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  • Writer's pictureMegan Dunn

What your Lactation Consultant wants you to know about tongue ties

My baby has a class 3 tongue tie!

The classification tells us where the frenulum (the tissue that connects the bottom of the tongue to the “floor” of the mouth) is attached to the tongue.  It’s not a measure of severity.  Class 1 ties go all the way to the tip of the tongue but are not necessarily more severe than Class 3. 


It’s a release, not a revision…unless you are doing the frenotomy again

Thinking of the procedure as a release is helpful because that is the goal.  With proper preparation, the frenotomy does release the tongue so it can function better.  However, your baby will likely still need post-release oral exercises to improve function, strength, and coordination.  This is why some babies will click more after the frenotomy.  The tongue can lift now but it doesn’t have the strength and coordination to stay up so it clicks as it falls.


The process of release has 3 major steps: pre-release preparation, a full release with good aftercare, and post-release therapy for functionality.


In my mommy group they said I needed to see a pediatric dentist

See the provider your Lactation Consultant recommends.  Seriously.  We see sooo many babies with ties and know how the different providers in our area work. A variety of providers can release a tongue tie (ENT, dentist, pediatrician) but one is not better than any other.  It comes down to experience, training, and a willingness to work in care coordination with other providers. The release is usually done by scissors or a medical laser – the tool is not nearly as important as the provider. 

Many babies don’t have dental insurance and paying out of pocket is not an option for all families, so review the options with your IBCLC and ask why they recommend specific providers.

My baby has lip and cheek ties

Okay, those may be contributing to some oral dysfunction, but the tongue is the major player in feeding and if that isn’t functional, then nothing is functional.  There is more limited information about the necessity and helpfulness of lip releases and even less information about cheek or buccal ties. You may want to start with a functional tongue tie first and maybe an upper lip release before anything else.  The fewer areas you have to manage with active healing and that your baby has to heal, the easier it will be for all of you.  You can always come back later and release those areas separately if it is needed later.


You need a Lactation Consultant on your care team

Jumping into a release without an IBCLC can leave you adrift.  The IBCLC does so much more than show you how to hold and latch your baby. The best outcomes for identification and treatment of tongue and lip tie (and ruling out other feeding issues), addressing feeding issues, and symptoms related to the tie come from working with a Lactation Consultant (IBCLC) who can work with you during the entire journey.  IBCLCs identify feeding problems and help manage your feeding plan, considering your needs and the needs of your baby.  IBCLCs can offer feeding therapy, referral to providers to do the release as well as providers to treat other issues (like muscle tension contributing to feeding problems) and support you throughout the process.


My insurance doesn’t cover an IBCLC

Yes, it does!  “Breastfeeding support” is a guaranteed coverage as preventative care even if your insurance is difficult about contracting with individual Lactation Consultants.  They are required to cover the care and if there is not someone in network with your plan, there are strategies to get the services covered.

Many IBCLCs take insurance and many offer telehealth if there is not someone near you. 

Find an IBCLC using these links:


Not all IBCLCs have training on oral habilitation and movement to support normal, functional feeding so ask about their background, experience, and approach.

 The board that certifies IBCLCs doesn’t guarantee that your Lactation Consultant actually has training for tongue ties.  It’s a huge oversight, but IBLCE (the certifying board) values other health licenses and allows people who already hold healthcare licenses to skip direct mentorship which – in my experience – leads to many IBCLCs not being properly educated or prepared.

Many hospital systems want their Lactation Consultants to be RNs so they will only hire RN-IBCLCs resulting in poorer care and outcomes.  Some hospitals call their nurses “lactation specialists” or other terms and don’t even require that their “lactation consultant” carries the IBCLC certification further diluting lactation and infant care.

This is not the case for all RNs, I know some really amazing and knowledgeable providers, but they have made extra efforts and done more than the minimum. So ask your LC what extra training, books, mentorship, online courses and more that they have completed to up their learning and skillset.


My baby is bottle feeding, do I need an IBCLC?

Yes, we can help. Our title is misleading and really should be something like Lactation and Infant Feeding Therapist.  But since nursing directly at chest is the biological norm humans are adapted for, deeply understanding lactation and infant feeding gives a base for bottle feeding knowledge and skills. Not everyone can directly feed at chest or even wants to and that’s completely understandable and I support you.


It's not your fault

Honestly, it’s not.  The system is rigged against us. Lactation and Infant Feeding is poorly understood and poorly valued.  Because so much of our research, literature, and observation comes from artificially fed infants over generations in the last century, our understanding of what is normal is not based on biologically fed infants.  Our expectations for infant feeding, sleep, pooping, growth, development, illness, and so much more is flawed.

Not only that, but less than 3% of physicians or nurses have any formal training about breastfeeding. They don’t know what they don’t know. 


This is why the best outcomes for all infant feeding come from working in a care team approach with IBCLCs as part of the team.

We do sooo much more than just showing parents how to latch their baby. 


Just yesterday, I helped parents understand when and how to swaddle their baby, how to make Tummy Time more tolerable for their baby, showed parents how to relieve their baby’s gas, helped connect a parent with mental health support, and demonstrated bottle feeding techniques while counseling on which tool to use for their specific baby.   That’s a drop in the bucket of all the topics I discuss daily with parents that are not breastfeeding specific but are related to feeding their babies and making milk.

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