Hey there! We are pediatric occupational and speech therapists who specialize in tethered oral tissues, feeding, lactation, and infant massage. We are also mothers who have experienced feeding difficulties due to tethered oral tissues with our children. The recent New York Times article discussed lip and tongue ties as a trend, causing fear-mongering with the most severe outcomes and monetizing procedures. It is important to take into consideration the facts from trained medical professionals who specialize in this area, as this can continue gaslighting mothers who are attempting to advocate for their children in times of distress. We are here to untie the knot. 

Preferred providers consist of a team approach. This team will assess oral function, feeding, swallowing, speech sound disorders, and muscular tension. Pre-op care is 

 in order to rule out alternate factors including reducing fascial restrictions, training caregivers, avoiding oral aversions, and establishing clinical baselines (Walsh, 2023). The following are considered preferred providers as a part of the multidisciplinary team.

It is critical to not only look at structure (frenulum or the “string” under your tongue) when diagnosing tongue ties. Function must be assessed in order to make a differential diagnosis. For example, 

 is the structure functioning in the presence of tight tissue impacting feeding, speech, body tension, breathing, sleep, etc? The structure 

 have a negative impact on function to warrant a diagnosis (Bulkin, 2023). This is typically first noticed in infancy; however can later be identified in children, adolescence, or adulthood.

In an excerpt from Dr. Richard Baxter’s response to the NYT’s article, 

This pre-procedure therapy accomplishes many objectives: “It allows the professional to assist in preparation for the procedure (what to expect, common troubleshooting issues, red flags, etc). If you think about knee replacement surgery, we want a strong calf and a strong hip to support that new structure.  

with tongue tie release.  We want to work on the jaw, lips, cheeks, etc.  Think about who heals better: An Olympic athlete or someone who does no physical activity?  We want to work to tone, strengthen, coordinate, and sequence patterns while inhibiting compensations prior to a procedure”   (Henning, 2019). 

Rushing a release can lead to suboptimal outcomes and it’s critical to wait for the optimal timing of release per your providers’ recommendations and child’s readiness. The body needs to be properly prepped: including a full-function oral motor assessment combining desensitization for oral aversion, decreasing tension patterns or discomfort, and regulating the nervous system.

“Due to wound healing principles, any wound left open post-procedure will try to contract and stabilize by reattaching. It is highly important for patients/parents to be instructed on active wound management techniques. The time to learn this is prior to the procedure for the best success” (Henning, 2019). 

 change in symptoms immediately after a release, however, continued improvements are observed after completion of post-op therapy to retrain the orofacial muscles on how to function with their 

“The goal is to gain and/or restore optimal function so you or your child can thrive” (Bulkin, 2023). As healing continues and skills increase, you may notice: Quiet nasal breathing, closed mouth posture with lingual palatal suction, improved sleep, infants who are 

 with decreased colic-like symptoms, quicker feeds, weight gain in infants, less grazing in children, increased speech intelligibility, decreased gagging/choking, and reduced hiccups, reflux, and constipation.

I decided in my pregnancy that I wanted to breastfeed for as long as possible with a personal goal of 1 year. I decided that I wasn’t going to check for ties until I noticed signs. I wanted an unbiased opinion so I could relate to my families at work on a more personal level. Unfortunately, these signs came earlier than anticipated. My son immediately demonstrated difficulties latching, regardless of position. I’ll never forget the overwhelming emotions I experienced- I felt anxious, defeated, like a failure, or at fault. I began hand-expressing colostrum and syringe feeding until he could latch successfully. I received lactation support in the hospital (it is difficult to be a mom

 therapist), however the possibility of ties was never discussed. We finally got a latch, and although it was shallow and painful, we powered through. He was 7lbs 7oz at birth and 7lbs 1oz at discharge. My anxiety then quickly transformed into concern. After a few days at home, I started experiencing significant discomfort including nipple trauma, painful latch, and vasospasms. I remember holding my breath, clenching my toes, and dreading each feeding. At this point, I knew there were ties and it was time to check. Sure enough, my son had upper and lower lip ties, buccal or “cheek” ties, and a tongue tie. I got established with an IBCLC, CST, and chiropractor. My team addressed compensatory patterns, strengthened oral motor skills, and released body tension. Once therapeutic readiness was identified, we scheduled with a pediatric dentist for releases at 3 weeks of age. My son latched 

 after his procedure. The pain had diminished and he was transferring more volume at the breast. It was amazing the difference- even I couldn’t believe the change! We continued seeing our team to ensure appropriate wound healing and retraining of orofacial muscles. Now, my son is 1 year old and we are still breastfeeding. I am forever grateful for this team who helped us navigate through this feeding journey and supported us along the way. Advocate! Breastfeeding 

 be painful and reaching your feeding goal 

Sitting in the hospital bed after my baby was born, I remember thinking when latching my son for the first time “ Am I doing this right?”.  I was a first-time mom. The overwhelming emotions of welcoming a child into the world, doctors and nurses in and out of my room, and my body aching from delivery heightened all my sensations. I made sure to check with lactation several times in the hospital to ensure our breastfeeding journey would be successful. Our first night home, my son cried the ENTIRE night. He nursed all night and wasn’t satisfied. His latch was completely shallow. I immediately knew something was off and made an appointment that week to meet with lactation from the hospital. At our appointment, she agreed his latch was very shallow and he was not transferring enough ounces to feel satisfied. She suspected ties and recommended seeing a speech therapist who specializes in feeding. My son was colicky, gassy, had horrible hiccups, constantly fell asleep at the breast, and had a poor latch with the bottle. We tackled triple feedings via breast, bottle feeding, and pumping around the clock every 2 hours. Sure enough, when our appointment arrived, we discovered he had a tongue and lip tie. I made sure to set up the necessary steps for pre-care therapy including a chiropractor, physical therapist, and speech therapist. My son had his release by a pediatric dentist at 3 weeks of age and we continued to work with our team for post-care and body tension.  At 6 weeks old, I made the decision to change course from breastfeeding to exclusively pumping and bottle feeding until my son was 12 months old. He is now a healthy thriving 5 year old! After my son was born, I knew what signs and symptoms to look for. I delivered a daughter 22 months later and my third child, another son, two years after her. Both of which had difficult feeding journeys after birth. Both of these two would latch at the breast; however, struggled to gain weight, were colicky, gassy, did not sleep well, and required triple feedings. With my two youngest children, we moved to Kentucky from a different state. Knowing the process, I scheduled appointments with a team of providers for consultations. Both my daughter and youngest son were diagnosed with bilateral buccal, tongue, and lip ties. We set up care with an IBCLC, CST, chiropractor, and speech therapist. My daughter had her release by a pediatric dentist at 6 weeks old and my youngest son had his release at 5 weeks old. With these two, I made a personal goal to try to breastfeed as long as I could. I wanted to try again after my first! I successfully breastfed both my now 4-year-old daughter, and 2-year-old son for 14 months each. My experience as a mother of three with feeding difficulties has inspired me to educate families on the benefits of therapy and establishing success for functional feeding. Let us be a part of 

In efforts to discontinue the spread of medical misinformation, here are some helpful resources. Families deserve to thrive! 

Helping your family build skills for life is our priority.  

 with one of our expert therapists if you have concerns about your child or want more information about the topic of tethered oral tissues! 

All Tied Up: Lip & Tongue Ties from Professional and Personal Perspectives

Flashcards have been a classic tool for building children’s vocabulary but did you know that this teaches children memorization rather than functional communication? We want children to be motivated and engaged in language. Flashcards are fun to look at a few times but end up getting tossed to the back of a shelf because your child thinks it's “boring”. 

When flashcards are used correctly, they can be a great on-the-go tool that strengthens your little one’s language skills. 

Try one of these activities next time you pull out the deck!

As parents, we strive to make every learning moment memorable and effective for our children. From object matching to scavenger hunts, describing details, and the thrill of hide-n-seek, these activities not only make language acquisition fun but also foster generalization and deeper understanding. So, let's redefine the way we utilize flashcards – not just as a tool but as a gateway to a world where language becomes an exciting journey for our little learners.

Helping your family build skills for life is our priority. If you are looking for personalized tools to build your child’s vocabulary and communication skills, 

 with one of our expert speech and language pathologists. They will provide you with creative games and activities that will engage your child while strengthening their speech and language skills!

Are Flashcards Outdated? 

Parents, below are 4 tips and tricks to encourage early communication with your kiddo. As a Speech-Language Pathologist (SLP) that has a passion for early language, I use all of these during my therapy sessions.

You can do this by announcing and talking through both your and your child’s routines, even if

you are not directly talking to your child. Try announcing the steps of brushing your teeth or

making a meal. During play, try narrating the actions of characters, putting noises to toys, and

labeling objects, colors, and animals while reading a book. Books with repeated words, different

textures and hidden doors provide lots of opportunities for early language development!

Playing at eye level and using fun language may encourage your child to explore language.

Bringing toys to your mouth will allow them to see how you move our lips, teeth, and tongue to

create words and communicate our thoughts. Build in opportunities to provide choices and allow

for increased time for your child to respond!

Examples of fun language: are “Ready, set, go”, “beep, beep”, and animal noises.

Parents often know what their child wants or needs even if the child is not producing any words.

Build on this by providing the want and modeling it back to them. Do this during play by

reinforcing their language and building on what they already know. If your child isn’t verbal,

continue to provide language input by modeling speech during play.

“Oh, drink! You want a drink of milk.”

Does your child try to put noises to cars or animals?

Try: “Yes! Car goes vroom!” or, “Cow says mooo!”

Pairing verbal language with sign language can spark your child’s interest and decrease their

frustrations with communication. Once they realize their words and actions serve a purpose (to

get those babies what they want) then they are more eager to explore and communicate. As a

speech therapist, some of my favorite beginning signs are “more”, “all done”, “open”, “eat”, and

Remember to be gentle with yourself. Developing language is an incredible and complex skill.

You don’t need to spend a lot of money on expensive toys to practice these strategies at home.

Sit outside and talk about what you see, participate in pretend play, or use common home

objects as toys. Providing increased input, letting your child lead, and expanding on their

sounds/words will provide lots of opportunities for growth! 

to ask your SLP for some suggestions and demonstrations at your next appointment!

To inquire about booking your child's initial Speech-Language Therapy evaluation or next appointment with one of Marshall's expert clinicians, please utilize the form 

To learn even more about Speech-Language Disorders, statistics, and FAQs, you can visit the 

Four Tips & Tricks to Encourage Early Communication

Giving the Gift of Language Expansion & Making gift-giving fun and resourceful! 

Moms, we know the feeling of panic when grandparents, aunts, and friends ask you for Christmas gift ideas for your little ones!  I can help give you some suggestions that will not only be great for gift-giving but also help your child develop speech and language skills too!! As a Speech Therapist (also known as SLP), I look at toys from a language perspective.  I 

toys that increase the opportunities for using words, and sounds and that let parents guide the learning and development of building language skills!  Here are a few of my favorites!!

Remember, it doesn’t have to be expensive or come in a big box to be an amazing gift!  Use your imagination to create new fun ways to play!  Expanding your child’s language skills should be fun and interesting to your child.  Ask your child’s therapist or teacher for some fun developmentally appropriate ideas for your child!  You can also search many toy sites online by age and interest levels!  This is super helpful! 

Learn more about Speech-Language Therapy 

Helpful Speech-Language and other various resourceful links found 

Kids Gifts Ideas 

So you may be wondering...what exactly is Pediatric Speech-Language Therapy?

Speech-Language Therapy is described as a treatment that helps to support and care for children who have difficulties with communication, feeding, eating, drinking, and swallowing. Our expert clinicians at Marshall Pediatric Therapy want to help answer some of the most FAQs when it comes to this discipline. 

What specific conditions does Speech-Language Therapy help to support?

Examples of when you might need to express your concerns:

What age should a child receive Speech Therapy?

Realistically, there is no specific age a child should receive any particular therapy discipline. it is never too early to start therapy and get an evaluation with a licensed professional as soon as you notice and or experience concerns. It is not abnormal for a child with a disability to show signs of developmental delays as early as 3 months old, if not sooner.

We always advocate for our families to ask plenty of questions to their pediatrician, after all, that’s why they are there for! At Marshall, we see newborn babies, all the way to age twenty-one with a wide array of conditions and concerns. Early intervention is so very important!

If you and your child receive a referral to receive Speech-Language Therapy, we highly suggest that you contact us first to see if you’re in the network for insurance to help offset the cost of therapy visits. Our helpful referral team and clinical support can guide you through all of your financial options and answer absolutely any questions you might have regarding billing/insurance.

At Marshall, we do our very best to always advocate for our families and to help break down the financial barriers that might keep someone from receiving the services they not only need but that they deserve.

For a list of our current insurance providers that cover Speech Therapy visits, you can click 

How we address Speech-Language Therapy at Marshall Pediatric Therapy: