Our guest today is Rachael Rose, speech-language pathologist and owner of Creative Speech Therapy in Manhattan. We discuss the identification and treatment of tethered oral tissues (TOTs) in infants, more commonly known as tongue ties and lip ties, and their impact on feeding, speech, and overall development. Rachael explains the importance of early detection and intervention to prevent long-term issues, the importance of trusting parental intuition, the need for a supportive team approach, and the challenges parents face in getting proper diagnosis and treatment.

Resources:

Creative Speech Therapy - Rachael Rose
Breath - James Nestor*
Tabby - screener (include images in the photos file – 2 that start with TABBY)
Hazelbaker Assessment Tool, Kotlow Scale, Martinelli Scale
Torticollis info (Boston Children’s)
Breastfeeding infants with congenital torticollis (NIH, Catherine Watson Genna, IBCLC)
Some articles on the education pediatricians get (or don’t) on breastfeeding/lactation:

Sponsor links:

Free “Pack for Your Best Birth” Packing List (with free mini-course option)
Free “Smart Questions to Ask Your Care Provider” Checklist
East River Doula Collective (find a doula, attend our free “Meet the Doulas” event)
Birth Matters NYC Childbirth Education Classes (Astoria, Queens and virtual)
Birth Matters Online/Self-Paced Course

*Disclosure: Links on this page to products are affiliate links; I will receive a small commission on any products you purchase at no additional cost to you.

Episode Topics:

Introduction to Rachael Rose, SLP

Rachael’s background as a speech-language pathologist and founder of Creative Speech Therapy in Manhattan
Her passion for infant and toddler feeding, and orofacial myology

What Are Tongue Ties, Lip Ties, and TOTs?

Explanation of tethered oral tissues (TOTs) and their impact on feeding and speech
Anatomy of oral restrictions: tongue tie, lip tie, cheek tie
How fascia and connective tissue play a role

Signs and Symptoms of Oral Restrictions

Common signs in babies: clicking sounds, poor latch, fatigue during feeding, gassiness, reflux, and weight gain issues
Maternal symptoms: nipple pain, need for nipple shields, and feeding challenges
How to distinguish between normal newborn sleepiness and feeding-related fatigue

Functional Assessment vs. Diagnosis

The role of speech therapists in functional feeding assessments
Which professionals can officially diagnose oral restrictions (ENTs, specialized dentists)
Importance of a team approach and collaboration with lactation consultants, doulas, and other specialists

Challenges with the “Wait and See” Approach

Research on delays in intervention and the developmental impact of waiting
The importance of early detection and intervention for optimal outcomes

Impact of Oral Restrictions on Development

How tongue and lip ties affect palate formation, nasal breathing, and jaw development
The ripple effect: from feeding issues to speech, sleep, airway, and even behavioral concerns
Connection between mouth breathing, sleep quality, and misdiagnosis of ADHD

Feeding Therapy and Prevention

Strategies for supporting infants and children with feeding difficulties
The role of exercises, stretches, and myofascial release
Preventing long-term issues like picky eating, need for palate expanders, and orthodontic work

Empowering Parents

Encouraging parents to trust their intuition and advocate for their child
Breaking down overwhelming care plans into manageable steps
The importance of family and community support, even when professional resources are limited