Could My Baby Have a Posterior Tongue Tie?
The short answer
A posterior tongue tie is a restriction of the tissue under the tongue that is not easily visible and must be felt by an experienced provider. It can cause breastfeeding difficulties including a painful or shallow latch, clicking sounds during nursing, and poor weight gain. Diagnosis and treatment recommendations vary among healthcare providers, so getting an evaluation from a lactation consultant experienced with tongue ties is often a helpful first step.
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By Age
What to expect by age
0-4 weeks
Posterior tongue ties are most commonly identified in the early weeks when breastfeeding problems become apparent. Signs include a painful latch despite appearing correct, clicking or popping sounds during nursing, baby sliding off the breast repeatedly, excessive gassiness from swallowing air, and nipple damage that does not improve with positioning changes. Unlike anterior tongue ties, a posterior tie is not visible when your baby cries or lifts the tongue.
1-3 months
If breastfeeding remains difficult despite working with a lactation consultant on positioning and latch, a posterior tongue tie may be worth investigating. Signs that persist include poor weight gain, long exhausting feeds, baby falling asleep at the breast from fatigue rather than fullness, and continued nipple pain. Some providers recommend a frenotomy (release procedure), while others prefer conservative management with bodywork and feeding therapy.
3-6 months
By this age, some babies with mild posterior ties have compensated and feeding has improved on its own. For those still struggling, a comprehensive evaluation by a pediatric dentist or ENT experienced with tongue ties can clarify whether a release would be beneficial. If considering a procedure, discuss the expected benefits versus risks with your provider.
6-12 months
Posterior tongue ties can sometimes affect the transition to solid foods, causing difficulty managing textures or gagging more than expected. If your baby had feeding difficulties as a newborn and continues to struggle with solids, mention the history to your pediatrician. Speech and feeding therapists can help with oral motor skills regardless of whether a tie is released.
What Should You Do?
When to take action
- Your baby has a visible thin membrane under the tongue but is breastfeeding well, gaining weight, and you are not in pain — not all tongue ties need treatment
- Your baby occasionally clicks during feeding but is otherwise transferring milk effectively and gaining weight
- Breastfeeding was difficult initially but has improved significantly with positioning adjustments and lactation support
- Breastfeeding is consistently painful despite multiple attempts to correct latch and positioning with professional help
- Your baby is not gaining weight adequately or feeds take longer than 40-45 minutes consistently
- You hear frequent clicking or see milk leaking from the sides of the mouth during feeds
- Your baby seems frustrated at the breast and has excessive gas or reflux symptoms
- Your baby is losing weight or not gaining weight despite frequent feeds
- You are developing recurrent mastitis, severe nipple damage, or considering stopping breastfeeding due to pain — seek an urgent lactation consultation
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Feeding Concerns
When to Introduce Allergens to Baby
Current guidelines recommend introducing common allergens (peanut, egg, cow's milk products, tree nuts, wheat, soy, fish, shellfish, sesame) starting around 4-6 months when your baby is developmentally ready for solids. The landmark LEAP study showed that early introduction of peanuts (by 4-6 months) reduced peanut allergy risk by 80% in high-risk infants. Do not delay allergens - the old advice to wait until 1-3 years has been reversed because early exposure actually prevents allergies.
I'm Worried My Baby Is Aspirating During Feeds
Aspiration means liquid or food enters the airway instead of the stomach. Occasional coughing during feeds is common and does not usually indicate aspiration. True aspiration is less common and may present as recurrent respiratory infections, a wet or gurgly voice after feeds, or chronic cough. If you are concerned, a swallow study can provide a definitive answer.
When Does My Baby Need Amino Acid Formula?
Amino acid-based formulas (also called elemental formulas) are prescribed for babies with severe cow's milk protein allergy, multiple food protein intolerances, or conditions like eosinophilic esophagitis who cannot tolerate standard or extensively hydrolyzed formulas. They are the most hypoallergenic formula available because the proteins are broken down into individual amino acids, making allergic reactions virtually impossible.
Could My Baby Be Aspirating During Feeding?
Aspiration occurs when food or liquid enters the airway instead of the esophagus. Signs include coughing or choking during every feed, a wet or gurgly voice after eating, recurrent chest infections, and breathing changes during meals. Silent aspiration can occur without obvious coughing. If you suspect aspiration, contact your pediatrician as a swallowing study can diagnose it.
Baby Biting Nipple While Nursing
Biting during breastfeeding is a common challenge, especially when babies start teething. It can be startling and painful, but it is almost always a phase that can be managed. Babies cannot actively nurse and bite at the same time because their tongue covers the lower teeth during proper sucking. Biting typically happens at the beginning or end of a feed when the latch is not active. With some gentle strategies, most babies learn quickly that biting ends the feeding session.
My Baby Keeps Clamping Down on the Spoon
Clamping down on the spoon is very common, especially during teething or when babies are learning new oral motor skills. It is often a sensory exploration behavior rather than a feeding problem. Using a soft silicone spoon and placing food on the front of the spoon can help.