As parents, we want the best for our children, and that often means navigating a maze of information when something doesn’t seem quite right. One area that has gained increasing attention, and often brings with it a host of questions, is tethered oral tissues (TOTs). You might have heard of terms like tongue tie or lip tie, and if your little one is struggling with feeding, speech, or even certain developmental milestones, these terms might hit close to home. Here at Michigan Pediatric Therapy, we understand the concerns and challenges that come with TOTs, and we’re here to shed some light on how pediatric occupational therapy (OT), specifically feeding therapy, can be a game-changer for your child and your family.

Let’s start by defining what we’re talking about. Tethered oral tissues, or TOTs, refer to restrictive pieces of tissue in the mouth.

• Tongue Tie (Ankyloglossia): This occurs when the frenulum, the thin piece of tissue connecting the underside of the tongue to the floor of the mouth, is too short, thick, or tight. This restriction can limit the tongue’s movement, affecting its ability to lift, extend, and move freely. Think about how crucial tongue movement is for everything from sucking to speaking!
• Lip Tie: Similar to a tongue tie, a lip tie involves a restrictive frenulum, but this time it’s the tissue connecting the upper or lower lip to the gum line. A significant lip tie can restrict the lip’s movement, making it difficult to flange (or flare out) during feeding, which is essential for a good latch.

While some TOTs are mild and may not cause significant issues, others can have a profound impact on a child’s development and quality of life.

It’s important to understand that not all ties are created equal. Professionals often classify tongue and lip ties into different types or “grades” based on the severity and attachment point of the frenulum. While there isn’t one universally accepted grading system, the most commonly referenced for tongue ties relates to where the frenulum attaches to the tongue. This can give you a better idea of what your healthcare provider might be referring to.

For tongue ties, these are often categorized into four types:

• Type 1 (Anterior/Classic Tie): This is often the most visible type. The frenulum is very thin and attaches right at the tip of the tongue, often creating a heart-shaped appearance when the tongue is lifted. This type can significantly restrict tongue elevation and extension.
• Type 2: The frenulum is located slightly behind the tip of the tongue, still visible and relatively thin. It restricts the tongue’s ability to lift and extend, though often less severely than a Type 1.
• Type 3: The frenulum is thicker, less elastic, and attaches closer to the base of the tongue, making it less obvious visually. It can still significantly restrict tongue movement, particularly elevation and cupping.
• Type 4 (Posterior/Submucosal Tie): This type is often called a “posterior tongue tie” or “hidden tie” because the frenulum is very deep, thick, and covered by a mucous membrane. It’s not easily seen but can cause severe restriction of tongue movement, often more so than visually apparent ties. This type requires a skilled assessment to diagnose, as the restriction is felt more than seen.

For lip ties, similar classifications exist, often describing where the frenulum attaches on the gum line relative to the lip, with some ties extending deeply into the palate. The higher and tighter the attachment, the more likely it is to cause issues.

It’s crucial to remember that the visual appearance or type of a tie doesn’t always correlate perfectly with the functional impact. A “mild” looking tie can cause significant problems, while a “severe” looking one might not. This is why a comprehensive functional assessment by a trained professional is so important.

When facing concerns about tethered oral tissues, it’s natural to wonder about the best course of action. While surgical revision (often called a frenectomy or release) is an option for some, it’s not always the only or first step. This is where pediatric occupational therapy and specialized feeding therapy become invaluable.

Our skilled pediatric occupational therapists at Michigan Pediatric Therapy are experts in understanding the intricate connection between oral motor skills, sensory processing, and overall development. We don’t just look at the tie itself; we consider the whole child and how the restricted movement is impacting their daily life.

It’s a common misconception that if a tongue tie or lip tie isn’t severe enough for surgery, there’s nothing that can (or should) be done. This is absolutely not true! Many children with mild to moderate TOTs, or even those without a definitive “tie” but still presenting with oral motor challenges, can benefit immensely from targeted OT and feeding therapy.

Our therapists utilize a variety of techniques to improve oral motor function, regardless of whether a revision is in your child’s future:

For many families, a tongue tie revision or lip tie revision is the recommended path. However, the revision itself is often just one piece of the puzzle. Without proper preparation and follow-up, the full benefits of the procedure may not be realized. This is where pre- and post-revision feeding therapy with an occupational therapist becomes absolutely crucial.

Think of pre-revision therapy as preparing the ground for growth. Our therapists work with your child to:

• Improve Oral Awareness and Tolerance: Often, children with TOTs have limited awareness of their oral structures or are highly sensitive to touch in their mouth. Pre-revision therapy helps them become more comfortable with touch and exploration within their oral cavity, making the post-revision stretching and exercises much easier. Sometimes this may be referred to as, “oral desensitization before tongue tie release.”
• Establish Baseline Oral Motor Skills: We identify current strengths and weaknesses in your child’s oral motor skills. This baseline helps us track progress and tailor post-revision interventions more effectively.
• Teach Pre-Stretching Exercises: While the tie is still present, gentle exercises can help prepare the tissues and surrounding muscles for the upcoming release, potentially leading to a smoother recovery and better outcomes, and increasing the range of motion.
• Educate Parents on Post-Care: We empower parents with the knowledge and techniques they’ll need for post-revision stretches and exercises, ensuring they feel confident and prepared for the critical healing period. “What to do after tongue tie surgery?” is a common question, and we provide clear answers.

The period immediately following a tongue or lip tie revision is vital for optimal healing and preventing re-tethering. Post-revision therapy with an occupational therapist is essential for:

• Maintaining the Release and Preventing Re-Tethering: The newly released tissues need to be actively stretched and moved to prevent them from re-attaching. Our therapists guide parents through specific tongue tie stretches or lip tie exercises that are appropriate for their child’s age and the specific revision performed. This is often the most critical component for long-term success.
• Re-Patterning Oral Motor Skills: After years of compensating for restricted movement, children often have ingrained patterns of movement that are not efficient. Post-revision therapy helps them “re-learn” how to use and coordinate their newly freed tongue and lips effectively for feeding, speech, and other oral motor tasks.
• Improving Feeding Efficiency and Comfort: We work directly with your child to optimize their feeding mechanics, whether it’s achieving a deeper latch for breastfeeding, improving bottle feeding techniques, or mastering chewing and swallowing solids. Our goal is to make feeding a comfortable and positive experience for both child and parent.
• Addressing Residual Challenges: Even after a successful revision, some children may still have lingering issues related to muscle weakness, sensory sensitivities, or behavioral feeding challenges. Our therapists provide ongoing support and tailored interventions to address these residual concerns.
• Collaborating with Other Professionals: We believe in a team approach. We work closely with your child’s pediatrician, dentist, lactation consultant, and have qualified speech-language pathologists on our team to ensure comprehensive and coordinated care.

At Michigan Pediatric Therapy, we are passionate about helping children thrive. Our team of highly trained and experienced pediatric occupational therapists and pediatric speech-language pathologists specialize in oral motor therapy and feeding therapy. We understand the unique complexities of tethered oral tissues (TOTs), including tongue ties and lip ties, and we are dedicated to providing individualized, evidence-based care.

We offer comprehensive, compassionate, and effective solutions, including:

• Expert Knowledge: Our therapists stay up-to-date on the latest research and best practices in the field of TOTs and oral motor development.
• Personalized Treatment Plans: We recognize that every child is unique. We conduct thorough assessments and develop customized treatment plans tailored to your child’s specific needs and goals.
• Family-Centered Approach: We believe parents and caregivers are an integral part of the therapy team. We empower you with the knowledge and tools to support your child’s progress at home.
• Holistic Perspective: We look at the whole child, understanding how oral motor skills impact overall development, and collaborate with other specialists as needed.
• A Nurturing and Playful Environment: We make therapy engaging and fun for children, fostering a positive experience that encourages participation and progress.

If your child is struggling with feeding, speech, or other developmental milestones, and you suspect tethered oral tissues might be a factor, don’t hesitate to reach out. We are here to answer your questions, provide guidance, and offer the specialized pediatric occupational therapy services that can make a profound difference in your child’s life. Let us help you unravel the tie and unlock your child’s full potential.

Contact Michigan Pediatric Therapy today to schedule a consultation and learn more about how our feeding therapy and oral motor programs can benefit your child. We are dedicated to supporting families throughout Michigan with exceptional pediatric occupational therapy for oral-motor issues, including those related to tethered oral ties (TOTs).

Michigan Pediatric Therapy
📍 27655 Middlebelt Rd., Suite 130, Farmington Hills, MI 48334
📞 (248) 939-4030
🌐 mipediatrictherapy.com