​About Tethered Oral Tissues (TOTs)

Have you ever heard the term tongue ties, cheek ties, or lip ties? These are types of Tethered Oral Tissues (TOTs), where a small band of tissue under the tongue, lips or cheeks is too tight or short, that in turn makes movements in the mouth difficult. This can lead to issues with feeding (chewing, swallowing), speech, and even breathing if not addressed. 
Could my child have TOTs?
​If your little one struggles with speech, feeding, breathing, and/or dental, it's worth checking for TOTs. Here are some commons signs based on how old your child is:
In Infants, it might look like (not limited to):
  • Trouble latching or staying latched while breastfeeding
  • Clicking noises while nursing
  • Slow weight gain or frequent fussiness
  • Gassiness and reflux due to swallowing too much air
  • Long feeding sessions or preferring bottle over breastfeeding
​In toddlers and older kids, you might notice (not limited to):
  • Difficulty articulating words
  • Speech delays or unclear speech
  • Picky eating, especially with certain textures
  • Mouth breathing or snoring at night
What to expect with treatment and recovery:
Once you know your child has a TOT (after a structural AND functional assessment), the next steps to expect include:
Step 1: Surgical Consultation
Consult with a pediatric dental specialist or a pediatric ENT that specializes in TOT releases.
Step 2: Pre-Procedure treatment
Pre-Procedure therapy helps your child get used to the procedure and the therapy while maximizing their range of motion and oral function. It also works to release fascial tension, which will make the procedure more effective. Additionally, this time allows our team the opportunity to establish a baseline, access limitations, and the ability to create the most effective post-procedure therapy plan to ensure the best possible results.
Step 3: Caregiver Training
At Hummingbird, we believe that family involvement is imperative to a child's development! Supporting you with education throughout the TOTs process will ensure a smooth recovery and long-term success after the procedure. Hummingbird therapists will train you on proper stretching and massage techniques to prevent reattachment and to minimize scarring. You will also learn neuromuscular exercises to help support your child while they are strengthening their tongue, lips, and jaw. Continuing the exercises learned in therapy sessions at home will help your child make continual progress outside our sessions.
Step 4: Release Procedure
A frenectomy is done to release the restrictive tissue using a laser or scissors in an office setting. The procedure is usually quick and with minimal discomfort. Healing begins immediately and proper post-care treatment is essential to make the procedure successful.
Step 5: Post-Treatment Therapy
Our post-treatment therapy plan will include stretching to prevent reattachment and avoid scarring and then focus on retraining the tongue and oral muscles to function properly.

Pre-feeding and Feeding Challenges: Therapy helps babies and children develop the skills needed for proper feeding, such as latching, sucking, chewing, and swallowing.
Oral Placement and Speech Challenges: Exercises focus on improving tongue and mouth movement to support clear speech and proper oral function.
Orofacial Myofunctional Challenges: Therapy works to correct issues with tongue posture, breathing patterns, and overall muscle coordination in the face and mouth.
Get the right support!
Catching TOTs early can make a big difference in your child’s health and development. If you think your child might have TOTs, don’t wait! If you are a current Hummingbird family, bring up your concerns to your therapist. A solid care plan including caregiver education, pre-procedure and post release therapy, can ensure the best outcomes. Hummingbird is here to help your child thrive with expert care and experienced guidance for tethered oral tissues!
Wondering if your child has Tethered Oral Tissues (TOTs)? Contact us!