Stop Treating the Tissue: Why Function Comes First in Tongue Ties
In this clinical monologue, Hallie Bulkin challenges the prevailing tissue‑centric view of tongue‑tie assessment and urges clinicians to re‑center the child’s functional abilities, goals, and family priorities. She argues that the tongue‑tie tissue should be considered only as one element of a broader functional story. Bulkin calls for a shift in clinical questioning—from asking whether the anatomy looks like a tongue‑tie to asking what functions are impaired and what concrete evidence supports those impairments. She outlines observable functional signs (e.g., limited tongue elevation, jaw compensation, difficulty with specific chewing movements) and emphasizes the importance of documenting measurable progress while noting any remaining limitations. By framing assessments in functional terms, clinicians can more effectively communicate with other providers, convey meaningful clinical data, and align treatment plans with the child’s and family’s priorities.
