Will releasing lip ties, cheek ties, and tongue tie (ankyloglossia) in a 12-month-old baby improve swallowing function?

Swallowing Dysfunction in a 12-Month-Old: Addressing the Real Problem First

The priority for this 12-month-old with swallowing difficulty is immediate videofluoroscopic swallow study (VFSS) to diagnose aspiration or laryngeal penetration, followed by dietary modifications (thickened liquids/pureed foods) that resolve swallowing dysfunction in over 90% of infants within 3-9 months—not releasing oral ties, which lack evidence for improving swallowing function. 1

The Critical Diagnostic Algorithm

Your first step must be VFSS, not frenotomy. Here's why:

• VFSS is the gold standard and identifies tracheal aspiration or laryngeal penetration in 10-15% of infants with unexplained symptoms, directly guiding treatment that works in >90% of cases 2, 1
• The study should test multiple consistencies: thin liquids, nectar-thick, honey-thick, and pureed foods to identify the safest diet 1
• At 12 months, this infant should have developed chewing ability (normally achieved at 10-12 months), and swallowing coordination continues maturing through age 5-8 years 2

Why Oral Ties Are Not the Answer for Swallowing Problems

The evidence on tongue-tie, lip-tie, and cheek-tie release is exclusively focused on breastfeeding difficulties in young infants—not swallowing dysfunction in 12-month-olds:

• Frenotomy studies demonstrate improvements in breastfeeding outcomes only: milk production, maternal nipple pain, and breastfeeding maintenance 3, 4
• Only 5.8% of infants with feeding difficulties required maxillary (lip) frenulum release, and this was specifically for breastfeeding problems 5
• No evidence exists linking oral ties to swallowing dysfunction, aspiration risk, or difficulty with solid foods/liquids at 12 months of age 6, 5, 3
• One study explicitly states that speech difficulties related to tongue-tie are "over-rated" and that mechanical problems (inability to lick lips, perform oral toilet) are the actual indications—not swallowing 7

The Evidence-Based Management Plan

Immediate Actions:

• Proceed directly to VFSS performed by radiology with speech pathology/occupational therapy to evaluate for aspiration 8, 1
• Look for red flags during assessment: choking, coughing, gagging with feeds, oxygen desaturation, recurrent wheezing, chronic cough, or recurrent pneumonias 1
• Remember that 55% of aspiration is silent without cough, so clinical symptoms alone are unreliable 1

Treatment Based on VFSS Results:

• If aspiration with thin liquids is identified: advance to nectar-thick consistency, which reduces aspiration by >90% 2, 1
• If aspiration persists with nectar-thick: advance to honey-thick or ultra-honey-thick consistency 1
• Postural techniques (chin-down posture) eliminate aspiration in 77% of cases when the appropriate position is identified 1
• Spoon feeding reduces aspiration compared to cup or straw drinking 1

Expected Timeline:

• In children without neurologic pathology, swallowing dysfunction resolves in 100% of cases within 3-9 months with appropriate dietary interventions 2, 1
• Repeat VFSS at 3-6 month intervals to document improvement and advance diet 1

Critical Pitfalls to Avoid

• Do not perform frenotomy based on the assumption it will improve swallowing—this is not supported by evidence and delays proper diagnosis 6, 5, 3
• Do not miss aspiration: 13% of infants with respiratory symptoms have swallowing dysfunction on VFSS, and most have silent aspiration 2
• Do not rely on gag reflex assessment—it has limited diagnostic value for swallowing dysfunction 9
• Do not overlook neurologic causes: neuromuscular disorders, developmental delay, and traumatic brain injury adversely affect swallowing coordination and require evaluation regardless of age 2

Additional Workup if Swallowing Dysfunction Confirmed

If VFSS confirms dysphagia, evaluate for:

• Prader-Willi syndrome (molecular DNA testing) if hypotonia and poor weight gain are present 8
• Gastroesophageal reflux via barium swallow, gastric scintiscan, or pH monitoring if failure to thrive exists 8
• Neurodevelopmental assessment including motor, social, language, and cognitive functions 8
• Mandatory referrals to feeding therapy, gastroenterology, speech/language evaluation, and occupational therapy 8

Bottom line: Oral tie release addresses breastfeeding problems in young infants, not swallowing dysfunction in 12-month-olds. Get the VFSS first—it will identify the real problem and guide effective treatment.