I have taken the Tethered Oral Tissue Speciality Training course (TOTS) along with numerous other courses related to tongue and lip ties, feeding, and oral motor function.  

For professionals interested in learning more about TOTS and the role of therapy/lactation in managing these issues, I have also created a continuing education course available on the Lactation OT website, geared to therapists working with tongue tied infants.  For more information, click here.

After seeing many babies both before and after tongue tie and lip tie release procedures, I have come to understand how important collaborative care is for these children.  If you go into a frenotomy expecting a “quick fix,” you may be disappointed.  Release providers who are well versed in tongue and lip ties and how these impact feeding usually refer their patients to a therapist or lactation specialist before or after a release procedure.

A therapist trained in feeding and TOTS is able to look at feeding in a holistic manner and consider the entire picture of function.  Often, feeding problems are not just related to tethered tissues.  Sometimes, a tie is merely one piece of a larger puzzle.  Other factors, such as muscle tone problems or torticollis, can play an important role.  If issues like these are overlooked, you may not get the results you are hoping from a frenotomy. Starting therapy before a procedure can be beneficial, especially if other factors are impacting feeding.  For more information on why pre-frenotomy therapy may benefit you or your child, click here.

What does therapy before and after a release do?

A therapist evaluates oral function, body alignment, and other factors that may be impacting feeding.  If you are scheduled to have a frenotomy, requirements for aftercare are reviewed and taught.  Regardless, strategies to improve oral motor skills and overall function are covered.  By working on building new muscle memory and improving function before a procedure, your baby may pick up on new patterns faster afterward.  If your child is older and anxiety may play a role in cooperation with aftercare, working with your child so he/she is accustomed to oral care prior to the frenotomy is very helpful.  Therapy after  a frenotomy focuses on improving oral motor skills, including coordination, strength, and endurance, along with guidance on wound management.

If you are breastfeeding, a lactation assessment is strongly recommended before a frenotomy.  There are numerous issues related to milk supply, transfer at the breast, nipple pain, etc that may not be related to a tongue tie.  It is important to look at the "big picture" to resolve breastfeeding problems.  A release procedure is only one part of the puzzle, even for tied infants.

Some signs/symptoms that indicate tethered oral tissues may be impacting feeding:


  • Consistently painful or shallow latch, despite working on technique and positions

  • Clicking when sucking, air intake, reflux

  • Falling asleep quickly at the breast

  • Baby always seems hungry; excessively frequent feedings

  • Lip blisters and poor lip flange

Bottle feeding

  • Clicking when sucking

  • Spilling from corners of mouth when drinking

  • Excess air intake when feeding

  • Feedings take in excess of 30 minutes

Older children:

  • Gagging and vomiting when attempting to manage foods, even though seems interested in food

  • Difficulty chewing

  • Seems to swallow foods whole

  • Constipation (related to poor chewing) or other GI difficulties

  • Pushes foods in mouth with chewing or seems to move head a lot when attempting to chew

  • Spits foods out frequently

  • Prefers soft/mushy foods

  • Protrudes or thrusts tongue when chewing or swallowing


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(337) 282-8703

(337) 918-3249 (fax)

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