How to Examine a Baby for Tongue-Tie or Lip-Tie

by Bobby Ghaheri

The only purpose of this post is to demonstrate how to examine a baby who may have a tongue-tie or lip-tie. Future posts will help to explain the symptoms of intraoral restrictions that can impact breastfeeding.

Our first year of medical school includes proper examination technique. For instance, if you don't know where to put your stethoscope, you might miss a heart murmur. Unfortunately, we aren't instructed on how to examine a baby who is having breastfeeding problems. If you don't know how to properly examine a baby for tongue-tie or lip-tie, you will be more inclined to say that they don't exist.

The first step is adequate illumination. A headlight is a great option and critical in freeing up both hands. There are very affordable (under $25 typically) LED camping headlights that can be used to get a great view of the mouth.

The next step is proper positioning. This is the most common error made by medical professionals looking for tongue-tie or lip-tie. The provider and the parent should face each other, knees touching. The baby is laid on the lap of this makeshift table, head towards the examiner. You cannot adequately evaluate a baby's mouth when they are sitting in a parent's lap in an upright position.

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The goal of the examination is to try and determine the degree of tension of the frenulum of the lip and tongue on the surrounding tissue. Does the baby react or not? If it seems uncomfortable to them, they often squirm. If the frenulum is tight, it will often turn white or blanch. Look at where the frenulum is attaching to the gumline or tongue.

Many providers recommend stretching exercises after a releasing procedure to avoid the possibility of reattachment of the wounds. In those instances, a parent would turn the baby so that the head is in their laps and the feet pointing away. Alternatively, the baby can lay on a changing table or mattress as the parent positions themselves about the baby to expose the lip and tongue for stretching.

This technique is also the preferred technique for obtaining pictures of the lip or tongue. You will need a second assistant to take the pictures once you have the lip and tongue in proper position.