Last week, I noticed a very large account run by occupational therapists making some pretty wild claims about tongue ties and frenectomies. They called frenectomies “barbaric”, stated that anyone trained in neuroscience would never recommend this procedure (which is simply not true), and tagged me in the post telling me that cutting a baby’s tongue for the sake of feeding violated the “first, do no harm principle”. These posts directed people to their course and their “solutions” which seem to be infant driven feeding, proper feeding positioning, letting a baby have 8 weeks of “practicing reps” while feeding, and possibly bodywork.
And I just sat there thinking… this is not it. This is not the full picture, and it’s not helpful for parents who are already trying to figure out what’s going on with their baby.
The conversation around tongue ties often feels very all or nothing, whether you are on social media or even in the doctor’s or dentist’s office. You have one group saying they don’t really matter, they’re overdiagnosed, and releasing them can do more harm than good. The other is very quick to release, without really slowing down to look at everything else that might be going on, or educating parents about the benefits of other therapies that can help with the tension in the body and improve feeding outcomes. If you’re a parent in the middle of this, it’s confusing. Both sides sound very confident.
But tongue ties are not simple.
They’re not just this little piece of tissue you can look at and immediately know what to do with. If that were the case, this wouldn’t feel so overwhelming for so many families. What matters is how your baby is actually functioning, how they’re feeding, how their body feels, how much tension they’re holding, how their nervous system is handling all of it. What’s happening right now is people are taking something that is actually really layered and turning it into this very black and white conversation. Like it has to be one or the other.
The truth is that yes, there are absolutely babies getting frenectomies when they don’t need them or aren’t ready for them. Sometimes the real issue is tension in the body, or positioning, or just needing better support with feeding. And when that doesn’t get addressed first, and you go straight to a release, it doesn’t fix things, and sometimes it actually makes things harder. I’ve experienced this myself. One of my own children had a frenectomy before I really understood any of this. We didn’t do the right prep, and there wasn’t enough support for us. It didn’t really help in the way I thought it would, and it actually made everything feel much harder, and he developed a nursing aversion that we had to deal with for several months. Looking back now, I’m not even sure he needed it.
Fast forward to my third child, I was very resistant to having her ties released and set out to do all of the bodywork and therapy and lactation support I could in order to hopefully prevent that from needing to happen. We did 9 weeks of intensive therapy and bodywork (like 3-4 appointments per week, seeing a variety of providers, getting all of the best opinions), and she wasn’t making progress, wasn’t gaining as she should. She was colicky and miserable every time she latched, and she needed to get released. It didn’t fix everything, but it did help her to start gaining weight almost immediately.
There is absolutely room to have a conversation about over diagnosing oral restriction and over treating with frenectomy (with lack of integrative care), but outright denying and dismissing very real tongue ties and issues that come with them, and asserting that all babies need is proper positioning and feeding techniques is not the way forward. What is missed in these conversations is that there are babies who do get the recommended support- bodywork, feeding support, oral motor therapy. Their parents are doing everything they can for them, and these babies are still struggling and unable to effectively transfer milk, and they are not progressing in the way we think they should. Ideally, babies would improve with all of this support, but sometimes, they just don’t. Not all babies will respond the same way, and time is a big factor, too. Waiting too long for the release could negatively impact mom’s milk supply. If baby is diagnosed with failure to thrive, is it really responsible to tell a parent to just wait it out? I don’t think so. In situations like this, a frenectomy can actually help. The key here is that ideally the frenectomy would be just one piece of the treatment plan in combination with other bodywork, lactation support, and nervous system regulation.
This experience is different for every single baby. Some babies do worse after a release that they don’t need or aren’t ready for, while on the flip side, there are babies who have their releases done with very little prep work and they immediately improved, and parents note it’s a night and day difference. So when someone says no baby should ever have this done, that just doesn’t line up with what a lot of families are actually experiencing.
And at the same time, frenectomies also aren’t usually a quick fix or fix all. Lots of babies need more. So this is why I think it’s so important for parents to be educated about this. Don’t dismiss the frenectomy outright, but find supportive, integrative providers who are willing to walk through this with you, and not rush to a frenectomy before baby is ready and prepared. Tongue ties are not just an issue in the mouth, believe it or not. You can’t just release a tie and expect everything to work if your baby’s body is still holding a ton of tension, or if their nervous system is overwhelmed, or if they don’t know how to use that new movement yet. So if a frenectomy is part of the plan, it should be part of something bigger. Body work, support, helping the baby actually use that new range of motion. And if it’s not needed, then that should be recognized too.
But just throwing it out completely and calling it barbaric? That’s not individualized, client-centered care. It’s also not realistic or reasonable. Parents deserve so much better than these extreme and unsupportive opinions. They deserve someone to actually look at their baby, their feeding, their whole situation, and help them figure out what makes sense for them.
