Infant Frenectomy

We are proud to offer top tier, TEAM APPROACH frenectomies at The Stewart Center – for all ages!

Tongue, lip, and cheek ties are more than just minor anatomical quirks—they’re oral restrictions that can impact everything from feeding and sleep to speech and facial development. The tongue plays a crucial role as the body’s natural palate expander. When it isn’t able to rest properly against the roof of the mouth—its ideal position—due to factors like tongue-tie, low muscle tone, or weak tongue strength, this can contribute to mouth breathing and improper jaw development. As a result, a variety of issues may arise, including speech difficulties, crowded teeth, increased risk of cavities, poor sleep quality, bedwetting, dark under-eye circles, persistent allergies, snoring, symptoms resembling ADHD, sleep apnea, behavioral challenges such as defiance or aggression, learning struggles, and more.

Yet, despite growing awareness, many families are left confused or misled because not all providers are qualified to diagnose or treat ties appropriately. In fact, most pediatricians, ENTs, and even some dentists receive little to no training in infant oral restrictions, which often leads to dismissals, misdiagnosis, or poorly done releases. That’s why who you see matters just as much as whether or not your baby has a tie. In this post, we’ll break down what these ties are, how they affect your child, and most importantly—how to find the right providers who are properly equipped to help.

What is a tongue, lip, & cheek tie?

What is a frenulum?

A frenulum is a small band of connective tissue that links two parts of the body. In the mouth, these tissues help stabilize movement, but when they’re too short or tight they can interfere with normal functions like breastfeeding, eating, speaking, oral and facial growth, and airway development.

Tongue Ties (Ankyloglossia): happen when the lingual frenulum, the tissue under the tongue, is too restrictive and limits the tongue’s range of motion, interfering with its normal function.
Lip (Labial) Ties: involve a tight labial frenulum, the tissue connecting the upper or lower lip to the gums.
Cheek (Buccal) Ties: refer to a tight buccal frenulum, which anchors the inner cheek to the gum and may restrict mobility or comfort.

How Can Oral Restrictions Affect Infants?

Feeding Challenges

A tongue tie can limit how well the tongue moves, making it hard for a baby to latch correctly to the breast or bottle. This may lead to shallow latching, fussiness, or poor milk transfer.
A lip tie can prevent the upper lip from flanging (turning outward) during feeding. Without this outward curl, babies may struggle to form a good seal, which can cause discomfort for the nursing parent and make feeding inefficient.
A cheek tie may interfere with a baby’s ability to generate strong suction. When the buccal frenulum is tight, it can limit natural cheek movement, disrupting the rhythmic muscle motion needed for a consistent and effective suck.

Breathing Concerns

A tight lingual frenulum (tongue tie) may impact how the tongue rests in the mouth, especially when sleeping. Restricted tongue movement can compromise tongue posture, potentially leading to airway issues or contributing to mouth breathing and snoring.
This can lead to a myriad of co-morbidities and developmental delays – both physically and emotionally.

Signs and Symptoms of Infant Oral Restrictions

MOM

Nipple pain
Nipple trauma
Incomplete breast emptying
Pain throughout feedings
Decreased milk supply
Engorgement and oversupply
Raw nipples that stay sore regardless of what you put on them to heal
Frequent mastitis
Use of nipple shields long-term
“Lipstick” shaped nipple after feeding

BABY

Difficulty breastfeeding or bottle feeding
Prolonged feeding times (45+ min)
Fussy feeding
Gas and Reflux
Difficulty with pacifier use
Limited tongue movement
Difficulty swallowing solid foods
Oral hygiene challenges
Snoring or sleep apnea
Blisters on lips
Milk constantly coating the tongue
Thrush or yeast infections
Latch issues
Pocketing or leaking milk
Lethargic at the breast
Hourly feeds after 2 weeks old
Baby is exhausted and cries immediately after waking
Sleeps for 1-2 hours at a time day or night
Sleeps with mouth open
Unable to latch
Jaundice
Use of bili lights in the hospital
Reflux
High palate
Recessed chin
Collapsing bottle nipple

*Just because a mom/infant has a symptom listed above, does not automatically mean that there is a tie. Some of these symptoms can have other causations.

Consequences of Not Releasing Oral Restrictions

The tongue’s natural resting position in the mouth plays an important role in oral development. When positioned correctly against the roof of the mouth, the tongue applies a light, consistent pressure that supports the proper growth of the upper jaw and encourages correct tooth alignment.

When the tongue is at rest—not involved in talking, eating, or swallowing—it should sit gently against the roof of the mouth. Ideally, the tip rests just behind the upper front teeth, while the back of the tongue makes contact with the soft palate.

How the tongue rests during childhood has a significant impact on the development of the jaws, palate, and overall facial structure. Poor tongue posture can result in a high or narrow palate, misaligned teeth (malocclusion), and other growth deficiencies.

Correct tongue posture helps maintain an open and healthy airway. When the tongue rests improperly—especially during sleep—it can contribute to issues like mouth breathing and sleep apnea.

Good tongue posture plays a key role in producing clear and precise speech. When the tongue doesn’t rest or move correctly, it can lead to challenges like lisps or articulation problems.

Some possible consequences include:

overactive gag reflex when they start to eat solid foods
bottle refusal when you go back to work or difficulty finding a bottle they “like.”
higher probability of choking due to pocketing food like they have done with their milk
improper jaw development, narrow palate, crooked teeth
headaches, migraines
delayed speech, lisps
ADHD, learning and behavior difficulties
sleep disorders like sleep apnea and upper airway resistance syndrome
tonsils, adenoids, and airway issues
frequent illness
sinus congestion, allergies, asthma
anxiety, depression
high blood pressure later in life
diabetes, heart disease, and other chronic illnesses later in life
just to name a few…

So, Your Baby has a Tie. Who Should You See?

The tongue and lip tie industry is booming. This is good in the sense that oral restrictions can wreak havoc on the body, and it is ideal for proper growth and development if they are caught and treated in the early weeks.

However, most providers are not properly trained. This leads to misdiagnosis on both sides and/or improper releases.

My first step would be an airway dentist

I would not trust the hospital’s diagnosis. I would not trust a pediatrician’s diagnosis. I would not trust ~most~ ENT’s diagnosis (there are exceptions). I would maybe trust a properly trained IBCLC (or myofunctional therapist for older kids and adults), but they can’t release. My first step would be an airway dentist, and let them refer from there.

The Importance of a Team Approach

Oral restrictions should be treated by a team approach. Typically an airway focused dentist, IBCLC/feeding therapist/myofunctional therapist (depending on age), and craniosacral therapist. We’ll get to this more below. A properly trained airway dentist will have referrals they trust to help you build your team – that’s why I would start there, and let them refer you out. It will ultimately cause less stress on your part.

Infant Tongue Tie Providers: RED FLAGS

A properly trained provider should be asking you what interventions you’ve already tried to see if there has been any improvement. They should not be offering to release right then and there. It should be a team approach. In fact, often times craniosacral therapy and feeding therapy alone can fix many problems.

Are They Mentioning an IBCLC?

They should ask if you’re working with an IBCLC, even if you are pumping or bottle-feeding. If not, they should connect you with one they trust. (If your child is no longer an infant, but under age 4, then a feeding therapist; and if 4yrs or older a myofunctional therapist).

A key role of an International Board Certified Lactation Consultant (IBCLC) is to support mothers in reaching their feeding goals. When working with babies who have tongue ties, the IBCLC focuses on maintaining the mother’s milk supply and making sure the baby is feeding well enough to grow and thrive. It’s important to get a baby as healthy, and feeding as well as possible before a release.

The IBCLC will observe how the baby latches and their positioning during feeds to ensure effective milk transfer. During this assessment, they’ll work to identify any underlying issues affecting breastfeeding—these could range from maternal factors like low milk supply due to thyroid imbalance or nutrient deficiencies, to baby-related challenges such as ineffective latching. Both too much and too little milk can present problems, so the IBCLC carefully evaluates for either scenario. In some cases, they can even help the baby achieve a comfortable, effective latch despite a tongue tie, which can be especially valuable in preparing both mother and baby for better outcomes if a release procedure is planned.

Based on what the IBCLC discovers during their assessment, they may suggest specific steps for both the baby and parents to take before moving forward with a tongue-tie release. These preparatory measures can help set the stage for a smoother recovery and better long-term feeding outcomes.

IBCLCs may also introduce pre-surgical oral exercises to help parents become comfortable exploring and working inside their baby’s mouth. These exercises prepare both the parents and the baby’s nervous system for the changes to come. When performed consistently in the week or two leading up to the release, these gentle movements can greatly enhance the benefits of the procedure.

Are They Mentioning Craniosacral Therapy?

If not, I would seek out another provider. They should be asking if you’ve seen a craniosacral therapist (some may refer to is as bodywork/bodyworker), specifically one who specializes in craniosacral therapy. If you haven’t already, then they should refer you to one before considering a release.

Craniosacral therapy can be provided by DOs, LMTs, OTs, DCs, PTs, sometimes even myofunctional therapists. Really anyone can practice craniosacral therapy if properly trained. Again, your tongue tie provider or IBCLC/Myofunctional Therapist should have well-qualified referrals.

Craniosacral therapy is a gentle, hands-on bodywork technique that can release fascial restrictions, help regulate the central nervous system, release tension patterns, and restore healthy movement.

Focusing solely on oral ties without addressing the underlying cause can still lead to complications. Tongue, lip, or cheek ties are often external signs of deeper fascial tightness. If the rest of the body isn’t also considered and treated, there’s a risk that the tie may reattach or become restricted again due to scar tissue formation.

The tongue is just one visible part of the body’s larger fascial network, which extends all the way down to the toes. This interconnectedness is why, in some cases, an infant may experience improved nursing after a tongue-tie release, but other issues—such as reflux, irritability, or discomfort—may persist. For some babies, the release brings full relief; for others, it doesn’t.

Signs of fascial tension in infants may look like:

Shows a strong preference for one side of the body when moving arms or legs
Discomfort or crying during tummy time or diaper changes
Tends to arch the back frequently, especially when upset
Often clenches hands into fists or keeps them near the mouth
Exhibits tension or stiffness in arms and legs
Becomes fussy or unsettled when placed in car seats or other baby containers
Experiences frequent gas, bloating, or signs of constipation
Has trouble feeding effectively (e.g., poor latch, slow weight gain, etc.)
Diagnosed with a tongue or lip tie
Displays symptoms like spitting up, colic, reflux, or frequent gagging
Noticeable flatness or asymmetry in the shape of the head

Why is Craniosacral Therapy Important Before/After Releases?

Pre release: A baby forms their oral ties in the first trimester, and starts to suck and swallow in the second trimester. The stability of the body comes from its ability to move properly. Craniosacral therapy releases tension in the jaw, hard palate, tongue, floor of the mouth, and cranial bones, which are ALL important for proper oral function. Releasing a tongue tie with tension present could result in not releasing enough, releasing too much, and/or the tongue loosing proper oral function – working against the exact goal of the release.

In fact, many times a mom and baby will see improvement in feeding just from craniosacral therapy.

Post release: The procedure is trauma. The exercises are traumatic to a newborns system. However, they are a necessary evil. If pre and post therapy is done correctly with a full team of providers, then the recovery is quicker, easier, and helps ensure optimal results.

Remember, the tongue is a muscle, and the frenulum forms in the first trimester of pregnancy. For many babies, this means they’ve never had full tongue function. If the release is done without any preparation, the body can enter fight-or-flight mode due to the sudden trauma of a new incision, disorganized sucking and swallowing, and the challenge of learning to move the tongue in new ways. This may cause the shoulders to tighten again and mobility to decrease after the procedure.

Preparation is key. Think of it like running a marathon. If you’ve never trained and you go out and run one tomorrow, you might start off okay, but quickly become exhausted, struggle to finish, or even injure yourself.

The same concept applies to a tongue that has been restricted by a tie. It’s a weak muscle that relied on the frenulum for support. Once released, if that tongue hasn’t been strengthened and supported through mobility work, it’s now loose but still weak. You may see initial improvement for a day or two, but without proper preparation and follow-up, issues like poor tongue elevation, tongue retraction, thrusting, milk pocketing, and inefficient.

What Equipment Do They Use and How Many Releases Do They Do?

Ask what they use to perform releases. Look for a pediatric dentist who has a Solea laser or CO2 laser. A provider with a cheaper laser may not be as invested. Additionally, the healing time and outcomes may be poor due to the thickness of the incision, and it may heal with a thick scar tissue band in place of the frenulum.

Ask how many babies they see per month. A good pediatric dentist is highly sought after, and should see 3-10+ babies per week, depending on your location.

Other Red Flags I Frequently Hear:

If a provider says “they’ll grow out of it.”
The provider only looks at the tongue, and doesn’t feel for tension or function.
A provider says, “there’s a tie, but it’s not that bad.”
A provider offers to release a restriction right then and there with no team/collaborative care
If. provider says there’s no tie because they can stick their tongue all the way out
- There is so much more than goes into a tongue tie evaluation than just looking. A provider should be looking at medical and birth history, appearance of the mouth structures and frenulum, tongue mobility, tension, oral rest posture, sleep screening, body compensation, symptoms reported by parent/caregiver ad/or child if older, speech sound assessment if applicable, and feeding/swallowing abilities