Tethered oral tissues (TOTs) can include lip-ties, tongue-ties, and buccal-ties in infants and children. This is when the frenulums, which are the connective pieces of tissues between the tongue and floor of the mouth, or the lip and gum, are short or thick and limit the movement of the lips, cheek, and tongue.

TOTs create symptoms that lead to a misdiagnosis of acid reflux, colic, or failure to thrive, all of which come with treatments that will not help with the true condition. Infants who have a tongue-tie or lip-tie will show difficulty latching, gasping for air when nursing, drooling excessively and gumming or chewing when nursing. This can lead to excessive air ingestion during feedings (known as aerophagia), leading to hiccups and gassiness, which can cause colic and acid reflux.

TOTs are not only uncomfortable for the infant, but breastfeeding mothers of children with TOTs also suffer from discomfort while nursing that lead to mastitis, thrush, and plugged ducts.

Pediatric feeding disorder (PFD) is impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction (1) . Conservative evaluations estimate that PFD affects more than 1 in 37 children under the age of 5 in the United States each year (2). For these infants and children, every bite of food can be painful, scary, or impossible, potentially impeding nutrition, development, growth, and overall well-being.