Restrictive oral ties are mucosal bands that are too short or too thick, limiting the mobility of the tongue, upper lip or cheeks. Long under-diagnosed, they are now recognised as a frequent cause of breastfeeding difficulties and sucking difficulties in infants.
What is a restrictive oral tie?
A tie (or frenulum) is a fold of mucosa that connects two structures. In infants, there are mainly three types:
- ✓Tongue-tie (lingual frenulum, under the tongue): the best known. When it is short or thick, it limits the tongue's elevation and extension — this is called ankyloglossia.
- ✓Upper lip-tie (between the lip and gum): can hinder a good latch at the breast or bottle.
- ✓Cheek (buccal) ties: rarer, they can also restrict oral mobility.
These ties exist on a spectrum: some are very visible, others are sub-mucosal (invisible to the eye but palpable). A tie is only "restrictive" when it causes a functional problem — appearance alone is not enough for a diagnosis.
Warning signs to watch for
Signs in infants vary depending on the degree of restriction:
- ✓Difficulty maintaining a correct latch at the breast or bottle
- ✓Clicking sounds during feeds (air swallowed due to a poor lip seal)
- ✓Very long and/or very frequent feeds, baby never seems satisfied
- ✓Insufficient weight gain
- ✓Irritability, crying during or after feeds
- ✓Regurgitation and/or colic (excess air swallowed)
- ✓Jaw tension, mouth not opening wide enough to feed
For mum too
Restrictive oral ties don't only affect the baby. A poor latch can cause intense maternal pain, cracked nipples, poor stimulation of milk supply and a sense of failure. If you're in pain at every feed, this is a signal not to ignore.
What role does osteopathy play?
Osteopathy does not treat the tie itself — that is the role of the surgeon (paediatrician, ENT specialist, oral surgeon) who performs the frenectomy (release of the tie) with a laser or scissors. Osteopathy works as a complementary approach, both BEFORE and AFTER this procedure.
Before the frenectomy: preparing the tissues
- ✓Releasing associated neck and cranial tensions, often present since birth
- ✓Improving mobility of the hyoid bone and the base-of-skull structures involved in the mechanics of suction
- ✓Reducing postural compensations (preferential head rotation, SCM muscle tension)
- ✓Preparing the baby for more effective rehabilitation after the procedure
After the frenectomy: optimising recovery
After the release, scar tissue can create new tensions and reduce the benefits of the procedure if nothing is done. Osteopathy:
- ✓Supports healthy scar tissue formation to avoid re-attachment
- ✓Releases muscular and fascial tension in the oral, cervical and cranial region
- ✓Helps the nervous system integrate the tongue's new range of motion
- ✓Works alongside the oral stretching exercises prescribed by the practitioner
A team-based approach
Optimal management of restrictive oral ties is multidisciplinary: osteopath, lactation consultant (IBCLC), the practitioner performing the frenectomy (paediatric ENT specialist or trained oral surgeon), and sometimes a speech therapist. Hilary works closely with these professionals.
Restrictive ties and other related symptoms
An untreated or late-diagnosed restrictive tie can be linked to other issues:
- ✓Colic and gas: air swallowed due to a poor lip seal distends the intestine
- ✓Reflux: the negative pressure created by inefficient suction encourages milk to come back up
- ✓Flat head syndrome (plagiocephaly): compensatory neck tension favours a postural preference
- ✓Sleep difficulties: persistent discomfort, a baby that is hard to settle
Hilary's specific training
Hilary Farid completed specialised training at the Centre YGY (Catherine Rybus, Paris) — a national reference centre for perinatal and paediatric osteopathic care. This training specifically covers the assessment and treatment of dysfunctions linked to restrictive oral ties, sucking difficulties and infant oral mechanics.