Hallie BulkinAsk HallieAI:Your On-Demand Mentor in Pediatric Feeding & Myo

Does a Tongue-Tie ALWAYS Need a Release?

8 Aug 2026 · 1 min

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In this expert monologue, Hallie Bulkin emphasizes that a visible tongue‑tie (frenulum restriction) in a 3‑month‑old infant with breastfeeding difficulties should not automatically trigger a release. She outlines a comprehensive functional assessment that examines the infant’s latch, jaw movement, seal and suction, suck‑swallow‑breathe coordination, and milk transfer efficiency. Bulkin also stresses the importance of evaluating the entire feeding dyad—including infant positioning, maternal anatomy, milk supply, pain, endurance, and the infant’s state regulation—to identify other contributors such as oversupply or positioning issues. She argues that even if reduced tongue protrusion is present, effective suction and milk transfer may render a frenotomy unnecessary. When referral for a tongue‑tie evaluation is warranted, the referral should detail the specific functional limitations observed, the compensations the infant uses, and the clinical reasoning behind seeking further evaluation, thereby providing greater value to families.

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I want you to consider for a second, like a 3-month-old infant with breastfeeding difficulties. There may be a visible restriction, but that can't be the entire assessment. You need to understand how the baby latches, how the jaw moves, whether the baby can maintain a seal and suction, how suck-swallow-breathe coordination is working for them, and whether milk transfer is effective, right? You also need the rest of the feeding dyad in that positioning, maternal anatomy, milk supply, pain, endurance, state regulation, right? All, all these things can influence the experience. Perhaps the infant has reduced tongue protrusion, but it's generating a strong suction and transferring milk effectively, right? Perhaps positioning or oversupply is contributing more to the difficulty than the frenulum. Restriction present, release not automatically indicated. That is what real assessment gives you. And when you do refer, the referral carries more value. Instead of sending a family out with possible tongue-tie, please evaluate, you can explain the functional limitation you observed, right? The effect that it's having, the compensations that child is using and why you believe further eval is actually warranted.