Hallie BulkinAsk HallieAI:Your On-Demand Mentor in Pediatric Feeding & Myo

Why You Can’t Diagnose a Tongue Tie Just by Looking!

19 May 2026 · 1 min

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In this instructional monologue, Hallie Bulkin critiques the common clinical practice of diagnosing tongue‑tie (ankyloglossia) solely by visual inspection of the tongue’s anatomy. She explains that while many clinicians are taught to recognize the physical appearance and classifications of a tie, they are rarely trained to systematically evaluate how the restriction functionally impacts feeding. Bulkin outlines the essential functional domains that should be assessed—bolus formation, lateralization, suction, swallow timing, endurance, and coordination—and argues that without this functional lens, anatomy becomes a superficial headline rather than a comprehensive story of the infant’s feeding ability.

Chapters

So this is where I see so many clinicians getting stuck because many of us were— maybe we were taught how to identify a tie, but we were not taught how to systematically assess its functional impact on feeding. We learned what ties look like, we learned classifications, maybe, maybe we learned the anatomy, or maybe you didn't learn any of that, right? But even if you got that, you probably weren't taught how to answer like, is this restriction affecting bolus formation? Is it limiting lateralization? Is it impacting suction? Is it altering swallow? Follow timing? Is it changing endurance? Is it affecting coordination, right? Without a feeding assessment, without that lens through which to look, anatomy becomes the headliner, right? It's kind of like, news story, here's the headline, it's all about the anatomy. And sometimes it's just one paragraph in a much larger news story. It's not the whole news story.