeding concerns early, reassure parents when everything is normal, and identify infants who may benefit from additional evaluation.
As our understanding of tongue-ties and oral function continues to evolve, I believe our greatest opportunity lies in collaboration, not competition.
If you’re interested in expanding your understanding of tongue-ties, feeding function, and interdisciplinary care, I invite you to explore the Tongue-Tied Academy Course. For pediatric therapists, lactation consultants, speech-language pathologists, occupational therapists, physical therapists, and other non-surgical providers (or pediatricians not looking to perform the procedure), the Tongue-Tied Academy LITE Program offers practical education focused on assessment, oral function, and collaborative care.
My hope is that together we can help more families receive thoughtful answers, earlier diagnoses when appropriate, and the compassionate care every child deserves.
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