Research shows that feeding challenges aren’t rare.
Up to 45% of typically developing infants and young children experience feeding or swallowing difficulties at some point, and this number climbs as high as 80% in those with developmental or medical conditions.
Yet all too often, if a tongue-tie isn’t found, the struggle is dismissed.
That’s why, as pediatric feeding therapists, our evaluation must go beyond tethers, we need to consider the full picture of oral motor skills, sensory systems, posture, environment, and parent observations to truly support each family from the very first feed.
Tongue ties have been having their moment. And yes, research continues to show the benefits of early identification and appropriate treatment of oral tethers.
But here’s the thing: not every feeding struggle comes with a tie attached.
The elephant in the room? Far too many families are dismissed when their baby’s feeding issues aren’t explained by a tongue tie.
“If there’s no tether, there’s no problem” is simply not true.
As pediatric feeding therapists, our role goes beyond spotting a frenulum. We must be skilled in evaluating the full scope of oral motor form and function, at both the breast and the bottle. That means looking at more than what’s under the tongue.
Here’s what should always be on your assessment checklist:
- Muscle strength, coordination, and range of motion involved in eating and drinking
- Ability to bite, chew, and swallow age-appropriate textures
- Oral reflexes and the child’s ability to manage saliva
- Sensory preferences and responses to textures, smells, tastes, and temperatures
- Feeding patterns– preferences, aversions, and how the child handles variety
- Posture and positioning during feeding, and other body-based behaviors
- Self-feeding skills, utensil use, and developmental transitions (when age-appropriate)
- Mealtime environment and routines– frequency, structure, and family dynamics
- Parent observations and concerns about comfort after feeding (colic, back-arching, spit-up, gassiness, fussiness, etc.)
Bottom line: You can’t rule out feeding challenges just because a baby doesn’t have a tie. The absence of an oral tether doesn’t mean the presence of optimal feeding skills.
Our job is to see the whole picture, muscles, mechanics, sensory systems, and mealtime experiences, so we can truly support families from the first feed onward.
