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Why are there so many tongue ties all of a sudden? There was a time, I remember it well, when tongue tie meant that there was excess connective tissue under the tongue that didn’t dissolve while the baby was in the womb. Since the fetal head starts out as two pieces, then fuses in the middle to create a whole structure, that tissue under the tongue sometimes doesn’t dissolve away. 4-10% of the population has it. No big deal. Just snip it – early on – because the tongue is a muscle and won’t develop normally if it doesn’t have freedom to move. It’s like being born with your shoelaces tied – you can walk, but it could be SO much easier.

I remember when I learned about tongue tie as a cause for breastfeeding problems. I was new in practice, and there was a pediatric surgeon, Dr. Elizabeth Coryllos, who did a lot of work with breastfeeding babies. It was obvious that when babies’ tongue ties were released, breastfeeding got better. But there were many more babies without tongue tie who had similar or even greater trouble. How could she explain that?

In  2004, she published a paper classifying tongue tie into four different categories based on the “degree” of tie. According to her logic, if tongue tie caused trouble nursing, then babies who couldn’t nurse and didn’t have tongue tie must have “invisible” tongue tie. That “invisible” tongue tie was later termed “posterior,” and a new diagnosis was born. A group was even formed to promote this new diagnosis: The International Affiliation of Tongue-Tie Professionals, and they went to work lecturing and spreading the word, quite successfully, I might add. Now everyone is talking about “posterior tongue tie.”

But what does that even mean? I have been on panels at breastfeeding meetings and tried, like everyone else, to wrap my head around it. If something is diagnostic, shouldn’t you be able to actually diagnose it on exam? Tongue tie is obvious, but this “posterior” thing was a unicorn. Practitioners scratched their heads and although no one wholeheartedly believed it, they cautiously started using the term. It has spread like wildfire through the breastfeeding community, which is now divided it into three camps: those who strongly believe, those who adamantly object, and those who want you to forget the whole thing and give your baby formula.  

I know head and neck anatomy – I’ve spent nearly 20 years milling around and manipulating it, and I can tell you this logic does not make sense. The head and neck structures are all interconnected. One structure affects the other. To truly understand the mechanism of a newborn suck and swallow, you have to look at the whole picture. When I see a baby who has been diagnosed with “posterior tongue tie,” I interpret it as meaning “I don’t know why this baby can’t latch, but there must be something wrong.” And it’s fine. At least it gets the mother/baby into the office, where I can explain the anatomy and physiology of mom and baby, and parents can make an educated decision about how to proceed.


Has your baby been diagnosed, or misdiagnosed, with tongue tie? Share your experience in the comments.

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