What is an oral function evaluation & why does your child need one?

You’re holding your little bundle of joy and you’re so excited to bond with them. But, as you begin breastfeeding, your baby isn’t latching properly. Or maybe is hungry a lot more often than expected.

*Cue frustration, worry, and that mother’s intuition that deep down you know something is up. 

Just know - you are not alone! 

There are many different reasons for difficulty with feeding. One reason may be tethered oral tissues (TOTs). The most well-known TOT is a tongue tie (lingual tie). But it’s also possible for your child to have a buccal (cheek) or labial (lip) tie. Now the presence of a piece of tissue, otherwise known as a frenulum, does not automatically mean that your child has a “tie” that affects the function of your body in some way. We have to look and see if your child’s tie impacts their feeding (breast or bottle), chewing/swallowing, breathing, sleeping, speech, or even body movements or posture. 

Now, like most people, you’re probably Googling a course of action. And “AHHH!” there is so much conflicting information out there! Now what? 

Seek out a professional who will appropriately assess your child’s oral function before immediately recommending surgery. Here are some professionals or types of therapy may need to search for: 

• An International Board-Certified Lactation Consultant (IBCLC): Supports breastfeeding through goals targeting latch, oral motor skills, milk supply, body positioning, progression, safety, weaning, and more
• Speech and Language Pathologists (SLP): Supports feeding, oral function, speech across the lifespan; you may need to look for an SLP who is trained to work in your area of need (e.g., picky eating vs. speech)
• Bodyworker: Typically an Occupational Therapy (OT), Physical Therapist (PT) or chiropractor who have received specialized training to support fascial tension and posture/alignment (e.g., stiff body posture or difficulty during tummy time)
• Oral Myofunctional Therapy (OMT) (for children older than 4 only!): OMT is a type of treatment provided by an SLP or Registered dental hygienist who is Certified in Orofacial Myology (COM®). OMT helps teach children strategies to modify oral habits, develops muscles and helps correct compensatory patterns (e.g., tongue thrust). 

---

So, what is an oral functional evaluation?

The purpose of an oral functional evaluation is to look at the structure and the function of the oral cavity as it relates to the stages of feeding and speech. We need to first see if your child’s oral cavity is working for them and if not, what exactly is going wrong. While there isn’t yet one standardized protocol for an oral functional evaluation, a professional is looking for a few things that are related to pre-feeding and feeding skills, like… 

1. Lingual (tongue) range of motion – tongue protrusion, retraction, lateralization, tongue tip elevation/depression
2. Labial range of motion – lip closure, rounding, protrusion, posture
3. Frenulum (thickness, attachment)
4. Suction (rhythm, coordination when swallowing/breathing)

---

And why does your child need one?

After an oral functional evaluation, you and the specialist can work together to create goals to help you an
d your child. This may mean implementing strategies or writing goals to support body tension and posture, speech, or progression of feeding.

If you’re thinking about a frenectomy (tie removal/release), it’s crucial you get an oral functional evaluation first. A TOTs release should be due to functional impact! It is also likely that you will still need to see a specialist following a frenectomy to support your child’s oral function – it won’t magically fix itself.

what to look for?

There are several symptoms that may indicate that your child has TOTs. These don’t necessarily mean that they do and these don’t necessarily mean you need to look into a release. But if you are seeing some of these symptoms at home, you want to seek out a professional.

In babies... 

• Difficulty latching, gumming, or chewing; leaking milk during breastfeeding
• Noisy eating (e.g., clicking/slurping), swallowing (gulping), or breathing
• Difficulty swallowing (coughing, gagging); reflux post-feeding
• A weak or excessively strong suck
• Open mouth posture at rest
• Falling asleep while breastfeeding
• Frequent feeds (< 1 hr)
• Difficulty holding a pacifier
• Difficulty during tummy time
• Stiff body posture

In toddlers and older children... 

• Slow to gain weight/underweight
• Picky eating (less than 20 foods)
• Difficulty using a straw
• Resistance to tooth brushing
• Crowding of teeth
• Poor sleep / snoring
• Mouth breathing
• Open mouth posture
• Gagging and spitting out foods
• Slow eating / prolonged mealtimes
  
• Keeping food in cheeks 
  
• Grinding teeth
  
• Difficulty producing any of the L, R, T, D, N, TH, SH, and Z sounds
  

Don’t forget- everyone’s experience is different – what your child needs (including their TOTs) may be very different from the next. To find a provider near you, check out the International Consortium of Tongue-Tie Professionals (ICAP).
https://tonguetieprofessionals.org/