Tongue Ties: Not a Fad — and Why Function Matters Most
If you’ve spent any time in parenting spaces recently, you’ve likely heard a lot about tongue ties. For some families, they’ve been framed as the missing piece behind feeding or sleep struggles. For others, they’ve been dismissed as a trend or an overdiagnosed concern. Caught between those two extremes, many parents are left confused, overwhelmed, and unsure who to trust.
Tongue ties are not a new concept, and they are not a fad. But they are also not the whole story. The truth — as it often is in pediatric care — lives in the gray.
Tongue Ties Have a Long History
Tongue ties, clinically referred to as ankyloglossia, have been documented for centuries. Historically, midwives carried a sharpened fingernail or tool specifically to release restrictive frenula when feeding was clearly impacted. Medical texts from the 18th and 19th centuries reference tongue ties and their potential effects on feeding and speech.
What has changed is not the existence of tongue ties — it’s our understanding of infant feeding, oral motor development, airway health, sleep, and neuromuscular function. We are also living in a time where parents are more informed, more observant, and more willing to ask questions when something doesn’t feel right.
Increased awareness does not automatically mean overdiagnosis. It means we are looking more closely.
Why the Controversy Exists
The controversy around tongue ties often stems from one central issue: a diagnosis alone does not guarantee improved function.
Some children experience clear improvements after a release. Others see little change. Some improve significantly without surgery at all. When outcomes vary, it’s understandable that providers — and parents — hold differing opinions.
The challenge arises when the conversation stops at anatomy alone.
A frenulum can appear restrictive yet function well. Another may look subtle but significantly impact feeding, sleep, or coordination. Structure matters — but function matters more.
What “Function” Really Means
When we talk about function, we are looking beyond what the tissue looks like and asking deeper questions:
How is feeding going?
Is milk transfer or chewing efficient?
How does the tongue move, elevate, and coordinate?
Are there compensations in the jaw, lips, neck, or body?
How is sleep — not just duration, but quality?
How regulated does the child seem during and after feeds?
These answers tell us far more than a visual exam alone.
The Tongue, Body Tension and the Fascial System
The tongue does not function in isolation. It is deeply connected to the rest of the body through the fascial system — a continuous web of connective tissue that links the tongue to the jaw, neck, chest, diaphragm, and beyond.
When tongue movement is restricted, the body often adapts in subtle but meaningful ways. Tension may show up in the jaw or neck, through shoulder elevation, changes in posture, or overall regulation. Babies and children are remarkably adaptive; they compensate long before they have words to tell us something feels off.
This is one reason tongue-related challenges may sometimes be associated with whole-body tension, feeding fatigue, difficulty settling, or disrupted sleep. The body is always working toward balance.
Supporting tongue function thoughtfully — whether through therapy, body-based work, or in some cases surgical release — means considering how the entire system is responding, not just what is happening inside the mouth.
Why Releases Don’t Always Lead to Change
A tongue tie release changes structure, but it does not automatically retrain the nervous system or oral motor patterns.
If a child has spent weeks, months, or years compensating, their body doesn’t instantly know how to move differently. Without proper support:
Old patterns can remain
Feeding may still feel difficult
Sleep may not improve
Families may feel discouraged or misled
This is why preparation before a release and integration afterward are so important. The body needs guidance to learn new, more efficient ways of functioning.
When Surgery Isn’t the Right Answer
Not every functional challenge requires a release. Many children make meaningful progress through targeted oral motor work, feeding therapy, body-based regulation, and support that addresses the whole system.
A thoughtful approach asks not just “Is there a tie?” but “Is this the right intervention for this child, right now?”
There is no one-size-fits-all solution.
How I Approach Tongue Tie Assessments
When families come to me with concerns about tongue ties, my focus is never on checking a box or rushing toward a procedure. I take time to look at the whole picture — feeding, sleep, oral motor skills, body tension, regulation, and how everything works together.
I collaborate closely with other professionals and believe strongly in preparation and follow-up support when a release is part of the plan. And when it’s not, we focus on strategies that can still meaningfully improve function.
My goal is clarity, not pressure — and support that helps families feel informed and confident in their decisions.
A More Grounded Way Forward
Tongue ties are real. They have always existed. And they deserve careful, informed consideration — not dismissal, and not reflexive treatment.
When we center the conversation on function, consider the whole body, and collaborate across disciplines, we move away from trends and toward integrity.
If you are navigating this space as a parent, know this: feeling uncertain does not mean you are behind or misinformed. It means you care deeply about doing what is right for your child.
And that is always the best place to start.
Quick Take for Parents
Tongue ties are real and have been recognized for centuries
Increased awareness does not mean they are a fad
Anatomy alone does not predict outcomes
Function and the whole body matter most
Support before and after decisions makes a difference
You do not have to have all the answers. Thoughtful, collaborative care exists.