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Tethered Oral Tissues (Tots)

How does OT address feeding difficulties in babies with TOTs?

OT helps to develop strength and coordination of the entire body, including the neck, face, mouth, and tongue. When the mouth and tongue have difficulty doing their jobs efficiently because of restrictions and decreased mobility, the body recruits other muscles to help make feeding easier. This causes the body to attempt to compensate and seek stability and strength elsewhere in the body; this can look like clenched fists, body tension (particularly in the neck), stiff ankles/toes, etc. OT understands that the whole body plays a part in feeding, not just the tongue and jaw, so there are improvements noted in all areas of the body.

How do I know if my baby may have TOTs?

Listed below are some signs & symptoms that may indicate a lip or tongue tie.

Feeding Symptoms

> not emptying breast

> falling asleep at the breast

> baby "chomps" at the breast

> nipple pain between feedings

> frequent mastitis/clogged ducts

> milk leaking from sides of mouth
> persistent pain with breastfeeding

> gagging/choking at breast or bottle
> clicking sound at the breast or bottle
> frequently unlatching from breast or bottle

> baby cluster feeds constantly & still seems hungry

> blanched, misshapen, or creased nipples after feedings

Non-Feeding Symptoms

> reflux symptoms

> poor weight gain

> high arched palate

> excessive drooling

> sensitive gag reflex
> heart shaped tongue
> plagiocephaly (flat head)

> excessively fussy or gassy

> torticollis (tightness in neck)

> white coating on the tongue

> tongue does not stick out past gums
> struggles in tummy time despite supports
> mouth breathing/snoring/sleeping with mouth open
> tongue does not elevate to roof of mouth when crying

Some babies have ties that may not currently impact their function.


Your baby likely will NOT exhibit all of these signs & symptoms together.

If you notice several of these symptoms, it is worth getting an assessment done by a knowledgeable & experienced provider to develop a plan for your family.

If you have a concern, trust your intuition & advocate for your baby.

We are here to help each step of the way!

Contact cassie

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