Is it a Tongue Tie? Why Therapy is the Best First Step.

Feeding Therapy for Infants with Oral Dysfunction and Tethered Oral Tissues (tongue tie, lip, and cheek ties)

Feeding your baby is one of the sweetest parts of early parenting, and a right of passage for women entering motherhood. So it is understandably frustrating and stressful when feeding does not go as planned. With tongue tie diagnoses on the rise, it makes sense that families may jump to questioning a tongue tie in these situations. However, a release surgery is not a quick fix, and should never be done without feeding therapy first. This is because, when there are feeding problems, the root of the issue is oral dysfunction. And while a tongue tie may be part of the reason, a release only improves range of motion, and does nothing to address oral function. Therefore, feeding therapy is always a necessary component of addressing infant feeding challenges, but a tongue tie release is not.

Symptoms that Suggest Oral Dysfunction, and Possibly Tethered Oral Tissues (TOTs)

When a baby struggles to latch, tires quickly at the breast or bottle, or shows signs of poor weight gain or reflux, the underlying issue may be infant oral dysfunction—often associated with tethered oral tissues (TOTs) like tongue ties, lip ties, or buccal ties.

Let’s explore how feeding therapy can support babies with oral dysfunction and TOTs—and why early intervention can make a big difference.

What Is Infant Oral Dysfunction?

Infant oral dysfunction refers to the inefficient or abnormal use of the muscles and structures of the mouth and face during feeding. This can affect sucking, swallowing, breathing, and coordination. Signs of oral dysfunction can appear early and include:

• Shallow or painful latch at breast or bottle

• Clicking or popping sounds while feeding

• Dribbling milk or poor milk transfer

• Long, frequent feeding sessions

• Gagging or choking during feeds

• Aerophagia (swallowing air), causing gassiness or reflux

• Poor weight gain

• Tension in the jaw, neck, or body

  
  

What Are Tethered Oral Tissues (TOTs)?

Tethered oral tissues are tight or restrictive frenula—the small bands of tissue under the tongue, upper lip, or cheeks—that limit normal movement. A tongue tie (ankyloglossia) is the most commonly discussed type and can directly impact an infant’s ability to feed effectively.

TOTs can contribute to oral dysfunction by:

• Preventing proper tongue extension, elevation, or lateralization

• Causing compensatory habits like jaw thrusting or nipple chewing

• Leading to muscle tension or fatigue during feeding

• Disrupting the balance between breathing and sucking

While not every baby with a tongue or lip tie will need treatment, many benefit from a team-based approach to evaluate both structure and function.

How Feeding Therapy Helps

Feeding therapy for infants with oral dysfunction and TOTs is tailored, holistic, and often collaborative. A skilled feeding therapist—typically a speech-language pathologist (SLP) or occupational therapist (OT) with infant feeding expertise—can assess oral motor skills, posture, reflexes, and coordination.

Key goals of feeding therapy include:

1. Improving Oral Function

Therapists work on normalizing oral motor patterns, supporting tongue mobility, and helping babies use their mouths more efficiently and comfortably.

2. Optimizing Body Alignment and Tension

Many babies with oral dysfunction also present with body tension or compensations. Addressing whole-body posture and regulation is essential to building a stable foundation for feeding.

3. Preparing for or Recovering from TOT Release

If a release procedure (frenectomy) is recommended, feeding therapy can help:

• Prepare the baby’s body and mouth for better post-op outcomes

• Teach parents pre- and post-release exercises

• Reinforce new feeding patterns and reduce compensations

4. Supporting Parent Confidence

Feeding therapy includes education, emotional support, and hands-on coaching to empower families and reduce the stress of feeding challenges.

The Power of a Collaborative Team

The most effective care often involves a team-based approach, including:

• Feeding therapist (SLP or OT)

• Lactation consultant (IBCLC)

• Bodyworker (e.g., pediatric chiropractor, CST)

• TOTs-aware release provider (dentist, ENT, or pediatrician)

This team works together to ensure the baby is not just structurally released, but also functionally supported—before, during, and after intervention.

When to Seek Help

If you're concerned about your baby’s feeding, trust your instincts. Early support can prevent frustration and set the stage for healthier development. Reach out to a feeding therapist if you notice:

• Feeding that feels stressful, painful, or inefficient

• Inadequate weight gain

• Feeding fatigue or frequent breaks

• Shallow latch or early popping off

• A known or suspected tongue or lip tie

Final Thoughts

Feeding your baby should be nourishing and connecting—not confusing or painful. When infant oral dysfunction or tethered oral tissues get in the way, feeding therapy offers a compassionate, evidence-based path forward. With the right support, babies can learn to feed with more ease—and families can feel more confident along the way.

Looking for support? Nourish Therapy specializes in infant feeding and tethered oral tissues. Carissa is a double board certified Speech-Language Pathologist and International Board Certified Lactation Consultant, with extensive bodywork training, including infant Cranial Sacral Therapy and Myofascial Release. This allows her to serve families in lactation, therapy, and bodywork pre/post frenectomy. Schedule a phone consultation to get started.