california advanced lactation institute
integrated lactation education

Tongue & Lip Restriction

How Feeding Works

We provide this information on tongue restriction and lip tie for the benefit of individuals working with breastfeeding families. We will update this continually as new information is being published in peer-reviewed journals at a rapid rate. It is critical for healthcare providers to remain up-to-date and to be familiar with the mechanics of breastfeeding as revealed in recent ultrasound studies and in recent expert papers. Please contact us if you have access to references or complete articles which are available to be shared freely and publicly in this forum.

 If you are concerned that your baby may be experiencing breastfeeding problems due to a tongue and/or lip-tie (tethered oral tissues), please see an IBCLC at no cost through Baby Café Bakersfield or contact  The Nest & Company, at 661-234-9894 for a fee-based, private consultation as soon as possible, and protect your milk production while you are awaiting resolution.  Babies with restrictions may not be capable of protecting milk production by themselves.  For an excellent instructional video on expressing your milk, please visit the following external video: 

This blog at is an excellent resource for parents and medical professionals alike which details issues surrounding tethered oral tissues, like tongue tie and lip ties.

Ground-Breaking Ultrasound Results Which Changed Our Understanding of How Breastfeeding Works

This is the link to the 2014 study published by Elad, et al regarding the biomechanics of how babies take milk from the breast.  This information followed ultrasound studies published by Donna Geddes et al previously, which advanced the understanding of breastfeeding beyond assuming what happens inside the baby's mouth to actually knowing what happens.  Specifically, the results of this study clarified how the baby's tongue moves during breastfeeding.  Because we now know that the tongue does NOT move forward and backward during suckling, nor does it use a peristaltic motion to strip milk from the breast,  we can see that the forward extension of the baby's tongue is NOT an accurate indicator of proper tongue function.  Instead, the rear portion of the tongue must be able to move up and down during suckling to remove milk from the breast.  If only the tip or the edges of the tongue can rise toward the roof of the mouth, the baby may not be able to properly breastfeed.  

An International Board-Certified Lactation Consultant (IBCLC©) who has specifically studied this aspect of breastfeeding is the most qualified person to help parents assess if their baby is experiencing oral restrictions that are affecting breastfeeding.  A trained IBCLC will assess all aspects of the breastfeeding situation and perform a full visual and functional assessment of the baby's oral anatomy.  This is a role specifically and clearly defined in the Scope of Practice of the IBCLC and the Clinical Competencies of the IBCLC.   


Effects on Speech

Walls, Andrew et al. Perception of speech and tongue mobility in three-year olds after neonatal frenotomy.  International Journal of Pediatric Otorhinolaryngology , Volume 78 , Issue 1 , 128 - 131.

Malocclusion/Dental Outcomes

Meenakshi, Swarna & Nithya jagannathan. 2014. Assessment of Lingual Frenulum Lengths in Skeletal Malocclusion. Journal of Clinical and Diagnostic Research 8: 202-204. doi: 10.7860/JCDR/2014/7079.4162.

Surgical Technique

JUNQUEIRA, Marina Azevedo, CUNHA, Nayara Nery Oliveira, COSTA e SILVA, Lidiane Lucas, ARAÚJO, Leandro Borges, MORETTI, Ana Beatriz Silveira, COUTO FILHO, Carlos Eduardo Gomes, & SAKAI, Vivien Thiemy. (2014). Surgical techniques for the treatment of ankyloglossia in children: a case series. Journal of Applied Oral Science22(3), 241-248. Retrieved September 17, 2014, from 10.1590/1678-775720130629.