It’s a confusing world out there in the pediatric feeding scene. Some voices claim lip and tongue ties aren’t real, while others cite research showing the real dangers of undiagnosed restrictions.
I’ve heard influencers casually throw around terms like “lazy eater,” suggesting that if breastfeeding is hard- well, that’s what bottles are for.
Don’t get me wrong- there is absolutely nothing wrong with bottle feeding.
But dismissing a mom’s desire to breastfeed simply because it’s challenging?
Suggesting that the only solution is to abandon the breast and switch to a bottle?
That’s not just short-sighted- it’s unacceptable.
It also dismisses the fact that a baby who struggles at the breast and is experiencing oral dysfunction will also struggle with the bottle and eventually with self feeding.
And here’s why.
What’s Actually Going On: The Role of Oral Motor Dysfunction
When a baby struggles to latch or fatigues quickly at the breast, it’s easy to blame milk supply, the mothers ability to help the baby latch, or that the mother just “can’t breast feed.”
But the truth is, that in many cases, the issue lies deeper- in the baby’s ability to functionally use their mouth muscles or an undiagnosed lip or tongue tie.
Oral motor dysfunction refers to poor coordination, strength, or control of the muscles involved in sucking, swallowing, and breathing.
Even in full-term, healthy infants, disorganized oral motor patterns can cause feeding to feel like a constant uphill battle.
Signs may include:
- Shallow latch or inability to maintain suction
- Frequent popping on and off the breast
- Poor lip seal or tongue movement
- Gagging, choking, or messy feeding
- Exhaustion or falling asleep before finishing a feed
These aren’t signs of laziness. They’re signs of compensation.
A growing body of research supports what many feeding therapists observe clinically: oral motor dysfunction is a common, often under-recognized root cause of breastfeeding difficulties.
- A 2019 study published in the Journal of Pediatrics noted that even in full-term infants, inefficient suck-swallow-breathe coordination could impair breastfeeding and lead to early weaning- even without visible anatomical ties (Andrade et al., J Pediatr (Rio J). 2019).
- In medically complex or preterm populations, studies have found that up to 42% of infants experience oral feeding dysfunction due to neurological immaturity, oral-motor delays, or impaired sensory integration (Ross & Browne, Cardiology in the Young, 2021).
- Even when tongue or lip ties are present, outcomes after frenotomy vary significantly unless paired with therapeutic support to retrain muscle function (Ong et al., Int Breastfeed J., 2021). In other words- structure alone isn’t enough; function matters.
Tied or Not Tied?
Too often, the conversation around latch issues gets polarized: “tie or no tie.”
But this way of thinking leaves out a huge piece of the puzzle.
Here’s what feeding therapists need to remember:
Anatomy doesn’t always equal function. A baby can have a “normal” looking oral anatomy and still be unable to coordinate suck-swallow-breathe efficiently.
Function can be trained. With the right support- oral motor therapy, cue-based feeding, positioning, pacing- many infants make significant gains without surgery.
Tie releases without therapy don’t guarantee success. Without addressing underlying dysfunction, some babies continue to struggle even post-frenotomy.
Why it matters for feeding therapists
If you’re a therapist working with infants- or thinking about becoming one- this is your invitation to look deeper.
Oral motor dysfunction is real.
It’s measurable.
And it’s often the missing link when families feel like they’ve tried everything and nothing is working.
Understanding the signs and knowing how to screen, assess, and support function can change the entire trajectory of a feeding journey.
For some families, it’s the difference between weaning in tears… and breastfeeding in peace.
If you’re an SLP, OT or PT, join us for a free training session so you can screen your littlest patients and help them access the care they need and deserve!
