It’s frustrating when you know something isn’t right with your baby’s feeding, but you’re being told again and again that everything looks fine.
Maybe there’s nipple pain. Maybe your baby is windy and unsettled, or feeds drag on for what feels like hours. Then someone looks under their tongue but still sees none of the tell-tale signs often associated with a tongue-tie.
This is the puzzle of the posterior tongue-tie. As chiropractors, we’re interested in how a movement is made and controlled, not just how it looks from the outside. Tongue movement is no different.
Let’s start with what a tie looks like, because a front tie is easy to spot. When the tongue lifts, the too-tight tissue tugs the tip into a heart shape, or shows up as a small web near the front.
A posterior tie, by contrast, sits further back, tucked under the surface, so there’s often nothing to see at all. And this is the one that can get missed.
Picture a rug. A front tie is a trip hazard sitting on top of it. A posterior tie is a cable running underneath. You can’t see the cable, but the rug never lies flat, and nothing slides across it smoothly.
If you can’t see it, you have to feel for it. The useful tool here isn’t a torch. It’s a finger.
The person checking runs a finger side to side under the tongue to feel how the tissue gives way. Soft and spongy is what you hope for.
With a posterior tie, they may feel something in the middle that resembles a small speed bump or fence beneath the tissue. Even so, the tongue may still move fairly well, which is part of why these ties are so easy to overlook.
Moving fairly well and feeding well aren’t the same thing, though. To feed well, a baby needs to lift the middle and back of the tongue, and that’s what creates the suction.
If something holds that section down, the seal can be hard to make. So babies find another way around it.
Many clamp down with their gums instead. That can break the seal at the corners of the mouth, allowing more air to enter during feeding. This is why you end up with a windy baby who brings milk back up and finishes every feed shattered.
Here’s the reassuring bit. A tie you can spot in a photo isn’t automatically a problem that needs solving.
What counts is whether it causes trouble. If feeding is going well and sleep isn’t a nightly battle, there’s nothing to fix.
Where it is causing trouble, though, the order things happen in matters. A release is a job for a dentist or surgeon, and chiropractic care sits alongside that work, never in place of it.
Weeks of difficult feeding can leave a baby tight through the jaw and neck. Hands-on work may help settle some of that, as one part of a wider plan.
And even after a release, a tongue with new movement available still has to learn how to use that extra freedom. That process takes time and practice.
How much time varies, because every baby is different. Some babies with a posterior tongue-tie feed well and need no further treatment, while others benefit from assessment by a team of experienced professionals.
The goal is never simply to identify a tongue-tie. It’s to understand why feeding isn’t working, and to help each baby feed as comfortably and effectively as possible.
