06/03/2026
TETHERED ORAL TISSUES (TOT)
Tethered oral tissues (TOTs) refer to restrictions in the mouth caused by tight or short connective tissue that limits normal movement. In babies with feeding issues, the most common types are tongue-tie (ankyloglossia) and lip-tie.
What are tethered oral tissues?
• Tongue-tie: A tight or short lingual frenulum (the tissue under the tongue) that restricts tongue movement.
• Lip-tie: A tight upper labial frenulum that can limit the upper lip’s ability to fl**ge during feeding.
• Less commonly, buccal ties (cheek restrictions) may also contribute.
How they can affect feeding:
Restricted oral tissues can interfere with the baby’s ability to latch and transfer milk effectively. This may lead to:
For the baby:
• Poor latch or difficulty staying latched
• Clicking sounds while feeding
• Prolonged or very frequent feeds
• Poor weight gain
• Excessive air intake, reflux, or gassiness
For the mother:
• Nipple pain or damage
• Misshapen ni***es after feeding
• Blocked ducts or mastitis
• Reduced milk transfer or supply concerns
Assessment and management:
Assessment usually involves a functional evaluation of feeding, not just looking at the frenulum. Practitioners such as lactation consultants, osteopaths, paediatric dentists, or doctors may assess:
• Tongue mobility
• Latch and sucking pattern
• Jaw and neck function
• Overall feeding mechanics
Management may include:
• Lactation support and positioning changes
• Manual therapy (e.g., osteopathy) to address tension in the jaw, neck, and tongue muscles
• Oral exercises
• In some cases, a frenotomy (release of the restrictive tissue) performed by a trained medical or dental practitioner.
Our osteopath, Amy, has done further training in this area so if you would like to book your bub in for an osteopathic appointment jump online or call 42770330 to book in.
