What does a latch problem look like?
Signs that your baby may have a latch problem related to tongue or lip tie include an inability to take a wide mouthful of breast; a latch that starts reasonably well but becomes progressively shallower during the feed; the baby popping on and off the breast repeatedly; clicking or gulping sounds during feeding; the upper lip curling inward rather than flanging outward; and the baby appearing to work very hard for relatively little milk transfer.
- Inability to take a wide mouthful of breast
- Latch starts reasonably but becomes progressively shallower
- Baby popping on and off the breast repeatedly
- Clicking or gulping sounds during feeding
- Upper lip curling inward rather than flanging outward
- Baby working very hard for relatively little milk transfer
- Nipple pain or trauma despite repeated repositioning
Why can't my baby latch properly?
For a deep latch, the baby needs to be able to cup the tongue around the underside of the breast, extend the tongue forward beyond the lower gum, and use a coordinated wave motion to extract milk. A tongue tie restricts this range of motion. The tongue may be tethered at the tip, along its length, or at the back of the blade of the tongue.
What about posterior tongue ties?
Posterior tongue ties — restrictions further back in the floor of the mouth — are the most commonly missed, because the tongue tip can extend forward while remaining functionally restricted in the critical cupping and elevation movements needed for effective breastfeeding. A baby with a posterior tongue tie may appear to latch, but consistently slips shallow, tires quickly, or creates nipple trauma despite what looks like an adequate latch from the outside.
Does bottle feeding help?
Some tongue-tied babies manage bottle feeding more easily than breastfeeding, because the teat delivers milk without the tongue having to do as much work. If your baby feeds better from a bottle but struggles at the breast, this is clinically relevant information and should be included in your assessment history.
What about lip tie?
A lip tie restricts the upper lip from flanging outward, preventing the wide, flanged seal needed for effective milk transfer and a stable latch. Lip tie and tongue tie frequently coexist, and both need to be assessed together. If you have been assessed for tongue tie but not lip tie, your assessment may have been incomplete.
Our approach — Release Restrictions, Retrain Function, Relieve Tension — looks at the whole functional picture, not just the restriction in isolation.
The National Tongue Tie Centre was established in 2007 as Ireland's first clinic dedicated entirely to the assessment and treatment of tongue tie. The centre treats over 1,000 patients per year and receives patients from across Ireland and internationally.
Led by Dr. Justin Roche (Consultant Paediatrician, FRCPCH, FRCPI, IBCLC), Kate Roche (Chartered Physiotherapist, IBCLC, Feeding Therapist). Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frequently asked questions
Yes, some babies with tongue tie breastfeed without significant difficulty. But many do not, and the clinical picture — including the mother's experience, the baby's behaviour, and observed milk transfer — needs to be assessed as a whole.
A posterior tongue tie is a restriction in the submucosal tissue of the floor of the mouth, further back than the visible frenulum. The tongue tip may appear free and able to extend, while the body of the tongue is restricted in the cupping and elevation movements critical for breastfeeding. It requires experienced assessment through lifting the tongue, a finger sweep and functional observation, not just a simple visual check.
This is a common pattern with posterior tongue tie. In the newborn period, the breast is softer and the let-down meets their volume requirements, which compensates for a partial restriction. As the baby grows and the demands on tongue function increase, the restriction becomes more apparent. Latch that deteriorates over weeks rather than improving should always be assessed.
Nipple shields can help a tongue tied baby transfer more milk by providing a firmer surface to work against and can support a compression-dominant pattern. They are a useful short-term support, but they do not treat the underlying restriction and many families find them difficult to manage long-term. They should not be seen as an alternative to proper assessment.
Lip tie varies in clinical significance. When it prevents adequate flanging of the upper lip and contributes to a shallow, unstable latch, it is clinically relevant. We assess both tongue and lip function at every appointment.
Book a comprehensive assessment at the National Tongue Tie Centre. Our clinical team will assess your baby's tongue and lip function thoroughly, explain what we find, and give you an honest recommendation. Call us, complete our online enquiry form, or visit www.tonguet.ie. Clinics in Clonmel, Co. Tipperary and Naas, Co. Kildare.
Frenuloplasty is a surgical procedure. Risks, benefits, and individual expectations will be discussed in full at your assessment appointment before any decision to proceed is made.
