07/21/2025
Tongue tie - Oral Tethered tissues
Class 1 or Class 4? What does it really mean? 👅
When we talk about tongue-tie classification, we’re only talking about where the frenulum is attached — not how severe or impactful it is.
📍 For example, using systems like Coryllos or Kotlow:
• Class 1: Attached close to the tongue tip
• Class 2: Just behind the tip
• Class 3 or 4: Further back toward the base
But here’s the catch 👇
A tie’s location doesn’t tell us how tight, restrictive, or functional it is.
So how do we assess severity?
🔑 We look at:
✔️ Tongue movement — can baby lift, extend, cup, and move side to side?
✔️ Feeding ability — is baby latching, transferring milk, and swallowing well?
✔️ Symptoms — pain, clicking, reflux, gassiness, milk leaking, or supply concerns?
✔️ Function — above all else.
You might see a Class 2 tie that causes no problems at all.
Or a hidden Class 4 that creates major feeding challenges.
👀 Bottom line? A quick look isn’t enough.
✨ Classification = location
✨ Severity = function + impact
If you’re unsure what your baby’s tongue tie means for feeding, growth, or oral development — reach out to a trained IBCLC, pediatric dentist, or bodyworker (Chiro, Osteo, Myofunctional therapist) who gets the full picture. Please note that even as an RN/IBCLC, it is not in my scope to diagnose, but I can certainly see ties often and can lead you to some skilled providers who can assess and release them, if warranted.
Not all providers (doctors, ent, pediatricians, nurses, lactation consultants, chiros, osteos, dentists, etc,) are trained in ties or trained/believe, or see the impact or function of ties in the same way. So this can often miss tongue/lip ties all together, or be told it’s not impacting feeding or oral function. This can certainly be frustrating for moms, babies and families, where function is impacting breastfeeding and milk supply.
Some notice immediate challenges with breastfeeding, others note it, if and when milk supply may decrease and (if) baby starts to lose weight.
Some breastfeed fine with out ties, and others can’t feed at all, or it is too painful for mom. There is truly a lot to consider.
