You Were Told There Was No Tongue Tie. Here’s What May Have Been Missed.
If you have ever brought up tongue tie concerns to a provider and been told your child is fine, you are not imagining things. And you are not alone.
This comes up constantly in my work. Parents who have researched symptoms, connected dots, noticed patterns, and then sat in an appointment and walked out with the same answer they came in with: no tongue tie found.
What most parents don’t know — and what most providers don’t explain — is that there are two different types of tongue ties, and only one of them is easy to see.
The One Most Providers Check For
An anterior tongue tie is the version most people picture. The band of tissue (called the lingual frenulum) runs close to the tip of the tongue and is visible when the mouth is open. In more obvious cases, you’ll see a heart-shaped tongue tip. This is the type that gets caught at birth, flagged at newborn checks, and referred for release.
It is the most commonly diagnosed type. And it is not the only type.
The One That Gets Missed
A posterior tongue tie sits further back under the tongue, beneath a layer of mucous membrane. You cannot see it just by looking. It requires a hands-on assessment — someone who knows what to feel for, not just what to look for.
This is why so many children go to a standard pediatric appointment, get a visual check, and get cleared. Not because there is nothing there, but because a visual check is not the right tool for this assessment.
Posterior ties can have the same functional impact as anterior ones — affecting how the tongue moves during feeding, speech, swallowing, and rest. In some cases, the functional limitations are even more significant because the restriction is deeper.
What Function Actually Matters
The question a thorough tongue tie assessment is trying to answer is not just: does this band of tissue exist? It is: can this tongue do what it needs to do?
That includes things like:
• Latching and transferring milk efficiently during feeding
• Moving food around the mouth to chew and swallow safely
• Reaching the places it needs to for clear speech sounds
• Resting on the roof of the mouth with lips closed at rest
That last one matters more than most people realize. The tongue resting position is what creates upward pressure on the palate, which drives the palate to widen and supports the nasal airway. A tongue that cannot rest in the correct position does not provide that pressure — and over time, that affects how the face develops.
None of this shows up in a visual check at a general pediatric appointment.
What to Do If You’ve Been Told Your Child Is Fine
A few things worth knowing:
A provider who specializes in tethered oral tissues (TOTs) performs a different kind of assessment than a general pediatrician or even a general dentist. The specialist is feeling for range of motion, compensatory patterns, and restriction under the tissue — not just looking.
If your child has symptoms that point to a tongue tie — feeding difficulties, open mouth posture, mouth breathing, speech concerns, snoring, restless sleep — those symptoms deserve a proper evaluation, even if someone has already told you there is no tie.
Getting a second opinion from a provider who specializes in oral function is a reasonable next step. You are not being difficult. You are being an advocate.
As someone who has been through this personally — as a clinician, as a patient, and as a mom of three girls who all had ties that were assessed multiple times before we had the full picture — I can tell you that the clearance you were given may have been honest and still incomplete. Both things can be true.
Not sure what symptoms to look for? Download the free Airway Symptom Checklist — a simple, plain-language guide designed to bring to your next appointment.