Posterior Tongue Tie Information

Last updated October 31, 2011
This page is dedicated to information regarding posterior tongue tie, inspired by the struggles I have personally faced as well as the heartbreaking stories of so many mothers dealing with this problem without any help from the professionals they turned to because of the severe lack of information out there.

My Story
Jeanette and Ernest's Story 
Kelly and Isaiah's Story
Heather's Story
Ruth Ann and Jefferson's Story
Identifying and Diagnosing a Posterior Tongue Tie
The following symptoms have been noted anecdotally by mothers of babies diagnosed with a posterior tongue tie. Remember that not all of the symptoms must be present in order to be considered a posterior tongue tie. There are varying degrees of ties.
  • Inability to achieve latch to bare breast
  • Clicking noises while sucking, more notable during bottlefeeding
  • Loss of latch on breast or bottle nipple
  • Loud gulping noises
  • Choking on milk or gasping for air mid-feed
  • Short and frequent feedings (grazing/snacking)
  • Noticeably strong suck
  • Decreased saliva production
  • Inability to effectively remove milk
  • Milk dribbling out of the mouth during feeds
Notes: These symptoms are exacerbated at the end of feedings or when the baby is very tired. The jaw muscles become exhausted or the baby simply lacks the energy to continue sucking. The strong sucking that can be felt with the nipple or a finger is two parts of the same problem; the baby must suck very hard to keep the breast/bottle in the mouth and the suck can be felt more because the back of the tongue is being held down. The baby will also have difficulty coordinating sucking and swallowing, leading to choking or just not breathing. Due to the extra energy required for feeding, the baby will feed for shorter periods and more often.

Secondary symptoms:
  • Low milk supply in mother
  • Nipple pain, sometimes with blistering from friction
    • The baby's tongue may feel like sandpaper and/or feel as though it is "humping" the nipple
  • Flattened/misshapen nipples following feeds
  • Excessive fussiness
  • Reflux, especially reflux that gets worse with medication
  • Anxiety at the breast
  • Weight loss/few dirty diapers
  • Strong preference for bottles
  • Chiropractic adjustments and other muscular therapies may not "hold"
Potential problems as baby grows:
  • Disruption of normal oral development
  • Difficulty eating solid foods
  • Difficult or delayed speech development
  • Severe tightness of the tongue and jaw may lead to restriction of joints and muscles in other areas of the body
Definitive Diagnosis of Posterior Tongue Tie:
Dr. Lawrence A. Kotlow, D.D.S., P.C., a dentist in New York has written numerous articles, including pictures, and posted them on his website about the posterior tie, as well as other types of tie. In one of the articles, Breastfeeding should be fun and enjoyable, he describes the way to diagnose the tie, which is done as follows: With a finger, run it underneath the tongue from side to side. The feeling of a tie can be describe as a fence, speed bump or ridge in the bottom of the mouth. A normally developed mouth floor will feel smooth. Any kind of a bump has the potential to cause problems.

Correcting a Posterior Tongue Tie
  1. Laser dentistry - this is the best option as it causes the least amount of pain, is more accurate at correcting a deep tie and heals better.
  2. A simple snip by anyone trained in correcting tongue ties. This takes mere seconds, can be done in a normal office visit and feeding can begin directly following the snip.
  3. Surgery with anesthesia - this is used in cases where a simple snip will not cut through enough tissue to release the tongue and when a laser dentist cannot be used, usually for insurance or regional reasons.
  • Once the tie has been corrected, remember to gently stretch and move the tongue with your fingers daily to make sure the skin does not heal back together.
  • If the baby is older when the tie is corrected, mouth exercises may be required to adjust the way the muscles work together, especially if breastfeeding is still being attempted. Mama and Baby Love has explanations of the exercises.
    Myths Regarding Posterior Tongue Tie
    • "There is no tongue tie because the tongue sticks out/touches the roof of the mouth/there's very little frenulum." All three of those things can be and usually are present in the case of a posterior tie.
    • "It's just reflux/colic." As previously stated, a baby with a tongue tie is having a lot of difficulty in feeding, which can lead to frequent and excessive fussiness or crying. A hungry baby is not a happy baby. If it hurt or was very hard to eat, wouldn't you be grumpy? Also, it may very well be reflux, but there's usually a cause for reflux that does not require medication to fix.
      • Remember that most professionals do not have a clue about what the symptoms are or how to properly diagnose a posterior tie. Unfortunately, care providers will mask their ignorance by attributing one or a few symptoms to something totally different and ignoring the bigger picture.
    • "It will stretch." or "It can't be fixed." These two are usually stated together and usually by someone who can identify the tie, but while well intentioned, has no idea what to do about it or perhaps doesn't want to bother doing something. While a tongue tie might stretch in time, it doesn't change the fact that it's causing problems now and there's no way of knowing if it will cause problems in the near future. A tongue tie is an abnormality, not a variation of normal. It can be and should be fixed if at all possible.
    • "Contact an IBCLC." This is only half myth. While an IBCLC is a great resource and is more likely to know about tongue ties, a posterior tie is still extremely underdiagnosed because there is just so little knowledge out there about it. The IBCLC I saw had 20 years of experience, but had absolutely no clue at all about my daughter's tie, even though it was actually very obvious. So sure, start with an IBCLC, but do not assume that the consultant will know anything about it.
    • This one I personally experienced and will throw in just because it is so absurd: Referring to the symptom of choking and gasping for air during feeds, a pediatrician said, "All babies do that!" No, they really don't.
    Other Conditions to Consider
    These conditions may also create symptoms similar to a tongue tie and are frequently seen in combination with a tongue tie. Check out every possibility.
    • Lip tie
    • High palate 
    • Temporomandibular joint disorder
    • Misalignment of the spine
    • Receded jaw
    Things to Keep in Mind
    • You are not alone. It is my strong belief that PTT is not as rare as it has been made out to be. I have seen a lot of mothers coming forward about their pasts with difficult nursing as well as mothers who are currently dealing with this issue. If you need support, it would not be difficult to find a sympathetic ear.
    • If you decide to have a tongue tie corrected and the first person you see says there's nothing wrong, get a second opinion. Get a third, fourth, fifth, sixth...find someone who will really listen to you. Don't take no for an answer unless that answer comes with a logical, thorough explanation and an alternative solution that works!
    • If you believe your child has a tongue tie, but are doubting yourself, this is normal. Even when I was absolutely sure that my daughter had a tie, I still doubted myself. In fact, I doubted myself right up until the very moment the ENT cut her tongue and she instantly had better movement. Remember that having a healthy, happy nursing relationship with your baby, or even giving your older child a better chance at normal development, is always worth pursuing, even if the pursuit leads to a dead end.
      If you would like to add information or ask questions, please feel free email me: mamametaphysical (at)! I'm doing this to help others and would be more than glad to hear from you!


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