Oral Restrictions and Watchful Waiting: When Breastfeeding Looks Fine (But Something Feels Off)

So, someone told you your baby may have a tongue tie, lip tie, or another oral restriction—but everything seems to be going okay. You’re not in pain. Baby is gaining weight. Latch isn’t perfect, but it’s not awful either. So what now?

This is a situation we call watchful waiting. And it’s a valid, evidence-informed choice—especially when breastfeeding is going well enough, but there are still questions.

What Is Watchful Waiting?

Watchful waiting means exactly what it sounds like: instead of rushing into a tongue or lip tie release, we continue monitoring how breastfeeding is going, how baby is feeding, and how everyone is feeling. The truth is, we don’t have a crystal ball. We don’t know what might happen in the future. Some babies with visible ties breastfeed well without intervention.
Often, the struggles may not happen until later, as the milk supply regulates or baby’s needs increase. Not all tight frenula cause problems right away, sometimes there aren’t any struggles with breastfeeding at all.

The American Academy of Pediatrics (AAP) recently released a new statement emphasizing a watchful waiting approach—advising against routine releases and encouraging clinicians to first provide skilled breastfeeding support and assess function.

While I agree with not rushing to a release, and our team is fully capable is supporting families that do not want to have a frenectomy performed on their baby, I also know that we are not doing babies and their families any favors by downplaying the issues that oral restrictions can cause across the entire lifespan.

I believe that breastfeeding support and the importance of oral function was in the hands of pediatricians for decades and the result was that the United States had dismally low breastfeeding rates.
Many professionals like Speech Language Pathologists and airway centric dentists are identifying issues in children and adults from untreated oral restrictions. Google “long face syndrome” and “open mouth breathing.” There are so many adults that are struggling with high palates, narrow jaws, low tongue posture, mouth breathing, snoring, sleep apnea, the list goes on.

Why It’s Complicated

As IBCLCs, we can’t diagnose tongue, lip, or buccal ties. What we can do is assess oral function. We describe what we see, what we hear, and what we feel: does baby’s tongue lift, extend, and cup the way it needs to for effective feeding? Are there signs of restriction, compensation, or inefficient milk transfer?

Where things often get tricky is when families take this concern back to a pediatrician who isn’t well-versed in breastfeeding or oral function. If the latch isn’t painful and baby is gaining weight, it’s often dismissed. But breastfeeding isn’t just about weight—it’s also about comfort, efficiency, and sustainability.

A baby may be gaining weight well, but the parents may be utilizing and relying on compensations like a nipple shield, topping off with a bottle, extra pumping and/or breastfeeding frequently, around the clock.

What Oral Restrictions Can Look Like

Sometimes oral ties are easy to spot. The latch is painful, baby is struggling to gain weight, and every feed feels like a challenge. These are the urgent cases—the SOS consults. Breastfeeding can’t continue without help, and many of these families choose to move forward with a release right away.

But not all ties look this dramatic. Some babies grow just fine in the early weeks by “drinking from the letdown”—that easy, hormone-driven flow in the first 6 weeks. Once milk supply regulates around 6–12 weeks, they may begin to struggle. They might gulp, choke, or seem gassy. They may have been labeled “reflux babies” even though medication doesn’t help. Latch that was once painless becomes uncomfortable. These babies are what we lovingly call “Fat, Farty, and Fussy”—they’re gaining, but not comfortably.

And then there are the babies who seem to be doing well but require constant feeding, contact naps, or middle-of-the-night nursing marathons to stay satisfied. These parents often co-sleep, use nipple shields long-term, and feel like something is just... off. These situations fall under what we call the “Sneaky Ties.” Breastfeeding technically works, but it takes a lot of compensation, which can be hard to sustain.

So, What Should You Do?

If you’re in this gray area, watchful waiting can absolutely be the right choice—as long as you have support and know what to look out for.

We recommend checking in regularly with a lactation consultant to track feeding patterns, latch changes, and oral function. You don’t need to decide everything right now. But knowing what may show up later can help you feel more prepared.

As your baby grows, here are some signs that oral restrictions might still be showing up:
– Difficulty chewing solids
– Picky or slow eating
– Choking or gagging on food or liquids
– Mouth breathing or snoring
– Speech that’s hard to understand
– Restless sleep, teeth grinding, or open-mouth sleeping
– Dental or orthodontic issues (high palate, not enough room for teeth due to narrow palate and jaw, receding gums)
– Bed wetting

Not all babies with ties experience breastfeeding difficulties or struggles in the future. But if issues arise, they’re worth exploring with someone who understands the connection between oral structure and function.

Need Help Figuring It Out?

Whether you’re leaning toward a release or just want to keep observing for now, you don’t have to do this alone. We’re here to help you assess what’s going on, create a care plan, and support your feeding goals—whatever they look like.

💛 Book a lactation consult (virtual or in-person) to explore whether oral function is playing a role in your breastfeeding journey.

👉 Click here to schedule your consult

No pressure. No assumptions. Just support, information, and the space to make the best decision for your baby. 💛