Tongue and lip ties in babies

Did you know that tongue and lip ties – collectively termed “tethered oral tissues” (TOTs) – are present in five to 10 percent of infants?

TOTs are congenital conditions, which means they are present at birth. Tongue tie is a medical condition where the bottom of the tongue is tethered to the floor of the mouth by an unusually short, thickened or tight frenulum (a membrane). An upper lip tie is an oral restriction that attaches the upper lip to the upper mucosa (the pink gums, just above the two front teeth).

How do I know if my baby has TOTs? 

The symptoms of TOTs vary widely and may affect an infant’s ability to breastfeed well. While some infants may be able to attach or latch onto the breast, they may suckle inefficiently. Other babies may not even be able to latch on. As a result, infants may take a long time to complete each feed or nurse frequently throughout the day, often waking up at night to latch repeatedly. The infant may also try to overcome the tongue restriction by compensating in other ways, resulting in gumming or chewing of the nipple, causing pain and bleeding. This struggle with nursing can often lead to a premature end to the breastfeeding relationship.

What are other problems associated with TOTs?

If left untreated, TOTs can affect a child’s speech, feeding and swallowing. Teeth alignment and the growth and development of the face and airways can also be hindered. Your child may also be at an increased risk of developing dental cavities (tooth decay). Even if your baby is able to stick his tongue out, he may still be tongue tied. Having a comprehensive oral examination by a trained professional is the only way to diagnose TOTs.

Paediatric specialists – paediatricians, paediatric dentists or paediatric surgeons – are likely to be the most up to date in the evolving field of breastfeeding medicine. If you’re facing TOTs-associated breastfeeding difficulties (see sidebar below), the best care is often delivered via a team approach.

At Thomson Medical Centre, this team is led by our Senior ParentCraft Educator and Lactation Consultant and Paediatric Dentist Dr Tabitha Chng. Do contact us for a consultation – we’re here to help you on your breastfeeding journey and beyond.


  • Poor latching and sucking
  • Clicking sound while nursing
  • Falling off the breast or fussiness, and frequent arching away from breast
  • Falling asleep before satisfied while nursing
  • Unsatisfactory nursing episodes
  • Chewing of the nipple
  • Colicky / reflux
  • Poor weight gain