Tongue Tie and Bottle-Feeding: What Parents Can Try
Most information about tongue tie focuses on breastfeeding. But many families bottle-feed, whether exclusively, alongside nursing, or with pumped milk, and they have questions too.
The good news is that many babies with tongue tie bottle-feed well. Bottle-feeding asks the tongue to work a little differently than breastfeeding. Still, some babies find it challenging, and small adjustments can make a real difference.
Signs bottle-feeding may be a struggle
These signs are reasons to try adjustments and talk with your baby's care team. They don't mean your baby has tongue tie, because each one can have many causes.
Milk leaking from the corners of the mouth
Clicking sounds during feeds
Gulping, coughing, or sputtering
Swallowing a lot of air, leading to fussiness or spitting up
Tiring quickly or falling asleep before finishing
Feeds that take a very long time
Pulling away, arching, or seeming frustrated
Fussy and gassy after feeds
Strategies parents can try
Check the nipple flow. A flow that's too fast can overwhelm a baby, causing gulping and coughing. A flow that's too slow can tire them out. Nipple "levels" aren't standardized between brands, so the same level can vary.
Try a different nipple shape. Babies have preferences. Some do better with a wider base, as they can latch on easier. Changing one thing at a time helps you see what works.
Feed in a more upright position. Holding your baby more upright, with the bottle closer to horizontal, gives them more control over the flow.
Try paced bottle-feeding. Paced feeding lets your baby set the rhythm. Start by letting your baby draw the nipple into their mouth rather than pushing it in. Keep the bottle roughly level so milk doesn't pour, and offer short breaks every so often by tipping the bottle down. Watch for cues that your baby needs a pause, like slowing down, widening eyes, or milk spilling out.
Support your baby's body. A calm, well-supported baby often feeds more easily. Make sure your baby's head, neck, and body are aligned and supported, and that they're not too tense or too floppy.
Burp along the way. Short burping breaks can help babies who swallow a lot of air.
Watch the clock gently. If feeds routinely take much longer than expected, mention it to your pediatrician. Long, tiring feeds can be a sign your baby needs more support.
When to call your pediatrician right away
Contact your pediatrician promptly if your baby isn't gaining weight as expected, has fewer wet diapers, is hard to wake for feeds, coughs or chokes often during feeds, or has trouble breathing while eating.
When to reach out for feeding support
If you've tried adjustments and feeds still feel hard, you don't have to keep guessing. Your pediatrician can check for medical causes and make referrals. A lactation consultant can help, especially if you're combining breastfeeding and bottle-feeding.
An occupational therapist can observe your baby during a bottle-feed and look at how they use their mouth and body, including oral-motor skills, posture, muscle tension, and suck-swallow-breathe coordination. An OT doesn't diagnose tongue tie, but can share observations with the provider evaluating your baby.
If bottle-feeding has become stressful, contact us to learn about infant feeding support.
