Tongue Tie, Stretches, and Baby Feeding: What the AAP Now Says (and What Parents Need to Know)
When our daughter was having feeding challenges, we did what most parents do. We asked for help.
We saw a lactation consultant. We wanted to do the right thing.
What we were told was overwhelming:
She needed a tongue tie and lip tie revision
We should start craniosacral therapy
We needed to do oral motor exercises like squeezing her cheeks
And we would have to do stretches in her mouth after the procedure
It felt like a lot. It was presented as necessary.
What we did not realize at the time is that new guidance from the American Academy of Pediatrics (AAP) was coming out right then, and it directly contradicts much of what we were told. We simply did not have that information yet.
What the AAP is saying now
The AAP’s updated recommendations make a few things very clear:
Not all tongue ties need treatment
Surgery should only be considered for clear, ongoing feeding problems
Many babies with visible ties feed just fine
And importantly:
Post-procedure stretches are not recommended and are not supported by evidence
A key piece that often gets misunderstood: how babies actually suck
Recently, I became certified in SOFFI (Supporting Oral Feeding in Fragile Infants), and this was one of the topics we discussed in depth. It completely shifted how I understand infant feeding.
Honestly, it was mind blowing.
One of the biggest takeaways is how feeding actually works:
Suction is generated in the back half of the mouth, not at the tip of the tongue
The bottle or breast is stabilized deeper in the mouth where suction is created
The front of the tongue, where most ties are identified, is not the primary driver of suction
What does that mean?
A visible tongue tie in the front of the mouth is often not the reason a baby is struggling to feed.
And about lip ties
We were told our baby’s lips needed to flange perfectly around the nipple.
But here is what matters:
Lips are not responsible for creating suction
Feeding does not require a picture-perfect flange
Babies can feed effectively without dramatic outward lip positioning
So a lip tie is very rarely a reason for feeding difficulty, and even more rarely a reason for a procedure.
About those stretches and exercises
We were instructed to:
Stretch inside our baby’s mouth after a release
Do oral motor exercises like cheek squeezing
Follow a strict routine after the procedure
The AAP now clearly states:
Post-release stretches are not evidence-based and should not be recommended
And beyond that:
There is no strong evidence that oral motor exercises improve infant feeding
Feeding is about coordination and responsiveness, not isolated muscle training
For us, these exercises added stress without clear benefit.
What about craniosacral therapy
We were told this would help improve feeding.
The reality:
There is very limited evidence supporting it
It is not recommended by the AAP as standard care
Sucking blisters are normal
This is another thing that caused unnecessary concern.
Sucking blisters:
Are common in newborns
Happen as babies adapt to feeding
Do not mean there is a tongue tie
Do not mean there is a functional oral motor problem
They are a normal variation, not a diagnosis.
The biggest takeaway: function matters more than appearance
The AAP emphasizes this clearly:
What matters is how your baby functions, not how their mouth looks.
Important questions:
Is your baby feeding and transferring milk?
Are they gaining weight?
Are things improving with support?
If yes, a procedure is often not needed.
What we wish we had known
If we had known what the AAP guidance was about to say, we would have:
Slowed down before agreeing to multiple interventions
Focused on feeding support instead of anatomy
Questioned recommendations that did not have clear evidence
And now, after additional training and learning, it is even clearer how much of feeding is about interaction, timing, and support, not forcing the mouth to move in certain ways.
But we did not know at the time, and many parents still do not.
If you are in this right now
If you are being told your baby needs:
A tongue or lip tie revision
Stretches or oral motor exercises
Craniosacral therapy
Know this:
You are navigating a space where recommendations have outpaced the evidence.
And now, the AAP is catching up and clarifying what is actually supported.
Bottom line
At the time, we followed the guidance we were given.
Now, with updated information, it is clear:
Many tongue ties do not need to be revised
Lip ties are rarely a feeding issue
Stretches and oral motor exercises are not recommended
Sucking blisters are normal
You did not miss something.
You were making the best decisions you could with the information you had.
Moving forward
Pause before jumping into invasive or intensive interventions.
Ask:
What is the actual feeding problem?
Is this supported by evidence?
What happens if we give this time and support first?
Because more intervention is not always better care.
And parents deserve guidance that is clear, honest, and grounded in evidence, especially in those early weeks.
