We also have this comprehensive checklist.

Mother:

• Pain latching on (not always), damaged nipples, nipple gets flattened after drinking or is discouloured (sometimes Raynaud) ;
• The use of a nipple shield, otherwise latching on not always possible;
• Baby cannot drink the breast well, causing clogged mammary glands or inflammation of the breast (mastitis);
• In addition to breastfeeding, formula feeding is required or the mother needs to pump to get production going.

Babies:

• Clicking sound (releasing vacuum);
• Baby cannot open mouth wide, sucks only the nipple in;
• Baby drinks very “forcefully”, sometimes bites, or clamps with the jaw;
• Drinks restlessly / impatiently at the breast or is quickly tired; Drinks briefly, releases a lot, or drinks “all day” on the breast;
• Drinking a lot of air, reflux symptoms, colic, spitting, burping, distended belly, wind;
• Moderate growth of the baby;
• Because the tongue does not reach the palate can up moving the palate sometimes remains high. This may give less space in the nose, making the baby appear to have a cold and continue to breathe through the mouth.
• Because the baby has difficulty fully using the tongue, a white deposit remains on the tongue. This is not a thrush, but taste buds with plaque (see photo);
• Babies with a tight lip tie where the front teeth come through around a year,  sometimes get problems with feeding again and “bite”.

Children:

• Problems with the pronunciation of letters where the tongue has to be raised to the palate. Unclear speech. Eating solid food gives problems when the bolus of food cannot be moved well in the mouth from left to right and from front to back and is difficult to swallow. The child pushes his fingers, or leaves the food in the cheeks or chokes. Some little ones refuse certain textures or “pieces.”
• It is difficult to lick the rear molars, which can cause cavities. Brushing teeth is difficult, especially if a lip tie is present.
• Or have middle ear infection, because they do not properly empty the Eustachian tube when swallowing.

More good information on www.drghaheri.com.

The midwife, lactation consultant, maternity care nurse or speech therapist, may have told you about the possible functional problems in babies and children due to a tongue tie or a lip tie. The knowledge is also shared among parents through the internet.

A tongue tie is not always easy to see, especially if it is deeper under the tongue. Not every doctor, midwife, lactation consultant IBCLC or maternity care nurse has enough experience to assess this properly. It is wise to find a practitioner with experience in this area. A lactation consultant IBCLC who has experience in assessing the tongue tie and lip tie may be able to assess it.  After doing an oral examination she may even find the tie “hidden” behind the oral mucosa. When in doubt, make an appointment with a lactation consultant or a practitioner with experience. Sending a photo is possible for review, but can never provide a definite answer.

Pediatrician Dr. James Murphy (link) came up with the following method. When the finger slides under the tongue, it should be easy and smooth. If it is difficult to move from left to right under the tongue over the floor of the mouth and a “string”, “speed bump” or “fence” is felt, this may indicate a tongue tie.

When the baby is crying, and the tongue stays down, it could be caused by a tongue tie actually pulling the tongue down. Sometimes only the sides of the tongue rise so that the tongue makes a bowl shape.

The upper lip should be able to flange relatively easily. If the lip is lifted and gently pulled, and the upper jaw turns bloodless where the lip tie is attached, that may be an indication of a lip tie. This test is also called “blanching” or anaemia test (see photo).

The release of a tongue or lip tie has been performed for years by various medical specialists or dentists. Often it concerns older children or adults with a functional limitation that requires surgical intervention. When drinking for babies or young children was difficult, formula was often used in the past. Nowadays people diagnose and treat rather at an early stage when there are (functional) problems. So it’s not so much a hype or trend, but has to do with early diagnostics. When functional problems are present, it is better to be treated at a young age than at an older age.

Providers use a classification system to describe the attachment or the lip tie. This system only indicates where the frenulum (tie) is attached between the lip and the upper jaw. Providers usually refer to four types or lip tie due to the Kotlow classification. (pictures below).
This system does not indicate the severity.
A class 1 lip tie is quite rare (no restriction in attachment).

A class 2 lip tie adheres to the gums somewhere in the middle above the gum line.

Type 3 can be a very flexible frenulum with no symptoms while a very tight frenulum (type 2) can give a whole range of symptoms.

Type 4 is therefore not any “worse” than type 2.

Although a tight type 4 obviously gives even less movement of the lip and can affect the ability of the lip to flange and hold on to the breast or bottle.
Babies and children manage to compensate really well with their jaw muscles and people can grow old with a lip tie often with hardly any symptoms.
Sometimes the upper lip tie creates a gap between the front teeth, but that is not always easy to predict exactly.
Brushing the front teeth can be difficult and painful with a tie “in the way”.
With debris stuck under a lip tie, caries may occur earlier in the upper front teeth. To determine if there is an impairment of the flange of the lip onto the breast a Lactation Consultant (IBCLC) can observe the breastfeeding. The Lactation Consultant lifts up the upper lip to see if it flanges out.
If there is blanching on the gum, there is tension. The tension may result in too little movement of the lips and ability to flange out and to open the mouth wide.

After the release, you may notice things that may last a little longer, such as lip swelling, drooling, gagging, or other discomfort or peculiarities.

* Granulation tissue; This is a small lump of extra scar tissue that can form on the wound. If you suspect you see this, send a photo, it is not serious and if it is a hindrance to drinking it can still be removed.

* Drooling; Because the swallow has to be learned again after tongue tie release, it is possible to notice drooling for a while in a child or baby.

* Reattachment; After the treatment, the wound simply wants to heal with scar tissue.  With doing aftercare you hope the wound does not close too quickly or too tightly. If too much reattachment occurs, the tongue or lip mobility can be limited again. When you live abroad it is the adviceble to check the healing with somebody knowledgable in a week, that can also be done at our clinic if you can stay a few days, but has to be arranged with making the appointment for treatment. In The Netherlands you can call the Tongue Tie Clinic for an appointment.

* Muscle pain; After the treatment the adults and older children notice (muscle) pain or discomfort in the jaws, tongue and throat sometimes as well. See the FAQ about pain relief.

* Baby spits more; Because the baby drinks more effectively, it may be that the stomach is not used to the amounts and it spits back up, but it may also be that the baby is still drinking air for a while.

* Smelly breath / mouth; We sometimes hear this from parents and can last from a few days to a week, it’s ussualy no problem whatsoever.

* Swollen upper lip; This can last for up to 5 days after lipband treatment.

*  Quivering jaws remain visible longer; Because the tongue, after it has come loose, many of the muscles still need to be trained, it may be that the compensation continues with the jaw muscles, but compensation behavior may also need a chiropractor or manual therapist to remedy it. See the FAQ about compensation behavior and videos explaining this.

* You have to help lips flange out; The baby is not used to flanging the lip, this may be helped.

* Suction blisters still present; They can be present for longer, especially on the upper lip.

* Crying doing aftercare; What we hear from parents and notice at the aftercare consultation that the baby cries with the aftercare exercises, but stops as soon as you stop or start feeding or changing diaper and such.

* White plaques/debris on tongue still visible; Because the palate is often high and the tongue is not well trained to stay up, even at rest, the white plaques/ debris on the taste buds remains.

* Bottleteat; We notice that the teats with a broad base cannot go deeper into the mouth, so a teat that can go deeper and gives more mouthfilling, such as the smaller, narrower types, is often better.

* Baby stays upset longer than 48 hours, crying, drinking worse. In the older baby who has had to compensate for a long time with a tongue tie. Before the treatment, often these babies were fussy and drinking poorly and found there own “technique”. Treatment of compensation behavior is often necessary. See FAQ compensation behavior. People often give painkillers for longer. But one also has to take into account a normal virus infection occurs at the same time. You can go to the doctor with a fever, see the FAQ about fever.

* Gagging may still be present after the release.

* A baby cannot swallow the tongue after the release.

* Apnea are also observed in babies . It is not directly related to the release. Tongue tie can be related, read the research.