Function Over Appearance: Tongue Ties & the Picky Eating Connection

In the world of pediatric feeding, we are talking about lip ties, lat struggles, and those so called lazy bottles.

Because here's the thing, right? Understanding two patterns isn't optional. If you work in pediatric feeding, it's foundational. Like, what are you even doing if you're not working on this?

You've probably heard those phrases tossed around in parent groups, maybe even in conversations with colleagues or friends. But like, what does it all really mean? What should we as feeding therapists be thinking about when we hear these phrases, concerns, or we hear these things, these conversations thrown around.

Right, okay, so here's why so many clinicians feel stuck, right? We were taught maybe in some tongue tied courses or in courses where they're talking about tongue ties. Now we're taught to look at the frenulum.

Now, if you're coming out of grad school undergrad, you're not taught to look

at any of this. But anyone who's even taught to look at the frenulum is typically not taught taught to understand the impact on function. All right, so what I want to really dive into is this myth that if it looks short or tight, it must be a tie. That is not necessarily true. Okay, so not all short frenula restrict movement. Some might look really tight, but they might actually be functioning beautifully. So again, it comes down to function. Form plus function is what is going to lead to a diagnosis. Looking at just form or just function doesn't really give us a definitive answer. Okay. Now conversely, posterior tongue ties often look pretty normal if you're just looking in the front, because visually you don't see the tie unless you know how to expose the tissue properly with a certain maneuver in a, like an intraoral assessment, an assessment in the mouth, under the tongue. But these posterior ties create major functional restriction. So do you see the difference here where sometimes a tie might look like. It might look like the tissue's tight and it's super tied, but there may not be a functional impact at play. Whereas you may not be able to see the tie, but it's there and it's creating a major functional restriction. And those are not the only two scenarios. I just want to highlight that to really dispel this myth of like, oh, if it looks short and tight and it's all the way at the front, like, yeah, it's causing a problem. Well, it might be.

Right.

But the appearance based mindset leads to over and under diagnosis of ties. Okay. And so what matters again is how the tongue moves within the oral cavity within the mouth and how this system compensates. Now, you know, if you've been following me for a while, I do not teach compensation. I do not say, oh, you know, they're compensating well, so let's just ignore it. Here's the thing. They may be compensating. Well, they may be, but why are they in your office? Why are they coming to see you? Why are they seeking help? Maybe it's because the compensations have become too much. Maybe the compensations are breaking down. So while there are other speech pathologists and all kinds of different work, whether it's feeding or myo or articulation, phonology, whatever, while they may teach compensations and plenty of the big names in the industry do, I do not believe in that. I believe in undoing compensations, figuring out the root cause, and getting down to the bottom line. Why is this happening if we can figure that out, and how do we then improve function? Everyone wants to thrive, not we don't want to be surviving all the time. And when you're teaching compensations, you're teaching survival mode because compensations take a lot more energy. And there are certain points where compensations will break down. That's. That's just the bottom line. That. That's that. Okay, I said it. There it is. So the other thing I want to highlight here is that misdiagnosis creates two big problems. Okay, so first, let's talk about over diagnosis. Children and adults, you know, will undergo an unnecessary releases with no functional limitation. And therefore, what are we releasing for? Just, does the tissue look tight? Right. Did we want to maybe try some other interventions first to see if that tissue releases? Not. Not that a true tongue tie will release itself, but sometimes tissue appears tight because it's compensating for something else that's

not doing its job.

And so there can be a change in the presentation of the tissue.

So I want to get your wheels

turning there a little bit. Now, under diagnosis, on the flip side, right, there could be missed T ties because it didn't look bad enough. But again, both scenarios delay functional progress, and it can create distrust amongst family and families and providers. And so the goal here, okay, is to shift from does it look tied? To does this tongue do what it's supposed to do? Is this tongue functioning and not just is the tongue compensating? Well, that might be a question we ask, but can this tongue do what it needs to do? Right. Does it have the range of motion? Does it have the functional ability to do what it's supposed to be doing? If not, can we support it to get to the desired result? Right. All right, now, the third thing I want to highlight here is why function is the missing link. I've already kind of drilled this in already, but let's think of it this way. Like your tongue is like the muscular hydrostat. Okay? It's not about the primulum. It's about mobility, coordination, control. And so function is going to impact every single system, whether that's speech, feeding, swallowing, airway. Right. Which then impacts sleep posture. Right. List goes on. So in a functional assessment is going to tell you, is this structure impacting behavior or performance? Right. Especially in these areas, these systems I just mentioned, form is static. Function, my friends, is what tells the story. Okay? So I just want you to kind of keep that in mind. All right? Okay. So let's talk about some, like, red flags versus normal variation, if you will, like what's normal, what's not. Let's break it down. So red flags for tongue tie dysfunction are especially on, like an infant, for example. Right. You're going to might maybe have poor latch, prolonged feeding times in infants, clicking, leaking, loss of suction, difficulty with elevation or lateralization. Now, this will move beyond the infant stage into toddlers and even through adults with that difficulty with elevation lateralization, separating the tongue at a certain age from the floor of the mouth, from the lips, the tongue, the jaw. Right.

Not.

Not the tongue from itself, but the lips, tongue and jaw should be working independently of each other by about 18 months of age. Are there compensatory floor mouth movements because of tension? Right. Do we see any tension in the face and the neck? You know, in older children, we may also see. And when I say older, I mean older than infancy. But drooling, skin, speech sound challenges, you know, oral fatigue, tongue thrust. Right. In adults, we may see all of that, plus airway restriction, snoring, oral tension. Right. And so it's kind of like that snowball that just keeps building with symptoms and dysfunction, unfortunately, as you get older. And so the other thing I want to highlight is like some normal variations. Like a normal variation that may not necessarily signify there is a tie at play. Right. A visible frenulum with full functional range. We should have a frenulum, a frenum, a frena, whatever you want to call it, that little tissue under the tongue, we should all have that. And. But we should have full range of motion. Okay? That's the key here. Number one. Number two, mild tethering, but no impact on eating, speaking, airway. Right. You know, so it appears to be a little tight, but there's really no functional impact. And we probably, you know, if we have concerns, we probably want to get in there and see is there something else that's making the tongue compensate, making the floor of the mouth compensate, that's making that tissue more tense? Maybe it's not truly tight short tissue. Maybe it's just a little tense because of another etiology. And then the last one is like a slight midline attachment without functional limitation. Okay. Which kind of goes hand in hand with what I was. With what I was just saying. So the real question here isn't like, is there tissue?

Because high.

The tissue should be there. It's is the tissue impacting function? Right. That is where your clinical reasoning skills, my friends, must come into play. So let's dive into how I train SLPs, OTs, PTs, RDHs, dental colleagues, right? How I train students and mentees in my programs to think about tongue tie assessment. Right? Because this is kind of like a functional diagnosis framework, if you want to call it that. It's where form meets function.

Right?

But function leads the way. So the framework, if you will, is function. Form, impact, decision. So let's break this down, okay? Start with function number one, function. What the tongue can or can't do, can it elevate, lateralize, extend without compensation? Is it coordinating with the jaw and the lips or other muscles stepping in to compensate? Are we observing during real tasks?

Right.

So when we observe, I want you to look and see what the tongue can do. Well, feeding, swallowing, speaking, breathing, whatever's in your scope of practice. And a function is limited. That right there is your first clue. Okay? So that's number one. That's number one in the framework. Number two is form. So first we start with function, then we move to form. So I want you to assess the anatomy here in context. Because, look, I know I've said function over form here, but it's function plus form that we really need to consider when making a diagnosis. So we do want to look at, like, is there a visible restriction or tension? That explains. Explains whatever functional limitation we're seeing. Where is the attachment of exist? Is it anterior, mid, posterior? What is the quality of that tissue? Right? Is it really tight? Is it elastic? Right. What does it look like? And just keep in mind that you're not like, just checking boxes on a eval form, right? We need to kind of combine what we're seeing with structure and then the observed function in order to make this diagnosis.

So I see this pattern all the time. Right. There's a baby, they're struggling at the breast or bottle.

And.

And the first thing that people want to do is blame a lip tie or the nipple on the bottle or worse. Sometimes they blame the baby. And I hear things, like, from, you know, parents and even providers, and they'll say, like, oh, they're just lazy. Um, no, no, babies are not lazy. Babies inherently need to feed to survive, and so they don't choose to be lazy. Let's just, like, put that to the side. Okay, here's the thing, right? There's always a reason if a baby is not feeding well.

All. Always.

And it's not about labeling. The labels drive me a little crazy. Right? So let's not label. Let's look deeper. As therapists, like, we are uniquely qualified and positioned to assess not just these symptoms, but the system. And so when a latch is shallow or a baby's only feeding on, like, one side. Right. Sometimes babies feed better on one side of the breast versus the other. Even in a certain position, they feed better on the bottle. Or maybe they're fatiguing quickly. Right. We need to ask why? Like, what is going on structurally? What is going on functionally? Is there anything going on neurologically? Because feeding is not a luxury. It is a survival skill. And if it's not going well, that affects the baby, it affects the parent or caregiver and the entire feeding relationship and dynamic.

Okay, So I want to talk about

how we can do better for our tiniest little clients or patients, you know, if you will. And so let's start with lip ties. Let's dive in. Oh, lip ties.

Okay.

So, you know, yes, upper lip frenula can absolutely restrict lip movement. But here's the truth. Not all visible frenula are problematic. In fact, many are completely normal and asymptomatic. So what we need to look for, and if you. If you've been on the podcast or you've taken any of my courses, you've been here for a while, you're gonna just hear me say the same thing over and over again. But we have to look as therapists for.

For function.

Can the baby flange their upper lip? Can they maintain a seal during sucking? Are they leaking milk? Is there clicking? Are they gassy?

Is a latch shallow?

Right. And here's something else that I want to make super, super clear. Classification systems, like the Class 3 lip tie or an anterior lip tie or whatever people are calling it, because I see all kinds of different terms thrown around. They mean nothing without a functional impact. If there's no functional impact. Whatever you want to label that tie is not helpful. So we have to stop relying on visual grades and start leading with function. Can visual grades be helpful, especially for, like, insurance reimbursement, if that, you know, they need to see numbers or classifications.

Sure.

When it comes to actually, like, creating a treatment plan and implementing that plan and treating the human, you know, that feeding dyad, the infant and mother, for example. Right. We gotta start looking at the functional impact and again, stop relying on numbers, grades, whatever.

Okay. Um.

Cause that's not leading with function. We can look at that, but also lead with function.

And so I want to give a

quick little case example.

Right.

Three month old was referred to me for severe lip tie. Parents were told that it needed to be released by release provider as soon as possible. But when I assessed the baby, we discovered the baby had low tone, poor lip activation. They were compensating by sucking in, like, harder with their cheeks. And we started oral motor therapy.

Sensory.

Oral motor therapy. And after, I think it was like three sessions, the latch was improving. They had better milk transfer. There honestly was no need for a release at that point. And so therapy first. Okay, when I say therapy first, like, yes, a lip tie may be present. Yes, a lip tie may be part of the story, but it's not the whole story. It's one piece of the puzzle or one piece of the story.

And we need to be looking at all.

All things and prepping that baby and trying to intervene behaviorally. When I say behaviorally, I mean with like, therapy first so that we can determine if that child actually needs to go through with a procedure.

Okay. And so, like, what about latch issues?

Let's, let's talk about latch issues.

Right.

So it's not just the tongue or the lip. I want you to drop the idea that the latch is just about the mouth. Because, yes, of course it involves the lips, but of course it involves the tongue and the jaw. But it also involves the head and neck control. It also involves reflexes and body positioning and tone and even respiratory coordination.

Right.

I've worked with babies who couldn't latch because they had undiagnosed torticollis or they presented with air induced reflux or overstimulation, or, you know, or, or, or, or, or. Right. Different scenarios. But I've also seen latch improvements dramatically with a simple, like, change in how we're positioning them. Maybe we're using a sideline position and we're teaching that to the caregiver. And we're integrating paste bottle feeding. If they're on a bottle.

Right?

And so what should you be thinking about as a therapist? You should be thinking about, like, is the baby able to stabilize their head and neck? Right. Are they able to sustain sucking without tiring out after a few seconds? Is there jaw excursion, is there sucks, while a breathe pattern coordinated? Like, there's a whole host of things that we really need to be. And these are the kinds of things that we talk through, like, every day inside the pediatric feeding hub, inside the membership, because these assessments, they can't be done in isolation. You need clinical reasoning and somebody to bounce ideas off of. And that, my friends, is what we're here for. So, you know, I want you to kind of think back to like, you know, all right, how do we rule out whether or not there's a lip tie present? How do we rule out whether or not this latch struggle is, you know, the tongue or the lip or a combination of those plus other things maybe? Right? And then come in the lazy bott, or as I like to call them, lazy labels.

Okay?

So it's so funny because I. Funny, not funny, but I had a parent refer to like bottles as, like the lazy way of feeding at some point. And then this whole like, lazy bottle about, I don't know, honestly, who came up with that term, but it just kind of seemed appropriate. And I had heard it before and it got attached to that, that, that story in my mind. But we got to stop using the word lazy as it refers to babies, whether it's a bottle, whether it's a baby. You know, bottles aren't lazy.

Baby. Babies aren't lazy.

And that term, it's distinct and it ignores the real underlying issues at hand.

Okay.

Most of the time when a baby's struggling with bottle feeding, there's a mismatch somewhere. Like the flow maybe is too fast or too slow. The nipple may be too long or too short or too firm. Right. The baby's oral motor system isn't, you know, coordinated.

It's.

The patterns are not. The sexual breathe pattern is off. Maybe they don't have the strength to maintain your, you know, the feed. Um, I had a patient who had been labeled as lazy because they couldn't finish a four ounce bottle. But on assessment, they had, you know, trouble with tongue retraction. They had poor suck strength, they. They had nasal congestion. It had made it hard for them to breathe while they were feeding. Right. And so that's not lazy. That's a capacity issue, a coordination. Right. It's not about laziness. It's about capacity, about coordination. And as therapists, it becomes our job, right, to identify that and then guide caregivers with compassion, not blame. And so I want to say it louder for all. All those you in the back, okay? For the people in the back. We don't blame the spoon when someone chokes on soup.

No.

So let's stop blaming bottles and start assessing the babies.

Right?

And as therapists, I think we have an obligation to lead the way with this and to stop using things like, oh, they're just a lazy feeder. Oh, they're just, you know, like attaching labels to a baby, negative labels to a baby. A baby as it relates to biological needs, breathing, feeding, you know, it's just. It's not a good look. And if we're doing it, of course parents, caregivers, and other professionals will do it. So let's lead by example and drop those terms out of our. Our everyday vocabulary. And I don't think most of you do this, but I have heard people refer to bottles as being lazy, and it's not nature's way and this, that, and the other. And look, you know, babies need to feed. So however that parent chooses to feed the baby, that's. That's their prerogative, right? That's up to them. It's not lazy. It's their choice.

Right? So.

And babies are not lazy. We'll just go back to that. So what can you do as a clinician if you're feeling, like, kind of fired up about this?

Good.

That means you care. And if you're also feeling a little overwhelmed, that, my friends, is okay, too, because this work that we do in the pediatric feeding space, it's complex. And so I want to give you, like, three practical takeaways today for your next feeding evaluation. Okay? Number one, don't jump to, like, a release referral right away. I want you to observe function first, and I want you to start with therapy for, like, two to three sessions and see what therapy can do. Now, if you are so dang sure that that child is so restricted that therapy is only going to help, prep them very little, like, minimally, you know.

Okay, fine.

But those scenarios are more rare than they are common. So if you're constantly jumping to a release referral after every evaluation, please don't. Please observe function and intervene. Start with therapy and see where it goes. Okay, Number two, I want you to look at the whole baby. Look at their posture, their tone, their reflexes, the feeding environment. We're not. We need to look at the mouth. We need to look under the tongue. Yes, please do that. But also look at the whole baby. And number three, collaborate. If you guys again, have been following

me for a while, you will hear

me talk about collaboration until, like, my ears bleed. Like, collaborate with IBCLCs. If you don't have lactation credentials, ENTs, body workers, you know, OTS, SLPs, right? Make sure you are clear on what you are seeing and why.

Okay?

And most of all, just don't try to figure it all out alone because you don't have to, you don't have to go it alone with this. So that, my friends, is why we did create the pediatric feeding hub. I want you to look at the whole baby. Look at their posture, their tone, their reflexes, the feeding environment.

We're not.

We need to look at the mouth, we need to look under the tongue. Yes, please do that. But also look at the whole baby. If you guys again, have been following

me for a while, you will hear

me talk about collaboration until like, my ears bleed. Like, collaborate with IBCs. If you don't have lactation credentials, ENTs, body workers, you know, OTs, SLPs, right? Make sure you are clear on what you are seeing and why.

Okay?

And most of all, just don't try to figure it all out alone because you don't have to.

I want to break down the progression of the four stages of chewing development from the early, like, munches to that full rotary chew. Because I see too often that people go for the full rotary chew. I'm like, wait, wait, hold on a second. Like, we forgot about all the other necessary milestones and skills that we need to develop that chew. We can't just go from not having it to having it. We gotta, you know, there's a couple phases, a couple things happen in between. So number one is a phasic bite reflex that is present in the first about six months of life. And it's a reflexive vertical jaw movement, like an up and down jaw movement. There's no voluntary chewing yet, right? So it's reflexive. The breast or bottle nipple goes in and that jaw is moving up and down. And the tongue should be doing a swallow breath pattern. But we're going to focus on chewing. So ignore that. That's a swallow. Breathe for a moment. So if you were to go in and like put your finger on the baby's gum, you might stimulate it. They might kind of close their, their, you know, jaw lightly. They're not going to clench down necessarily. But it's that reflexive movement that starts up and down, up and down, up and down. You're watching it keep moving the wrong palate, I mean to move the bottom one, the mandible. So this is typically seen as well when babies are learning to mouth toys. Early teethers, you know, they're exploring intraorally. And this is really important because it helps to strengthen the jaw and prime the oral musculature for what's to come. Right. So you're going to see those up and down movements only there's not going to be any lateral side to side motion yet. And clinically this sets the stage for the munching phase. And so it just looks like, like I said, up, down, up, down, almost like chomping, if you will. This is a really good time to introduce, you know, multiples dissolvable solids for safe practice and things. But you know, depending on who you talk to, it's also a really good time to give baby, you know, maybe give them a big. As we introduce texture through foods that are not just liquid. Right. So the vertical munching pattern between six to nine months, where that jaw, you know, that's the first voluntary chew pattern. It's just that simple open and close of the jaw, up, down, up, down. Right. And it's really common as babies begin purees, you know, to soft solids. Even for babies following like a modified baby led weaning program or baby led weaning where they may be biting on hard things, you know, with some supervision again you're going to get that up and down jaw movement pattern. And arguably it's really good when you have those harder things for the jaw development. But we don't have to go there. So the tongue is going to stay mostly midline at this point with not. We're not going to see that side to side movement. Some people are giving, you know, steak bones like the big ones, you're not going to break, the baby's not going to break a piece off of under supervision or steak on a bone or a hard carrot or a hard piece of celery, something the baby's not going to break anything off of. But you're going to supervise just in case because it is really, really beneficial for jaw development and the masseter development and all those surrounding muscles to have this experience when the baby is voluntarily chewing up and down, up and down, up and down. But again, depends who you talk to. Okay, the diagonal chew pattern is next. That's number three. Right. So first was our basic bite reflex, second is our vertical munch pattern, and third is our Diagonal two pattern. And then fourth, we finally get to the rotary chew. So for the diagonal chew, number three, right? This is usually about nine to 15 months or so. The jaw begins to move diagonally. Okay. The tongue actually starts to shift food from side to side, but it's usually staying more to one side. And this is like where true chewing starts to emerge. Because the baby's going to use a lateral tongue motion and move this food over to the molars or to the teeth or to the gums. And then they're going to also bring their jaw over and up to the midline. Down, over, up to midline. But we're not crossing the yet. Okay. That's why it's just a diagonal down, across and up and around. Right, up, but not around yet. So some people might start here with like softer fruits, veggies, small bites of pasta or meatballs to kind of play with this and have them have good success in this stage. Or even just like little pieces of cut up like cubed chicken or steak or something that's a little more chewy. Clinically. Right. This is a phase where some kids get stuck if they're not exposed properly. If they kind of. They might stay in the vertical and not actually move into. Sorry, yes, they may get stuck before they enter this stage is what I meant to say. They may get stuck in the vertical chew. The last stage we talked about that munch, that up and down munching pattern. And they may not actually move into that diagonal coordination, that, you know, diagonal chew pattern. So a lot of the kids that we see typically are stuck in that munch chew pattern. Okay, Just so you're, just so you're aware. Now, number four is that rotary shoe pattern that we start to see between 15 to 36 mines, big range, but like by three years of age, they should have mastered that circular rotary to that mature chewing pattern where the jaw moves in a very clear circular. And if you're on YouTube, you can see this, a very clear, you know, food goes in. They might move it to one side, chew to, or moving it around, or chewing or moving it around the tongue, right? And where the jaw is crossing this line here and moving in what looks like almost a circle one way or the other. And so what's happening here is that the tongue and the jar are working in sync to break down tougher foods more efficiently. And the child can chew on both sides. They can move the bolus around. The bolus, again, is just the chewed up food mixed with saliva. They can manage mixed textures and this stage supports advanced feeding skills. Right? And at this point you're probably going to have a more, you know, start to have clearer articulation closer to 3 than you did at 2, for example, right? You're not completely clear at 3. It's usually about 75% intelligible. But as your oral motor skills advance, so do your other skills like your speech sound development skills. So if a three year old is still munching, right, straight up and down, up and down, up and down, or they're pocketing food in their cheeks, that my friends, is a sign that we need to intervene. It means the system has not fully matured and it's time for a feeding evaluation. So I like to run through that because there's so much confusion around the four stages of chewing development. And so hopefully that phasic bite reflux into a vertical munch pattern, into a diagonal two pattern, into the rotary two pattern, hopefully that helped to kind of break that down and make that really, really clear. But here's what, here's where most therapists then, you know, and even parents miss the connection. Okay? The bottle to solid transition is really a chewing transition. The jaw and the tongue, right? They need stability before they can handle new textures. And so that's why like prolonged bottle use can actually delay chewing. Babies who never learn efficient sucks follow breathe patterns also tend to struggle to coordinate swallow breathe pattern. And early introduction of appropriate textures around six months, depending on like readiness cues is going to help promote jaw and tongue dissociation. I kind of spoke about that a little bit. So what I want you to clinically watch for here is if there's like, there's no tongue lateralization past 10 to 12 months, they're relying on, you know, mouthing foods in the front and just kind of like munching. There's persistent gagging at times or even choking on lymph nodes, lumpy textures. Usually it's more of a gagging than it is a choking, fatiguing while eating or pocketing food. Right. These, these are not picky eaters. These are the kids who have missed key oral motor milestones. And a lot of them might be flagged as picky eaters by their parents because they become picky as to which food they'll accept because of these things that we need to be watching for clinically, right? These skills that they just haven't developed. Is that always the case?

No.

Is it the case a lot of the times in the kids that, that we see. And so the good news is that you can Address this through functional feeding therapy. Right. I want to talk really quick again. I just want to, like, review the age expectations and any red flags to look for. Okay, so let's talk about what's typical again and when to go deeper. And so age milestones really quickly. Zero to six months, that's when we want that reflexive bite. Okay. I'm kind of reviewing here. Six to nine months is when we want that voluntary vertical to a vertical munch. Right. That chewing pattern. Then at nine to 15 months, we want the diagonal chew to develop. And then around 15 to 36 months, the rotary chew should be established. Okay. And so if you're not seeing the following things that I'm going to share with you, these are signs that we need to look into this further. So what are those signs? No munching by eight to nine months. There's still vertical chewing only past 16 months. Right. They've got that up and down chewing pattern only. And they're now 16 months old. They're gagging or choking with solids beyond the early learning phase. Like they're no longer new to them. Right. And most often, again, like I said, gagging is going to be more common. Choking will be less common. Choking is like face is turning blue, they can't breathe. They can't, they're not audible. They can't make any noise because they literally cannot breathe. Their airway is completely blocked. Versus gagging is where they start to become a little like, you know, you'll hear them, it's audible. They don't like what's happening. Something's triggering their gag reflex. Maybe the food comes back out. That's a bit more common. And so I like to kind of highlight the difference. If the tongue is thrusting out, like pushing food out, repetitive, repeatedly, persistently. If there's difficulty transitioning textures or the only chewing on one side, that's a big one. And then if mouth is open when they're chewing or they don't have a great lip seal, that's another thing too. Okay. Because these signs are all telling us that there's a breakdown in strength instability

or in coordination or all of the above.

And so it's our job to go in there as feeding therapists and figure out, like, where that breakdown lives. Like, what is the root cause of all of this. Right. I recently had a two and a half year old that I was looking at who could really only manage crackers and pouches. No proteins, no mixed textures. And when he was assessed, he had really good speech clarity, actually at two and A half, but no rotary chew. Everything was that vertical, you know, and it wasn't even really the munch. He was actually mashing the food between his tongue and his palate. And within a few sessions of like, targeted functional chewing work, think like food play, lateralization, dog raining, he started to actually, like, manage ground meats and soft veggies. A little bit easier to manage than

like your grilled meats, right?

And the, the secret wasn't sensory. It was motor. It was motor. Now you can't really separate sensory from motor, right? I always, I believe both are at play most of the time. However, there was a big motor component here. And that's why understanding the chewing progression changes everything about how you assess and how you treat. So next time you see a child who's stuck on soft textures or they're pocketing food, I want you to look behind, you know, beyond that behavior that's surface level and ask, like, what's happening with their two pattern? Are they vertical, diagonal or rotary? And if you want to see like real video examples of these two stages and like, learn how to assess them clinically, I got you. Because we, we, we were asked by so many students in the past to like, just have more examples of this. So we have them inside feed the peas. We break down chewing, development, assessment, treatment step by step. We have like actual case footage of like chewing and what it should look like. And so anywho, go to feedthepedes.com because here's the thing, right? Understanding two patterns isn't optional. If you work in pediatric feeding, it's foundational. Like, what are you even doing if you're not working on this? So that, my friends, is where it's at. I cannot wait to see you inside P2 Peas if you haven't already taken our course. Course. If you have. Amazing. I hope that this was a good refresh for you and that's that. We'll see you inside. Quick disclaimer.

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