Tied up in paediatric feeding disorder? A comfort-first approach to tethered oral tissues

Background: Tethered oral tissues (TOTs), including tongue tie, can impact feeding experiences in infants and children, potentially contributing to challenges such as breastfeeding and bottle feeding difficulties, restricted eating, feed aversions, oral sensorimotor delays, and dysphagia. While the relationship between TOTs and paediatric feeding disorder (PFD) continues to be explored in research, clinicians often grapple with multifaceted decision-making and treatment planning when TOTs are present.

Method: This presentation applies the Circles to Feeding™ Approach to examine the impact of TOTs on paediatric feeding disorders. This approach is a responsive feeding therapy model that prioritises comfort and felt-safety as the foundation for feeding progress, drawing on trauma-informed care, self-determination theory, and neurodevelopmental principles. The presentation will explore the role of TOTs in paediatric feeding disorder across the domains of Comfort, Curiosity and Capability as key considerations in assessment and treatment.

Results: Clinical case examples will illustrate how the Circles to Feeding™ Approach supports clinical reasoning in identifying the source of feeding challenges and guiding intervention decisions. These examples will highlight diverse feeding presentations, including how therapeutic and/or surgical interventions can influence feeding experiences across Comfort, Curiosity and Capability, while bringing potential risks if comfort is not adequately considered.

Conclusions: A responsive, comfort-first approach focused on all levels of the feeding system helps clinicians navigate the complexities of TOTs in paediatric feeding disorder. By carefully identifying the source of feeding difficulties and prioritising comfort, interventions can better support progress while minimising unintended disruptions to positive feeding experiences.

Carly Veness, CPSP, IBCLC, MSPA, is a Certified Practising Speech Pathologist and International Board Certified Lactation Consultant (IBCLC) based in Melbourne, Australia, working in both clinical and research roles over the past 20+ years.