Assessing for tongue tie takes a true hands on assessment, not just a quick look under the tongue during a cry or looking at a picture. An assessment isn’t complete without the provider’s fingers sweeping under the tongue, lifting the tongue, and seeing how the tongue moves in all direction, and then more importantly, knowing the difference between a normal tongue frenulum and a tied or restricted frenulum. Just because a person is qualified to “assess“ for tongue-tie, does not mean they necessarily know how to do so. And just because a baby has a frenulum, that doesn’t mean it’s tied or restricted. And if your pediatrician told you there’s no tie just because baby can stick their tongue out, that wasn’t actually an assessment.
As a speech therapist, I look at 3 things when doing an assessment on infants: what does the tongue look like, what can the tongue do, what symptoms is it causing. The tongue needs full range of motion (in and out, side to side, and up and down ) for feeding, dental hygiene and to some extent speech. Some babies with a frenulum can still have range of motion maintained. The frenulum does not impact function. Symptoms to watch out for are feeding difficulties (can not grasp and hold a nipple for breast or bottle feeding, fatigues easily from tension on the tongue and jaw, cannot create the vacuum needed to draw breast milk so weight gain is poor or milk supply suffers, chokes and gags during feeding)
When range of motion is restricted, or is causing symptoms, I will refer to a pediatric dentist who also looks at how the frenulum is impacting structure: is it pulling on the structures of the floor of the mouth and the jaw? Is it putting tension on the bone? In those cases, when function is restricted and it is currently causing symptoms, a revision is warranted.