Infant Tongue Tie: Why Every Breastfeeding Struggle Needs Full Assessment
In this presentation Hallie Bulkin argues that any infant experiencing breastfeeding difficulties deserves a thorough feeding and lactation assessment that considers the full spectrum of possible contributors. She emphasizes that pain, milk transfer, latch quality, infant weight gain, maternal anatomy, and infant anatomy are all critical factors and that clinicians should not default to attributing problems to a tongue‑tie (frenulum) without solid evidence. While acknowledging that tongue‑tie can be a factor, she stresses the need for strong clinical justification before referral. Bulkin also explains that the assessment lens must evolve as children grow: for toddlers and preschoolers, the evaluation shifts to a developmentally appropriate pediatric feeding perspective that incorporates oral‑motor function, sensory‑motor development, and, when relevant, speech considerations. This approach aligns with the practices of pediatric feeding therapists who adapt traditional Mayo Clinic feeding goals to suit the broader pediatric feeding context.
