TOTs & Lactation
"Fed is best."
Newborn feeding can be difficult, but we are here to help moms walk through the feeding journey! Whether feeding is difficult due to ties, posture, latch, tension, etc., our therapists will provide you with tips and techniques that can help make this process more enjoyable for both you and baby, as well as referrals to additional providers as needed (such as dentist who can release tethered oral tissues).
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But feeding is not just difficult for newborns! Feeding and nutrition can be a concern for infants, toddlers, children, and teenagers! Here at BPT, we believe in holistic care to approach feeding from the anatomy and function of the mouth/tongue AND the sensory aspects of feeding and the body tension that limits feeding and daily life! We have a team of SLPs and OTs who primarily dedicate their caseload to TOTs and feeding!
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So what are tethered oral tissues (TOTs), aka ties, and why do they cause so many issues?
speech, occupational, physical therapy
TOTs are when the typical anatomy of the tongue and/or lip are abnormally short and can lead to restriction of movement and inefficient feeding. The presence of TOTs can also be atypical in itself. For example, while everyone has a lingual and labial frenulum, a child shouldn't have any ties in their cheeks. Our specialized SLPs and OTs are trained to screen for ties and to determine if function is truly impaired and the ties need correcting.
It is possible for TOTs to not cause issues with function, but often times they do! This is because TOTs are made up of fascia, which runs from the head to the toes, it's not just present in your mouth! TOTs affect feeding, breathing, sleeping, gross motor skills, and so much more! That's why we are firm believers in early intervention and assessing function, not just structure.
TOTs affect more than just feeding...
Difficulty with Latch
A tell tell sign that a baby has a tongue tie is a shallow latch at the breast or bottle. Your baby may also slide or pop on and off the nipple, appear to gum or chew at the nipple, or have milk leak from their mouth during feeds. Even difficulty holding onto a pacifier can be a sign of TOTs! If you are dreading feeds, it's likely your child is too!
Difficulty with sleep
Your baby may have a tongue or lip tie if they snore, are a noisy breather, or breathe through their mouth. Babies with ties tend to have short sleeps and may wake often, or they may sleep restlessly and move a lot in their sleep. Or maybe you notice your baby sounds congested frequently, cries frequently or has other symptoms of colic, TOTs could be the culprit!
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These sleep issues may even affect your infant as they age! Childhood sleep apnea is often associated with TOTs!
Difficulty with feeding
TOTs tend to cause difficulty with feeding itself. Your baby may gag, choke, or cough often during feeds, or you may hear clicking as they eat. They may appear to have difficulty swallowing or transitioning to purees/solids. Or maybe they don't tolerate formula or always seem hungry and not full. Babies with ties also often have difficulty gaining weight!
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Also, if your baby has long feeds, falls asleep during feeds, or gets frustrated during feeds, it may be time to get a speech and OT referral for TOTs from your pediatrician or dentist!
Difficulty with GI
Babies with frequent gas, constipation, reflux, and spit up may have a tongue, lip, or cheek tie to blame! If TOTs can be the issue behind feeding, they can absolutely be the culprit behind GI distress!
CHECK OUT THESE CERTIFICATIONS
Difficulty with Nipples/supply
Nursing mothers, TOTs affect you too! If you have difficulty with sore nipples, damaged nipples, mastitis, or thrush, your baby's TOTs could be the culprit! Even if you need to use a nipple shield during feeds or you notice that your baby prefers to feed on one side, TOTs may be the reason!
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Mama, if you have difficulty with oversupply, low supply, clogged ducts, or never feel emptied, once again, your child's TOTs could be to blame!
Difficulty with emotions
Having a baby is a lot on a body and there is lots to adjust to after the baby comes! But mothers, if you're experiencing postpartum anxiety or postpartum depression in addition to any of the previously mentioned experiences for you or baby, it may be time to look into getting your child assessed for TOTs!
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Even if your child has difficulty with their own emotions and regulation, it could be a sign of TOTs! If your child has a pacifier or security item way longer than usual or has frequent meltdowns, they may have tension from ties! Or if baby has a hard time self-soothing and is relying on mom for regulation, they may also have tension!
Difficulties in older children
As mentioned above, TOTs affect everything from the head to the toes! Here's some signs to watch out for in toddlers/older children:
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Grazing on food instead of eating meals
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Not finishing meals
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Packs food in cheeks, chokes and/or gags frequently, and/or spits out food
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Reflux, gas, or constipation
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Picky eater
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Sleep apnea
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Complains of headaches or migraines
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Poor dental hygiene and/or cavities
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History of ear infections and/or ear tubes
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Tonsils or adenoids removed
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Trouble eating with a spoon or flips utensils over
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Gap between front teeth
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Difficulty with b, m, t, d, s, or w
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Sensory processing difficulties
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History of defiant behaviors
if something feels off...
Your mama brain and gut connection can give you great insight! If something feels off with your infant and their feeding, consult with your pediatrician about getting a referral for speech and OT! It never hurts to check and make sure that feeding is fun, satisfying, and easy for you and baby/child!
CHECK OUT THESE CERTIFICATIONS
Click on a logo to see a description of that training!!
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All of our TOTs therapists are required to have specialized training in identifying TOTs and treating them before joining our TOTs team. However, many therapists on the TOTs team are so passionate about feeding therapy and early milestone intervention that they have additional trainings besides the TOTs training!
10000000% RECOMMEND 💚💙
My daughter saw BPT for oral, cheek & lip ties earlier this year - regardless of the situation or questions I had along the way, we always received the very best care from our initial diagnosis throughout our entire journey, we felt like family during each visit.
From the bottom of my heart, THANK YOU BPT!