Visual Indicators of Tongue and Lip Ties

         Ever since my original tongue tie post, Hidden Causes of Children’s Eating Difficulties,  I’ve received countless questions from hesitant parents wondering if what they’re looking at under the tongue is in fact a restriction. I shared a link in my post, from Dr. Ghaheri’s website, that shows how to examine a baby for a tie but many people have a frenulum that doesn’t cause restriction – how do you know if your child’s is a problem?

          First, symptoms are the number one indicator. No matter what you think you do or don’t see, if you’re having nursing or eating difficulty with your children, they’re experiencing symptoms that likely indicate a restriction. Here’s a list of other possible reasons you could be having nursing problems, to help you identify other potential solutions. If those don’t line up for you, or you’re still suspicious of a tie, here are 3 symptom lists and which tie they indicate:

Tongue and lip tie symptoms that can occur while BREAST FEEDING:

  • Thrush for mom or baby
  • Falling asleep while nursing
  • Pain while nursing
  • Frequent feedings
  • Baby falls off the breast while nursing
  • Baby is gassy, colicky, and/or spits up
  • Has shallow latch
  • Clicking sound when nursing
  • Inability to drain you of milk/breasts still feel full after nursing
  • Early weaning
  • Easily distracted while nursing
  • Waking frequently at night to nurse
  • Low milk supply
  • Over active let down
  • Excessive milk supply
  • Mastitis
  • Lip blisters
  • Cupping of the tongue when crying
  • And/or cracked/blistered/bleeding nipples

Tongue tie symptoms that can occur when eating SOLIDS:

  • Gags and chokes on food often
  • Chewing and spitting food out
  • Pocketing food in their cheeks or lips
  • Preferring purees or very soft cooked food
  • Difficult time eating things of certain textures/consistencies
  • An aversion to solids/eating in general
  • Only eats small amounts of food at a time before wanting to be done
  • Failure to thrive

General LIP TIE symptoms:

  • Upper lip unable to flange properly – tucks under while nursing or bottle feeding
  • Tooth rot on the top 4 front teeth
  • Gap between the 2 front teeth

            visual indicators of tongue and lip ties

       Second, visual clues. Just as every person can have a different combination of symptoms, every person can have a different combination of visual indicators depending on their “class” of tie. If you see a photo below of something that’s not applicable to your child, that doesn’t mean they’re not tied. If even one of these photos resembles your child’s tongue or lip and you’re experiencing even one tongue tie symptom, I highly recommend making an appointment with a preferred provider. Here are photos and descriptions of the various visual indicators of ties:

          Cupped Tongue:

When your baby cries, are the sides of the mouth raised higher than the tip? When you examined your child for a tie, did the sides of the tongue lift higher than the middle? A restricted tongue can’t elevate properly. [Important to note: a cupped tongue doesn’t always mean a tongue tie. According to Dr. Bobby Ghaheri, if there’s floor of mouth muscle tension, it can mimic a tongue tie and cup the tongue.] Here are examples of 3 “cupped” tongues:

Forked Tongue:

The tie can also cause the tip of the tongue to “fork”, or not stay rounded at the tip. In some cases the fork is present constantly but in other cases it’s only evident when the child sticks out their tongue or makes certain movements with their tongue while talking. Here’s an example of a forked tongue:


Two Bottom Middle Teeth Point Inward:

The muscle tension from the tongue tie can cause a domino effect of problems. According to Dr. Bobby Ghaheri, “In the battle between muscle and bone, muscle always wins. So in turned lower teeth are often indicative of a tongue tie because the tongue tie is pulling on the bone and remodeling it.”

Gap Between Two Front Teeth:

Many lip tied children will have a gap between their two front teeth. The frenulum, in some cases, starts at the base of the gums, keeping the teeth from being able to come together, as seen below.


Upper Lip Strains To/Cannot Touch Tip of Nose: 

When you lift the lip, do the sides come up higher than the middle like in the first photo below? [Class 3 Tie] When you try to lift the lip to touch the tip of the nose is there strain? If you look at the middle photo below you can see the yellow color at the tip of Emery’s lip that indicates her lip is being strained when I pull it that high, which mean’s there’s restriction. [Class 3 Tie] Is the lip unable to reach the tip of the nose, as seen in the bottom right photo? [Class 4 Tie] The fourth photo is of a non-restricted upper lip – note there’s a frenulum but there’s no strain when pulling the lip up.

Unrestricted upper lip

Upper Lip Tucks in While Nursing:

Because of the inability for the lip to fully lift up, many lip tied babies can’t fully flange their upper lip around the breast or bottle. If your baby is still nursing or using a bottle, examine the lips during feeding times – is the lip tucked in or is it fully flanged out over the breast or bottle? The left and middle photos are of “tucked” lips while the baby on the right has the ideal, fully flanged lips. If their lips are tucked, try to flange them after they’ve latched – do the lips stay in the correct position or do they tuck back in? [Important to note: According to Dr. Bobby Ghaheri, A tucked lip doesn’t necessarily meant there’s a lip tie, it could also mean the upper lip is simply being used more aggressively to hold on to the breast instead of the tongue.]

Lip Blisters: 

If the lips are not flanging properly, baby will likely have lip blisters. The photo on the left is of normal lips, the photo on the right is of blistered lips from a tied baby. These occur from nursing or bottle feeding with an improper latch.


Hopefully this helps give you a better idea of what you’re looking at as you’re deciding whether or not to see a preferred provider. If you missed my previous posts, you can find them linked below:

Please note, I am not a professional! I’ve had no specific training in ties, I was just a worried mom with a screaming, hungry baby who researched for hours on end, for months. I’m very willing to talk with you about ties, but I do recommend you email Dr. Bobby Ghaheri using this link, or another preferred provider for professional advise. As always, if this information could help just one family I will be over the moon! My first post on ties has hands down been my most popular post and I’m so thankful that our suffering was not in vain, that our family’s struggles are being used to help others find solutions for their own challenges! Every comment, email, and IG message gives me chills of excitement that the word is getting out and families are getting the help they desperately need! Please share this with anyone you think needs to know about ties and their misunderstood effects.

much love,