Why the Hospital Won't Tell You Your Baby Has a Tongue-Tie (And What to Do Instead)
A Quick Note from Cheyenne
I’m excited to share something a little different on the blog! This post was written by my friend and colleague, Bethany Lovern, whose expertise fills a gap that comes up often in the birth and postpartum world but isn’t my area of expertise.
Bethany brings her perspective as a Speech-Language Pathologist and Certified Breastfeeding Counselor to a conversation I know a lot of families find themselves navigating. I’m happy to make space here for her knowledge and hopefully give families another place to start when feeding just doesn’t feel quite right.
You left the hospital with a baby and a lot of unanswered questions.
Breastfeeding hurt. The latch felt shallow. Your baby worked hard at every feeding and came off the breast not quite satisfied. But when you asked the nurses or the hospital lactation consultant, you were told things looked okay. Maybe a pamphlet. Perhaps a nipple shield. Or a recommendation for a free breastfeeding class.
Now you are home, still struggling, wondering why the hospital missed tongue-tie entirely when something clearly felt wrong. Here is the honest answer.
It's NOT Incompetence. It's Policy.
The hospital lactation consultant you saw may have been excellent. Many of them are. But she was working inside a system with very specific rules about what she was and was not allowed to say.
The word "diagnose" is legally reserved for physicians, dentists, and ENTs. Hospital lactation consultants, even highly experienced ones, are not permitted to use it. So even when an experienced hospital LC can clearly see a posterior tongue-tie affecting feeding, she cannot say "your baby has a tongue-tie."
She can say the latch looks shallow. Frenulum involvement might get noted in a chart. A recommendation for a follow-up appointment might be made. But the words your family needed to hear, the ones that would have given you a clear direction, are not words she was allowed to say in that setting.
That is not negligence. It is protocol.
Knowing this does not make it less frustrating. It does, however, change how you think about the gap between what you were told and what was actually happening in that hospital room.
The Referral Problem No One Mentions
There is a second layer to this worth understanding. Hospitals run their own outpatient lactation programs. Free classes, follow-up appointments with employed consultants, support groups. Those services exist inside their system, and there is institutional pressure to keep patients within it.
Sending a new mama to a private lactation consultant, certified breastfeeding counselor, or SLP outside the hospital network bypasses that structure. So typically, that referral does not happen. Families get sent back to the free class instead.
The free class is not bad. But it is a group setting, not an individual assessment. A class cannot watch your specific baby feed, assess your baby's oral motor function, or tell you whether a tongue-tie is affecting milk transfer in your particular case. For a family dealing with a functional feeding issue, a group class is simply the wrong level of support.
What Gets Handed Out Instead
One more piece of this worth naming. Hospitals receive free products from formula and infant care companies. Pacifiers appear in the newborn take-home kit. Nipple shields get handed over when a latch is not working, often without detailed guidance on how to use one, how to wean from one, or what to watch for while it is in use.
These things are not always wrong. A nipple shield can be genuinely helpful in specific situations with proper follow-up. But when they are given without a clear clinical reason and without a next-step plan, they manage a symptom rather than address its cause.
A tongue-tie that is not identified does not improve because a nipple shield is added. The underlying restriction remains.
What a Functional Feeding Assessment Actually Looks At
This is where things change. A hospital latch check is typically a visual observation. A provider watches the beginning of a feeding and notes whether things look reasonable from the outside. A functional feeding assessment is something entirely different.
As a Speech-Language Pathologist with a master's degree and a Certified Breastfeeding Counselor, my clinical scope covers both oral motor function and feeding. That means looking at what is happening inside the mouth, not just what the latch appears to be from across the room.
Tongue movement. Jaw function. Palate shape. Whether the tongue elevates, cups, and creates the peristaltic wave that draws milk efficiently. Whether baby is building and maintaining suction or compensating in a pattern that works short term but costs both of you in the long run. A tongue-tie is not always visible. Posterior tongue-ties in particular may look unremarkable in a quick glance at the frenulum. What surfaces in a functional assessment is how the tongue actually moves and what it cannot do.
Because of my dual clinical background, I can document clinical findings formally. When a functional evaluation supports a frenectomy referral, I can provide that referral along with the clinical documentation a specialist needs to move forward. That is a capability the hospital system cannot offer, regardless of how skilled its individual providers are.
If you are starting to wonder whether a tongue-tie has been part of your picture all along, the free Tongue-Tie Symptoms Guide is a helpful first step. For families with cost questions, this post on what a tongue-tie evaluation in Indiana actually costs covers the full range, including FSA, HSA, and superbill options.
What to Do When Something Still Feels Wrong
You do not need a hospital referral to see me.
If you left the hospital with unanswered questions, if feeding is still painful, if your baby is working hard and not transferring well, or if your gut says there is more going on than you were told, that feeling is worth following.
Start with the free Tongue-Tie Symptoms Guide and note how many signs feel familiar.
Then seek a functional feeding assessment. Not a class. An actual evaluation with a provider who can assess oral motor function, perform a weighted feed, document clinical findings, and hand you a clear next step before they leave your house.
For families whose baby had a tongue-tie revision and feeding still has not improved the way they expected, this post on tongue-tie recovery time covers what the post-release period actually requires and why that work matters.
And if your baby was never flagged at all but something has always felt off about how they feed, this post on lip tie vs tongue-tie can help you understand what the different restrictions look and feel like.
Bethany Lovern serves families in Brownsburg, Avon, Plainfield, Zionsville, Danville, and the westside of Indianapolis.
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