Tethered Oral Tissues

Tongue Tie

A tongue tie is present at birth. A tight band of tissue tethers the tongue to the floor of the mouth. Tongue ties can affect how a child eats and interfere with breastfeeding.

Lip Tie

A lip tie occurs when the tissue that attaches the gums to the lip is tight. This may make movement of the lips more difficult, leading to open mouth posture, difficulty with speech, or a gap between front teeth. In babies, a lip tie affects breastfeeding by making a deep latch more difficult.

How to identify TOTs

  • Baby’s Signs:

    • Shallow latch at breast or bottle

    • Falls asleep while eating, Slides or pops on and off the nipple

    • Clicking sound while nursing

    • Feeding feels like a full-time job (frequent feeding every 1-2hrs or more)

    • Poor weight gain

    • Milk dribbles out of the mouth while nursing or bottle feeding

    Mom’s Signs:

    • Pain during latching or nursing

    • Flattened/lipstick shaped nipples after feeding

    • Blistered/sore nipples requiring nipple shield

    • Poor/ incomplete breast drainage

    • Blocked ducts or mastitis, Engorgement

    • Decreased milk production

    • Mouth breathing

    • Lips apart at rest

    • Ongoing choking, gagging, clearing of throat, or coughing during meals

    • Difficulty transitioning to solids

    • Aversion or avoidance of all foods in specific texture or nutrition group

    • Difficulty with speech articulation

    • Poor sleep

    • Mouth breathing

    • Lips apart at rest

    • Hyperactive gag reflex

    • Teeth grinding

    • Speech concerns

    • Unrestful sleep - Snoring and/or Sleep apnea