April 22, 2025
Why Tongue Function Matters: Podcast Episode #287
Kaili Ets and Kristin Revere discuss why tongue-tie release is just one piece of the puzzle regarding tongue function. Kaili is the founder of Kaili Ets Family Wellness.
Hello, hello! This is Kristin Revere with Ask the Doulas, and I am thrilled to chat about tongue function and why it matters for infants, with Kaili Ets of Kaili Ets Family Wellness.
She is a seasoned pediatric occupational therapist, infant craniosacral therapist, holistic sleep, and reflux specialist, who has also done extensive training in tongue ties.
Kaili is also a mama of two. She is lovingly called the holistic baby guru and is known for handling the more complex cases and really diving deep into the root cause when she supports her clients, whether it’s body tightness, compression, reflux, tongue dysfunction, or possible tongue ties, sensory processing differences, or reflux issues. She is obviously the guru with all of her extensive trainings and her specialties.
She is here to simplify your search, answer questions, and take you on a journey to understanding not only your baby and child, but also yourself on a whole new level and help you both thrive.
Welcome, Kaili!
Thank you so much for having me! I’m so excited to be here, and I can’t wait to chat about this topic that I’m super passionate about!
Yes! And as birth and postpartum doulas and with a team of lactation consultants as well, we do run into a lot of questions from families about tongue function. I’m thrilled to have your expertise in this discussion and how it may not always be a tie. I feel like now with education and information compared to when I started as a doula 12 years ago, everything almost goes to that assumption of, “Oh, it’s a tie. It’s a lip tie or a tongue tie.” I’d love to hear your thoughts!
And this is the thing, right? I feel like tongue ties are the new trend going on right now. But the more you learn about it, the more you start to realize that it’s not always just a tongue tie, and this is why I have a lot of clients who will go and get a tongue tie release and nothing changes. And then they’re even more frustrated. So I kind of want to start a little bit from the basics of why we’re even worried about the tongue.
The tongue is such a key player in feeding, breathing, swallowing, digestion, speech, overall posture, and even sleep. When a baby struggles with any of these, especially when we see early feeding difficulties, whether it’s at the breast or the bottle, or maybe a little bit later on with intro to solids, it’s easy to assume that the tongue tie is to blame. In reality, tongue dysfunction can happen for so many different reasons. And so a restriction of the frenulum – the frenulum is that little “string” of fascia under the tongue – that can limit mobility. Other factors can limit the tongue function. So it could be because of a too short or too tight or too thick frenulum under the tongue or one that’s way too far forward and it’s affecting the ability of the tongue to make all of the movements. But here’s the thing: body tightness or fascial restrictions – fascia is a connective tissue that is over all of our muscles and organs and nerves and everything in our body, and it’s like the white piece on raw chicken that you try to cut off, and it’s so hard to cut off. That’s fascia, and it protects everything underneath. It’s really good at protecting, but not so good at releasing.
So sometimes it’s fascial restrictions, and there’s a front line of fascia that connects from the tip of the tongue all the way down the neck through the diaphragm area in the stomach, through the hips, all the way down to the tip of our toes. And if there is tension anywhere in the body along that deep frontal line, whether it’s from in utero positioning or birth or something like that – it can actually restrict how the tongue moves. So it might have nothing to do with the lingual frenulum, which is that little “string” under the tongue. This is why sometimes when we release a “tongue tie,” it doesn’t really do anything, because the tongue is still not working because of other tightness.
And the tightness could be trauma from birth or a variety of issues?
Exactly. And then the next layer of that is that the tongue actually relies – sometimes it’s the tongue that’s not working properly. Sometimes it’s the cheeks that aren’t doing what they should be doing. Sometimes it’s the lips that aren’t doing what they should be doing. So it’s kind of like all of them work together. But cranial nerves are another really important piece of tongue function, and that’s something where people are like, what? But if there’s compression, if there’s any cranial bone molding from birth or in utero positioning – when babies come out, they often have those cone-shaped heads. You’ve got some overlapping of the different bones in the head. That molding, that cranial molding, if it doesn’t kind of come back into that nice, round shape – even flat head syndrome can also affect cranial nerves. It compresses the nerves because there’s a lot of nerves that come through the back of the cranial bones, and if those get compressed or squished, then the nerves are going to get compressed, and then the nerves are not doing what they need to do in order to make the tongue work properly. And so it could be because of those bones in the head. It could also be because of tight jaws or a recessed jaw, which often a lot of babies have. That’s again putting pressure on those nerves, meaning that then those muscles are not working the way they need to work.
And the other piece is that when the tongue is restricted – and by restricted, I mean it’s not working well. It’s not doing what it should be doing. Babies often develop habits like clenching their jaw; maybe they’re doing something weird with their lips to purse their lips, or they start chomping because they’re not actually using their tongue properly, but they have to figure out another way to get the milk out. So they then develop all these compensatory patterns, which then just makes everything even harder, also.
So, really, this is why tongue tie releases are sometimes very necessary, but they’re really one piece of the larger puzzle. So this is why we really need to understand more of what is a tongue tie, what is not a tongue tie, what else could be affecting the tongue function, because it’s not always a tie.
Obviously, from everything you explained, there are so many other conditions. And we have a craniosacral therapist in the area that does a lot of infant work, and it’s amazing to see the difference in everything from sleep to temperament to reflux.
Oh, my gosh, don’t even get me started on all of that. Reflux really is increased air intake. That’s one of the main causes of reflux. Why are babies getting air while they’re feeding? Probably because their tongue is not working properly. Maybe that’s because of a tongue tie, but maybe it’s because of something else. Body tightness is a huge piece of the puzzle, and that’s often something that gets overlooked in tongue tie releases. Pediatricians and dentists are not really thinking about body work, to be honest here. Some of them know about it, but some of them really don’t. And some of them are all about, “Your baby has a tongue tie. Let’s do the release and you’re good to go.” And no, you’re not good to go! They’re so much more involved!
But even when you have a tongue tie release or when you release the tightness, for example, that might be causing the tongue dysfunction – fine, then you have a tongue that works better and has more range of motion, but guess what? That tongue still doesn’t know what it needs to do. We still then need to strengthen the tongue in all of the different ways that it should be working and moving. So for example, lots of families that I work with, their doctor will be like, oh, no, your baby can stick their tongue out. It’s not a tongue tie. Their tongue is fine. And you’re like, okay, but sticking your tongue out is not actually what we need for good, efficient feeding. We need that tongue to be around the nipple of the breast or the bottle. We need that tongue to be elevating up to the palate. We need the tongue to be doing that peristaltic, kind of wave-like motion in order to really efficiently create that vacuum seal and extract the milk. And all of those pieces are reliant on, A, the tongue having that range of motion, but also that tongue being strong enough in all of those different movements to be able to feed efficiently.
And what happens is when we have a restricted tongue – so whether it’s because of a tongue tie, whether it’s because of body tightness – and that often happens in utero – the baby has had many months of not using this tongue properly to swallow in utero, and then they come out and they’re born, and they’re using all of the same compensatory patterns that they were using in utero. Now we have this baby who has tongue dysfunction and has no clue how to use their tongue properly. And when we release that tongue – let’s say it really is a tongue tie because of a frenulum that’s too tight or too short or too thick or too far forward – the doctor or dentist releases that and there’s more range of motion, but that tongue still needs to be rehabbed or retrained on how to work properly.
With a knee surgery, you don’t just expect that, oh, yeah, you had your surgery. We put the knee orthotic or prosthetic in place or whatever it is, and now you’re good to go. No, no. You get sent to many weeks of physical therapy to strengthen the knee and get it working properly and get the muscles to be really doing what they need to be doing and stretching things that are tight and strengthening things that are not strong enough. It’s the same thing! The tongue is also a muscle. But actually, the tongue is eight different muscles, and we need to strengthen all of those muscles and teach them what we want those muscles to actually do. And that’s a big missing piece in this whole tongue tie world that we have right now where families will go and they’ll get an assessment and the dentist will be like, yep, there’s a tongue tie. Let’s release it today.
And because families don’t know any better, they think that this is the magic pill. It’s going to solve all their problems. They get the tongue tie release. They do their wound care stretches. And then that’s it. And their issues still don’t get resolved. Maybe some things improve a little bit. Overall, they’re like, what is going on? Why didn’t that work? And that’s because we have to retrain the tongue. We have to do some oral motor therapy to get everything working properly. And that’s really something that I support with, but it’s something that I feel like dentists and pediatricians just don’t quite get.
That makes sense. My son actually had a tongue tie, and there weren’t a lot of pediatric dentists in my area who offered laser at the time. So I went through a doctor, and it luckily worked. We had exercises that seemed to be more than basic wound care, but I was struggling with that clicking sound during breastfeeding and pain. My children are 21 months apart, so I knew that it wasn’t normal. At the first pediatrician appointment, she recognized that there was a tongue tie. So we acted quickly, and then by following the exercises, it worked. But it sounds like that isn’t something that’s standard care?
Right. I think that we’re moving in that direction more so. I think there’s still a lot of pediatricians and a lot of pediatric dentists who don’t really understand that the tongue tie release is just one piece of the puzzle. So I think that you really lucked out. That sounds great. That’s exactly what we ideally want. Ideally, you want a provider who, first of all, is going to do a comprehensive assessment of what that tongue is actually doing. And looking inside the mouth or looking to see that the tongue is sticking out is not a comprehensive assessment to see what the function of the tongue is. That’s really what we care about, the function of the tongue. You can have tightness in the tongue and that tongue is still doing what it should be doing, in which case the tongue tie release is not needed at that moment. We really want to look at the function and not just the structure or what it looks like. And this is why with a comprehensive assessment, you really want your provider to have their finger in your baby’s mouth, feeling the tongue and what is it doing, is it moving, how is it moving, is it cupping, is it moving up to the palate, where is it restricted. What’s going on inside the mouth? We can’t look at that and understand.
And I think a big piece too is that body work. Craniosacral therapy is an amazing piece of the puzzle also for tongue function, and I think that can really help set up families, if they have access to it, for potentially a more successful tongue tie release as well, if that is needed.
But a lot of the time, like you mentioned before, craniosacral therapy can do a lot of improvements just from a few sessions without ever having considered the release. And the tongue tie release will only work – “work” – if it’s actually the lingual frenulum that’s the tight part. Too short or too thick, and that’s the part that’s causing the restriction. If it’s these other things that I mentioned earlier, like the body tightness elsewhere in the body or the cranial nerve compression – then the tongue tie release is not going to fix the problem.
I see both sides of the coin. I see some families who get the release done and they have a similar experience to yours where they had a good provider, it sounds like, and things are great and they saw a lot of improvements. And then I have the families who didn’t know, and so they just got a release because their dentist or whoever they want to see said, yep, your baby has a tongue tie. We need a release. Here we go. Let’s do it. And they don’t see any improvement.
Now, the other thing that I see a lot is where families will come in and say, oh, my provider told me that it’s nothing to worry about. It’s just a mild tongue tie. I hear that all the time. And I’m like, here’s the thing. How can it be a mild tongue tie? It’s either that the tongue tie is there, or it’s not. Everybody has that lingual frenulum under the tongue. Everybody has it. We need that. And it actually does regrow after you have it released. We just want it to grow in a more flexible, kind of stretchy position. But everybody has it. That’s what helps your tongue stay kind of grounded to the floor of the mouth so it’s not flopping around in your mouth. We need that for stability in our mouths.
So this is the other piece where it’s like, how do you qualify mild? It’s either causing dysfunction and that frenulum is too tight or too short or too thick or too far forward, and that’s the thing that’s causing dysfunction – or it’s not causing dysfunction, and then it wouldn’t be considered a tongue tie because there’s nothing to worry about and everything is working fine. So that’s the other piece of what I see. I see families getting dismissed. And this is the piece, too: I wish those doctors or pediatricians who are saying, oh, no, it’s just a mild tongue tie – what they’re actually saying is, I don’t see too much tightness in that lingual frenulum, or it’s moving well or it’s stretchy or whatever it is; it’s long enough. They have their own assessment for the actual lingual frenulum. But what they’re missing is, okay, that tongue is still not working well, and they’re missing the piece of why else would it not be working well?
That makes sense. And as you mentioned before, they may not have enough awareness to refer to a craniosacral therapist or other specialist. Or it’s just, I guess, an easier fix to go the route of, it’s either a tongue tie or it’s not, and move on. Of course, we’re limited in time with our medical professionals. They may have awareness and referral sources, but things are stretched. So I love that you’re educating not only on your own podcast but also podcasts like Ask the Doulas, so families can advocate for themselves and understand all of their options when it comes to tongue function and anything from sleep issues to colic to feeding issues, like I experienced pain in breastfeeding.
Exactly. And I think the other piece that’s important to know is that tongue ties and tongue function are not thing that are taught in regular curriculum for pediatricians, for pediatric dentists. Even for lactation consultants, occupational therapists, speech language pathologists, physical therapists, whatever – it’s not taught in the standard school curriculum to become a doctor or a dentist or an occupational therapist.
Really, this tongue function piece and this tongue tie piece is separate professional development that you have to do on your own because you’re passionate about it. And this is where, unfortunately, I feel like doctors – I’m in Canada, and I hear all the time that doctors dismiss families for a variety of reasons because they just don’t know. They’re not admitting to the fact that, well, I don’t know; maybe you should go see XYZ person. They’re not making the appropriate referral.
This is also why sometimes you hear your provider say that tongue ties aren’t actually a thing and that’s just a fad. Or they’ll outgrow it; don’t worry. Or for lip ties: oh, don’t worry. Eventually, your toddler is going to fall, and that lip tie is going to get cut. Oh, my gosh. This is not what we should be telling families! That’s really not helping the situation in that moment.
Right, and it can affect speech later. There are so many issues!
So many issues! The thing also with the tongue and the tongue function is that we want to remember that our optimal resting posture for good airway openness and patency, breathing, and all of that airway stuff, but also dental arches and development and palate and all of that – having our tongue up to the palate, resting just behind our top gumline; our gums or teeth slightly apart, and our lips closed. The amount of babies that I see these days who have their mouths hanging open and drooling all over the place and not feeding well because they’ve got all the milk spilling out because their lips aren’t working; their tongue isn’t working. There’s just so much going on with our babies in terms of tongue function but also just overall body function.
But that is our optimal resting position, and having that mouth closed and that tongue up to the palate is what is going to help develop our palate. It’s going to help with our breathing and eventually our sleeping, as a result. If we’re mouth breathing during sleeping, we’re not getting into a deep sleep. There’s so many different things. If we’re mouth breathing, we’re more chest breathers instead of deep belly breathers, which means that we’re also going to be more in a heightened state of arousal, like that sympathetic arousal state, which means that we’re going to be more sensitive and potentially with a higher needs temperament and more fussy and prone to going from zero to sixty.
You mentioned the tightness, and there are so many things to look for. It sounds like seeing a craniosacral therapist, addressing any concerns with the tongue, and then certainly doing exercises and stretches and making sure that tongue placement is correct, because there are so many issues with mouth breathing. Our sleep consultants and overnight doulas address a lot of the sleep concerns, and we are referring to craniosacral therapists and infant massage therapists. There are so many different treatments beyond seeing a pediatric chiropractor, for example, to recommend.
Yeah, exactly. There’s so many symptoms that you can see. I don’t know if you want me to go through some of the signs that might indicate that there’s tongue dysfunction going on and there’s something going on with the tongue, whether that’s tongue tie or something else.
That would be great.
There’s definitely things like shallow latch, slipping off the nipple of the breast or the bottle; short, frequent feeds; falling asleep during feeds. I know feeding to sleep is definitely a thing. I did that with both my kids. But when your kids are falling asleep shortly after the feed starts, often it’s because they’re so exhausted. They’re working so hard to try to get that milk out, and they fall asleep as a result. Also, a big red flag is if they feed better when they’re asleep or half asleep. That’s another piece that I’m always kind of asking families about. Any of that clicking, milk dribbling out the side. Also reflux, that excessive gassiness, or those babies that have the hard bellies. That means that there’s more air in there. Also, obviously, if Mom is having some difficulties in terms of nipple pain or blisters. That means the baby is often chomping or clamping instead of sucking properly. Then we also have, like I mentioned, that open mouth posture. When they’re sleeping, if their mouth is open, but also if they’re just kind of awake, it rests. So they’re not babbling or crying or eating or anything like that, if they’re just kind of hanging out, that mouth should be closed.
Even things like snoring, noisy breathing, those are all little red flags that something is going on with the tongue potentially because we shouldn’t really be noisy breathers. Everybody thinks it’s so cute when babies are snoring, but actually it’s not. Yes, I know it’s cute, but if you only knew that that means that there might be something more going on. Even frequent night wakings. Sometimes that’s because they’re not getting a full belly or because they have the gassiness or because they have the reflux. All of those are symptoms of something and might mean that there’s tongue dysfunction going on.
Gagging or choking on milk, or eventually when they start solids – if we’re getting a lot of that consistently, or they’re not progressing in their solids ladder from purees to more solid food and chunks and all of that – if they’re having difficulty progressing, then that could be a sign that there’s something going on with the tongue as well.
Of course, later on, there’s delayed speech or difficulty with certain sounds. If your baby has a high or narrow palate, that’s going to be an indicator that the tongue is not getting up to the palate the way it needs to be. It can later on lead to things like dental and orthodontic issues. This is why a lot of people probably have their braces because we just are running out room in our mouths. Why are we running out of room in our mouths? Because the tongue is not doing what it’s supposed to be doing. And also because our diet has changed a lot. There’s lots of different things.
So those are some of the main ones. There’s so many more, but those are some of the main ones that I really make sure to ask families that I’m working with. I like to just know the big picture. Just like I ask about their birth and their pregnancy and all of this stuff, I really want to understand what is going on with this baby and with this family.
Right, that makes sense. And then for babies who prefer to feed on one side, that would also be something to look out for?
Exactly, and that’s also telling me that there’s some body tightness going on. Why do they have that preference for one side? Often, also, if they have the head turning preference and then they have that preference for feeding on one side – and a lot of times, moms are like, well, I have more milk on this side than that side. But you’re like, okay, but why? It’s interesting, right? If your baby is not using their tongue properly, then yeah, your body is going to start thinking, well, I don’t really need to be making or producing more milk. That’s another piece. A lot of times, moms will think it’s something to do with their supply, but it’s actually their baby who is not efficiently sucking and extracting that milk. Talk about why that’s happening.
For centuries, we’ve been doing this, right? Evolution has figured out, how do we make this all work. And when it’s not working, we really need to get curious.
Exactly, and find the root cause and not the quick fix, like a tongue tie revision.
And maybe you are doing a quick fix initially. For example, babies with reflux. Sometimes, the reflux medication is really helpful and is needed. However, that should not be the end of the story. That should be like, let’s put your baby on this medication so that they’re not in so much pain and discomfort while we’re trying to figure out what is causing the reflux.
Excellent point. We are running out of time, but I would love for you to share a little bit more of your wisdom. Any final tip for our listener?
Realistically, my one tip always for families is to trust your instincts. If something isn’t feeling right, whether it’s feeding struggles or you’ve got sleep issues or you think your baby has some tension in their body – it’s worth exploring that. And it’s worth finding or looking for a provider who really understands the whole picture and understands function and all of that. That’s a big piece that I kind of want people to take away. But I also want people to understand that it’s not just about whether it’s a tongue tie or not. Really get your finger in your baby’s mouth and see what that tongue is doing. Do they suck on your finger? If they can’t even figure out how to suck on your finger, guess what: they’re not sucking on the nipple of the breast or the bottle. They’re not extracting the milk well. Why can’t they suck? That’s what you then need to figure out.
That makes perfect sense. And so as far as how to work with you directly, you mentioned before that you’re in Canada, but you also offer other ways to work with you.
Yes, I have lots. My website is a good place to start. You can also follow me on Instagram @theholisticbabyguru. I also have my podcast, Mothering From Within. I’m on YouTube. Both of those places are going to be talking all about baby development and sleep and looking holistically at the root cause of things. And then I also wrote a book called Mothering From Within, and it dives deep into all these things as well.
So there’s lot of opportunities. I do offer virtual international sessions, as well, if you really want to pick my brain a little bit more about your specific situation. But there’s lots of free and lots of really cost-effective ways to get my wisdom.
Beautiful. And how can our listeners find your book?
It’s on my website, but it’s also available through Amazon. That’s probably the easiest. You can also go to an online bookstore like Barnes and Noble, or if you’re in Canada, then the Chapters Indigo. But Amazon is usually the easiest. Unless you want a signed copy; then you can order through me.
Love it! Well, thank you so much, Kaili! We’ll have to have you on to address another topic in the future.
Totally! I love talking all about babies and toddlers and all the things!
You are amazing!
Thank you so much for having me today!
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