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Difficulty gaining weightFeedings take too long or seem tiringMealtimes feel like a battle or are stressful for the familySigns of oral motor problems, such as a weak suck, open-mouth posture, or excessive droolingLiquid leaking from the corners of the mouth while suckingRegular coughing or choking during feedsGagging or spitting foods outA very limited list of accepted foodsPain with latch or breastfeeding, even after working on techniqueA suspected tongue or lip tie that may be affecting feeding

A release procedure is rarely a quick fix on its own. Some babies feed well right away, but most need extra support to get feeding on track. Frenotomy works best with a team approach.Therapy before and after a releaseI evaluate oral function, body alignment, and anything else that may be affecting feeding. Building new skills before a procedure helps many babies pick up new patterns faster afterward. If a frenotomy is scheduled, we review aftercare ahead of time, and for toddlers we work on getting comfortable with oral care so aftercare goes more smoothly. After the release, therapy focuses on coordination, strength, and endurance, along with gentle wound care.Why a lactation assessment mattersSupply, milk transfer, and nipple pain can have causes that have nothing to do with a tie, and tie symptoms overlap with other issues. If the tie isn't the true cause, a release may not solve the problem. A full breastfeeding assessment looks at both parent and baby, includes watching a feed, and usually takes 1.5 hours or more.At Flourish, you get feeding and oral motor therapy and an IBCLC lactation assessment in one visit, from one provider.Not sure about a frenotomy?An assessment is a great place to start. Frenotomy is always elective, and families often hear conflicting advice. Tongue tie is a functional diagnosis, so the decision should rest on how your child is feeding, not on how the tie looks. I'll explain what is affecting your baby's feeding, walk through your options, and give you conservative strategies that may help with or without a release.My approach to home programsInfant feeding is its own subspecialty, and more exercises aren't always better. Doing too much too fast can lead to feeding aversion, so I take a "less is more" approach: a focused home program built around your baby and your family, adding activities only as they're helpful.Signs a tie may be affecting feedingBreastfeedingPainful or shallow latch despite work on positioningClicking, swallowing air, or refluxFalling asleep quickly at the breastSeems always hungry; very frequent feedsLip blisters or poor lip flangeBottle feedingClicking while suckingMilk spilling from the corners of the mouthExcess air intakeFeeds lasting more than 30 minutesToddlers eating solidsGagging or vomiting with foods despite interest in eatingDifficulty chewing or swallowing food wholePrefers soft, mushy foods; spits food out oftenTongue thrust, or lots of head movement when chewingConstipation or other GI issues related to poor chewingProfessionals interested in the role of therapy and lactation with tethered oral tissues can find my continuing education course on the Lactation OT website.

Evaluations are generally 90 minutes, but may run longer or shorter depending on complexity. Treatment sessions and follow-ups are 45 minutes to 1 hour. Choose the type of evaluation below to see what to expect.Breastfeeding evaluationA detailed interview and history about the issues you're experiencingOral motor assessment, examining your baby's suck and oral structuresMotor and body assessment, to pick up on any difficulties that may be contributing to feeding issuesObservation of breastfeeding, with help with latch and positioning strategiesPre- and post-feed weights to estimate milk transferReview of a home program tailored to you and your baby's specific needs, plus a written care plan sent by email or text after your visitDiscussion of recommended next stepsBottle feeding evaluationA detailed interview and historyOral motor assessmentMotor and body assessment, to pick up on any difficulties that may be contributing to feeding issuesObservation of bottle feeding, with trials of different feeding tools as neededBaseline weightReview of your home program, plus a written care plan sent by email or secure text after your visitDiscussion of next stepsStarting solids or tube-to-oral evaluationA detailed interview and historyObservation of a feedingMotor and body assessment, to pick up on any difficulties that may be contributing to feeding issuesOral motor assessmentTrial therapy to see which approaches your child may respond to best in feeding treatmentReview of your home program, plus a written care plan sent by email or secure text after your visitDiscussion of recommended next stepsTo prepare:Keep track of everything your child eats and drinks for 2–3 days before your evaluation (a food and drink log).If you're coming to the office, bring foods your child easily accepts along with some they refuse or have difficulty managing.Videos of mealtimes at home are very helpful for "slow to warm" toddlers, who may not eat the way they normally do with a new person watching.Pre- or post-frenotomy evaluationA detailed interview and historyObservation of feeding, including everything in a breastfeeding, bottle feeding, or solids evaluationReview of what to expect the day of the procedure and afterwardIf post-frenotomy, review of baby- and toddler-friendly wound management strategies

Evaluations are generally 90 minutes, but may run longer or shorter depending on complexity. Treatment sessions and follow-ups are 45 minutes to 1 hour.Most families are in and out in a few sessions, often just the evaluation and one or two follow-ups. For some, the home program from the first visit is enough. More complex problems, such as weight gain concerns, may need several follow-ups to check that the plan is working and adjust it, and some children make the fastest progress with weekly sessions. We'll decide together what fits your family best.