Full movement of the tongue is needed for normal feeding, swallowing, chewing, speech, and breathing. The tongue needs to be able to move:

👅 In and out (and stay out for an extended period of time when breast or bottle feeding). The tongue should be able to protrude past the lower lip without any tension on the tongue. The tongue tip should be round or square and not notched or heart shaped.

👅 Side to side (enough to eventually clear food from the back molars). The ability to move the tongue side to side helps move food to the teeth for chewing.

👅 Up and down (the MIDDLE of the tongue being able to move up and down is actually what is needed for a baby to be successful at the breast). If your pediatrician told you your baby could stick their tongue out so there was no tie but didn’t check how the middle of the tongue moves didn’t actually assess your baby for a tie and doesn’t understand how the tongue needs to move for your baby to feed.

If the tongue cannot do these movements, it can have a chain reaction to limit or negatively impact other systems, including the respiratory system. Snoring in a baby is never normal. Open mouth posture except for when baby is sick is not normal.

Having a visible frenulum does not necessarily mean the tongue is tied. If the tongue has a frenulum but it still allows the tongue to move in all directions, it is not tied. A visual inspection from a picture or video is not enough to diagnose a tie. Only a hands on assessment where the tongue movement is challenged in all directions is enough to tell us whether or not the tongue is tied.