How to Take Proper Pictures of a Lip and Tongue Tie

harlyn (1)

Continuing advances in technology help us share anything imaginable.  Smart phones are getting smarter and social media is molding seamlessly into our lives.  In the world of tongue and lip ties, technology has helped many moms with limited access to help and support.  Therefore, it is common for parents to seek help from Facebook support groups as a means to figure out if ties could possibly be part of their problems. Consequently, my news feed is full of close up pictures of oddly stretched babies mouths with the frequent query, “Is this a tie?”

Visual assessments of photos can help screen for ties but there are limitations.  An orthopedist can see a picture of a bone sticking out of an arm and make a general assessment of a “broken arm”, but would still need to collect more information to arrive at the proper and specific course of treatment and management.  Same with ties.  One can suspect a tie from a picture, but cannot determine function unless a feeding evaluation has taken place.  A proper functional exam is key to an optimal diagnosis.

When the provider is a long distance away, having a good visual assessment prior to making the long trip is important for reassuring the parents that their time and gas money is well spent. The following is a step-by-step tutorial describing my way of taking pictures.  I utilize this this technique primarily for record keeping, communicating between lactation specialists, and even presentations.

What you will need:

1. Camera or smart phone – Nowadays, any iPhone, Samsung, Motorola or other smart phone will work very well.

2. Two people – One person to take the picture and the other to lift lip and tongue.  I see a lot of one person/one handed pictures using the thumb to barely lift the lip.  This is insufficient.

3. Good lighting – Any professional photographer can attest how lighting can affect the quality of a photograph.  Just make sure the surrounding light is not too dim.

4. Swaddle or blanket – This will help minimize your child’s movement which may affect the ability of the camera to focus.

Camera Tips:

Tip 1: The most challenging part of getting a high quality image is the ability of the lens to focus.  Less movement of BOTH the camera and the baby will allow the camera to focus better.

Tip 2:  With iPhones, the “focus lock” feature may help if the baby moves a lot.  Hold your finger in the center of the screen for a couple of seconds and a yellow focus box should appear.

Tip 3:  If taking photos isn’t turning out so well you can record a video instead and then screen shot the part of the video that displays the best image.

Step 1: Wrap your baby up.

For younger babies, wrapping up in a swaddle helps keep their arms out of way and minimizes any unwanted movement.  This may help the camera focus better.

For older infants it’s best to secure body with a larger blanket.

Step 2: Position yourself for optimal viewing

A. Treharne eval 2

You may lay your baby flat on a bed, changing table or between your legs on the floor- whichever seems most comfortable.  The person doing the lifting of the lip and tongue needs to be positioned behind the baby’s head (as if you’re a dentist) so when they look down, the baby is upside-down.  The photographer needs to be forward facing with the camera as perpendicular to the baby’s face as possible.  Avoid capturing really low, high or slanted angles as it can create distortion.

How to take a picture of the lip:

Using both index finger, FLIP the lip up to the nose.  You may find it easier to use a “pinching grasp” as shown below.  Use your other fingers to help stabilize the jaw, chin and any head movement.  Try to get the outer skin of the upper lip to touch the nostrils as seen in the picture below.  Both light and dark pink zones of the gums should be in view when properly lifted.
lip for blog

How to take take a picture of the tongue:

Using both index fingers, press deeply into the floor of the mouth (that squishy area underneath the tongue) and lift up as high as you can.  Your two fingers should be no more than 1/2 inch apart.  While hold the tongue up, use your remaining fingers to push down on the lower lip and chin area.  This helps to expose the area better as well as stabilize and minimize head movement.

Keep in mind that there are different types of tongue ties so the less obvious posterior ones really need to have the tongue filly lifted in order to assess visually.  In most posterior tongue tie cases, I cannot give a good visual assessment based on the appearance from crying alone.

Tongue for blog

For more information please check out

A Mom’s Journey

Click below to read about a mom’s story:

Breastfeeding Struggles: Tongue & Lip Tie

The Triad for The Dyad

Triad for the Dyad final.png

I find it very important to focus on a comprehensive approach when it comes to treating ties. A few years back I heard Dr. Bobby Ghaheri speak about ties. He said something that was really eye opening to me and it was this…”Breast-feeding is a fundamental part of an infant’s life. If something is wrong with this instinctive behavior, then the baby must compensate in a way that forces them to biologically change.” This statement summarizes the complex nature when it comes to ties.

In most cases it truly takes a dedicated team of hardworking professionals to get the baby back on track. In the depiction above, I break it down into 3 main categories: The lactation team, the surgical team, and the bodywork team.

I put the lactation component at the top because this is where it all starts. The International Board Certified Lactation Consultant (IBCLC) has the highest level of training when it comes to breastfeeding care. I look at the IBCLC as the quarterback in determining what needs to be done when breastfeeding is problematic. They truly are the breast (and bottle) feeding experts and should be the first point of contact when breastfeeding problems ensue.

The surgeon component consists of many different professionals, as noted in the diagram. Is there any type of provider in the list that has superiority among the rest? I talked to a close colleague who did a 2 year pediatric dental residency after we graduated. When asked how many tongue tied babies he treated during his residency his answer was zero. I talked to another colleague who is an oral surgeon and asked the same question. How many tongue tie cases did you treat during your 4 year residency? About 10. How many on babies? Zero. As you can see, treating tongue and lip tied infants is not vastly taught. Instead, it requires a passion and desire to help distressed mothers who are having trouble feeding their infant AND a thirst for knowledge that was never taught. This applies to IBCLCs as well.

The third component, the bodywork and therapy, is a very general category of professionals that help with the compensations as a result of ties. Every baby that has feeding symptoms is a candidate for body work. Some babies require a lot of therapy and some may not need as much. I have seen babies improve even more after surgical release when bodywork was done before and after. Babies just seem much more relaxed and balanced after bodywork therapy.

The main point is that when we are dealing with tongue or lip tied babies, one aspect of the team cannot function alone. I am constantly consulting with IBCLCs, SLPs, PTs etc when it comes to the care of an infant. I find the most success when all 3 points of the triad are in sync and streamlined harmoniously. Unfortunately, the system as whole is not set up this way. We may not be there yet, but we’re closer than we were yesterday. If there is no struggle, then there is no progress.