Nobody Told Me the Problem Might Be in My Baby’s Mouth, Not My Body

This article is part of the Nella Vosk Breastfeeding Nutrition & Milk Supply: Evidence-Based Guide for Australian Mothers — your comprehensive resource on nourishing yourself and your baby through every stage of the feeding journey.

This article is part of Nella Vosk’s Nobody Told Me series — a growing collection of posts about the information gap that too many mothers encounter after birth. Every article in this series starts from a moment a mother wasn’t told something she needed to know, and works back through the clinical truth behind it. You can find the full series at nellavosk.com.au/pages/nobody-told-me.

Nobody told me the problem might be in my baby’s mouth, not my body.

She was hungry all the time. Or seemed to be. She’d feed for what felt like hours, come off unsettled, and want to go back on within twenty minutes. My nipples were painful in a way that wasn’t getting better with time. My breasts never felt drained after a feed. She wasn’t gaining weight the way the maternal and child health nurse expected.

Everyone I spoke to focused on my supply. What I was eating. Whether I was drinking enough water. Whether I was stressed. Whether I needed lactation cookies, a pump session, a referral to a GP for domperidone. Nobody, until week seven, said: has anyone looked at her tongue?

The answer was a posterior tongue tie. Undetected at the newborn check, significant enough to be causing ineffective milk transfer with every feed, and the reason that her persistent hunger and my persistent pain and my apparent “low supply” were all the same problem — and the solution was not in me at all.

This post is for every mother who is doing everything she has been told and still struggling, and who has not yet been asked: has anyone looked at your baby’s mouth?

What Tongue Tie Is

Tongue tie (ankyloglossia) is a condition in which the frenulum — the small band of tissue that connects the underside of the tongue to the floor of the mouth — is shorter, thicker, or attached further forward than usual, restricting the tongue’s range of motion.

A tongue that can move freely can extend beyond the lower lip, lift to the upper palate, and move laterally side to side. These movements are critical for the mechanics of breastfeeding: an effective breastfeeding latch requires the baby to extend their tongue over the lower gum, cup the breast tissue, create a seal, and use a rhythmic wave motion of the tongue to draw milk from the breast. A tongue that is tethered cannot do this fully.

Tongue tie affects an estimated 4 to 11% of newborns, though prevalence estimates vary depending on how tongue tie is defined and assessed. It is more common in males than females and can run in families.

It is worth noting that not all tongue ties cause breastfeeding problems. Some babies with a visible frenulum restriction breastfeed perfectly well with no intervention. The clinical significance of a tongue tie is determined not by its appearance alone but by its functional impact — whether it is impairing the baby’s ability to transfer milk effectively.

Anterior Versus Posterior Tongue Tie: Why Posterior Is Routinely Missed

There are two main types of tongue tie, and understanding the difference matters because one is commonly missed at routine newborn checks.

Anterior (classic) tongue tie

The frenulum is visible and runs close to the tip of the tongue. When the baby cries or opens their mouth wide, the tongue tip may appear notched or heart-shaped, and the restricted frenulum may be clearly visible as a tight cord under the tongue. This type is more likely to be identified at birth or the newborn check because it is visually obvious.

Posterior tongue tie

The frenulum restriction is at the base of the tongue rather than the tip. The tongue may appear normal on casual inspection — there may be no visible cord, and the tongue may extend and lift reasonably well on voluntary movement. The restriction is felt rather than seen: on digital palpation (a gloved finger under the tongue), the tethering can be detected as a tightening at the base of the tongue that resists elevation. This type requires an experienced examiner who specifically checks for it, and is routinely missed at standard newborn checks by clinicians who are only looking for visible anterior ties.

Posterior tongue tie can cause all the same breastfeeding problems as anterior tongue tie — in some cases more severe ones, because the base-of-tongue restriction affects the wave-like pumping motion that drives milk extraction particularly significantly. Many mothers whose newborn was “checked for tongue tie” have actually only been checked for anterior tongue tie.

How Tongue Tie Symptoms Look Like Low Milk Supply

The most important thing to understand about tongue tie and breastfeeding is the distinction between a supply problem and a transfer problem.

A mother’s milk supply is governed by the supply-and-demand mechanism: the more effectively milk is removed from the breast, the more milk is produced. A baby with a tongue tie who cannot transfer milk efficiently is a baby who is not removing milk effectively — and a breast that is not being effectively emptied is a breast that receives a reduced signal to maintain or increase production.

This means that tongue tie typically presents, from the mother’s perspective, as low milk supply. She sees:

• A baby who seems perpetually hungry and never satisfied after a feed

• Frequent feeding that does not resolve the hunger — feeds that seem to go for a long time but don’t settle the baby

• Poor weight gain or slow weight gain despite apparent willingness to feed

• Breasts that never feel fully drained after a feed

• Nipple pain that does not improve as breastfeeding is established — because the tongue’s abnormal movement creates friction and compression trauma with every feed

What is actually happening in most of these cases is not that the mother’s body cannot produce enough milk. It is that the baby cannot extract the milk that is there. This distinction is critical, because:

• Interventions that address supply — galactagogues, power pumping, more frequent feeding — will not resolve a transfer problem. They may temporarily mask it by increasing supply above what the baby can access, but the underlying inefficiency continues.

• The correct intervention is addressing the transfer problem — either through technique modifications (positioning, latch work, suck training) or, where indicated, through frenotomy (the tongue tie release procedure)

A breastfeeding mother who is being advised to eat more lactation cookies, pump more, or take domperidone for what has been assessed as “low supply,” but whose baby has not been thoroughly assessed for tongue tie by an experienced clinician, may be treating the wrong problem.

How to Tell If Tongue Tie Is Affecting Breastfeeding

There is no single symptom that definitively indicates tongue tie — diagnosis requires assessment by a qualified clinician. But a pattern of the following signs, particularly in combination, is worth pursuing for assessment:

Signs in the baby

• Difficulty latching or repeatedly coming off the breast during a feed

• Clicking sounds during feeding — caused by the tongue losing its seal on the breast, allowing air in

• Visible lip curl inward rather than outward during feeding — an indication that the baby cannot maintain the seal

• Excessive wind and gassiness due to air swallowed during feeds

• Very short or very long feeds — the baby may tire quickly from the extra effort of inefficient feeding, or may stay on the breast for extended periods because they are not getting enough milk per minute of feeding

• Slow weight gain or weight loss despite appearing to feed frequently

• Unsettled behaviour after feeds that does not resolve with further feeding attempts

• Restricted tongue movement: the tongue cannot extend beyond the lower lip, or cannot lift fully to the upper palate when the baby cries

Signs in the mother

• Persistent nipple pain beyond the first week of breastfeeding — particularly pain that occurs throughout the feed rather than only at the initial latch

• Nipple trauma: blanching (the nipple turns white immediately after a feed), cracking, blistering, or nipple shape distortion after a feed (the nipple comes out wedge-shaped rather than round)

• Recurring blocked ducts or mastitis — caused by incomplete breast drainage at each feed

• Perceived low milk supply that does not respond to evidence-based supply-building strategies

• Breasts that feel persistently full or do not feel drained after feeds

If you recognise this pattern, the next step is a feeding assessment by an International Board Certified Lactation Consultant (IBCLC) who is specifically experienced with tongue and lip tie assessment. A GP or maternal and child health nurse can assess, but an IBCLC is the clinician most likely to identify a posterior tie that a brief visual check may miss. For guidance on how to access an IBCLC in Australia, the article on when to see a lactation consultant explains what to expect from the assessment.

Does Tongue Tie Prevent Breastfeeding?

Not necessarily — and this is an important nuance. Not all tongue ties require intervention. Some babies with tongue ties breastfeed effectively with no procedure. Some improve significantly with positioning adjustments and IBCLC support alone, without any tongue tie release. The decision about whether to proceed with frenotomy (the tongue tie release procedure) should be made on the basis of functional impact — whether the tie is demonstrably affecting feeding — rather than on its appearance alone.

The question is not “does my baby have a tongue tie?” but “is this tongue tie affecting how my baby transfers milk?” A thorough assessment answers both.

Tongue Tie Snip or Laser: What’s the Difference?

If a tongue tie release is recommended, there are two main methods used in Australia:

Frenotomy (snip/scissor release)

A quick, simple procedure in which the frenulum is divided with sterile scissors, most commonly without anaesthetic in young infants (whose frenulum has few nerve endings and minimal blood supply when thin). The procedure takes seconds, healing is rapid, and the baby can go straight to the breast afterwards. This method is widely available through paediatricians, GPs with specific training, and some lactation consultants. Cost is generally lower than laser, and many practitioners can do it as part of a consultation.

Laser release (frenotomy by laser)

The frenulum is divided using a laser rather than scissors. Proponents cite more precise division with less bleeding, particularly for posterior ties where the tissue is thicker. Critics note that current evidence does not demonstrate superior outcomes for laser versus scissor release in infants, and that laser procedures are generally more expensive and require specialist equipment. Some practitioners use local anaesthetic for laser procedures; practice varies. Recovery and aftercare are broadly similar to scissor frenotomy.

The current evidence does not strongly favour either method over the other for uncomplicated tongue tie release in infants. The most important factor is the skill and experience of the clinician performing the procedure, and the quality of the IBCLC support before and after the procedure to maximise the breastfeeding outcome.

What to expect after the procedure

Many mothers notice an immediate improvement in latch comfort and feeding efficiency after tongue tie release. Others find that improvement takes days or weeks as the baby learns to use their tongue in a new way. IBCLC follow-up in the days and weeks after the procedure is important — suck retraining exercises are commonly recommended to help the baby develop the tongue patterns that were restricted before the procedure.

It is worth setting realistic expectations: tongue tie release is not always a complete solution. If breastfeeding problems persist after the procedure, IBCLC support to address technique and supply should continue alongside the physical healing.

Breastfeeding Positions for Posterior Tongue Tie

While awaiting assessment or after a tongue tie release, certain breastfeeding positions can help maximise milk transfer for a baby with tongue tie:

Laid-back feeding (biological nurturing)

The mother reclines at 45 degrees or more, with the baby lying chest-to-chest on top of her. This position uses gravity to help the baby maintain latch and reduces the work required to keep the seal on the breast. Many mothers with tongue-tied babies find this the most comfortable and effective position before a release.

The football hold

The baby is tucked under the arm, with their body alongside the mother’s and their head at the breast. This gives the mother good control of the baby’s head position and allows her to support and guide the latch while seeing clearly what is happening.

Side-lying

Mother and baby lying on their sides facing each other. This position reduces the baby’s need to maintain head control against gravity and can make feeding less tiring for a baby who is working harder than usual to extract milk.

For detailed guidance on latch technique, the article on how to get a good breastfeeding latch is the most comprehensive resource. An IBCLC who specialises in tongue tie can provide hands-on positioning guidance specific to your baby’s anatomy and your own.

Nutrition While You Investigate Tongue Tie

If you are in the process of getting a tongue tie assessment — which can sometimes take days or weeks depending on where you are and who you can access — supporting your own nutrition is one of the most useful things you can do in the interim.

A mother who is feeding a baby with undiagnosed tongue tie is likely feeding more frequently and for longer than a mother with a well-transferring baby. The caloric and nutritional demands on her body are correspondingly higher. She is also more likely to be in pain, stressed, and not sleeping adequately — all of which increase the nutritional demand on an already depleted postpartum body.

Maintaining adequate caloric intake, staying hydrated, and supporting the specific nutrients most depleted by birth and breastfeeding — iron, DHA, zinc, magnesium — will not resolve a transfer problem, but they will support your body’s capacity to sustain the feeding relationship through a difficult diagnostic period. For practical guidance on snacking during a breastfeeding challenge, the article on best postpartum snacks for energy and milk supply covers accessible, one-handed options that work in real breastfeeding life.

Getting Help in Australia

If you suspect tongue tie is affecting your breastfeeding, these are the pathways available in Australia:

• Contact the Australian Breastfeeding Association (ABA) helpline (1800 686 268): ABA counsellors can provide support and guidance and can help you understand whether your baby’s feeding pattern warrants further assessment.

• Request a referral to an IBCLC through your GP or maternal and child health nurse. Specify that you want an assessment for tongue tie, including posterior tongue tie, and ideally seek a clinician who performs frenotomy or has specific tongue tie training.

• Search for tongue and lip tie support groups and community referrals in your state. Parental communities (including online groups) for tongue tie can be a useful source of recommendations for experienced practitioners in your area.

• Ask your hospital’s lactation service if you are still within the early postpartum period.

The Australian Breastfeeding Association helpline is available seven days a week: 1800 686 268. If you are experiencing significant feeding difficulty and cannot access in-person support quickly, calling the ABA is a useful first step.

Keep Reading

These posts connect to the tongue tie and supply picture:

How to Get a Good Breastfeeding Latch: Pain-Free Attachment Guide

Lactation Consultants 101: When to Get Help & What to Expect

10 Proven Ways to Increase Your Milk Supply

Power Pumping to Increase Milk Supply

Overactive Let-Down: How to Help Baby Handle Fast Milk Flow

Best Postpartum Snacks for Energy and Milk Supply

Breastfeeding Nutrition & Milk Supply: Evidence-Based Guide

If your breastfeeding difficulty is related to a transfer problem rather than a supply problem, no supplement will solve it — and the right assessment can change everything. While you are navigating the assessment and management pathway, supporting your own nutrition is one of the few things within your control. The Nella Vosk lactation range is formulated by a Certified Postpartum Nutrition Professional to support the breastfeeding mother’s body through the full range of challenges that the first months can bring.

ABOUT THE AUTHOR

Kelly Northey is a Certified Postpartum Nutrition Professional (CPPNP) and founder of Nella Vosk, an Australian maternal and family wellness brand. She specialises in breastfeeding nutrition, milk supply, and the clinical realities of early motherhood that are too frequently undercommunicated. Learn more about Kelly.