Why Early Screening and Treatment Matter More Than Ever
by Bella Kavalerchik, PT, myofunctional therapist
Did you know that the foundations of your baby’s oral health begin forming as early as 4 months into pregnancy? By birth, the tongue and oral tissues continue to play a crucial role in essential functions like breathing, feeding, and swallowing. Yet one common condition – tongue-tie (ankyloglossia) – often goes unnoticed at birth, and then during routine pediatrician’s check-ups.
Tongue-tie occurs when the band of tissue under the tongue is too tight, restricting tongue movement. While some cases are obvious, others – especially posterior tongue-ties – can be deceptively difficult to detect. In such cases, the tip of the tongue might move freely, while the deeper part of tongue remains restricted, causing significant challenges for the infant and the family.
Why Early Detection is Critical
Countries like Brazil have made tongue-tie screening a standard part of newborn assessments. Unfortunately, there is no such standard procedure in the United States. This important condition remains underdiagnosed, often leading to a cascade of avoidable issues.
Tongue-tie can interfere with:
- Breastfeeding: difficulty latching, poor milk transfer, nipple pain
- Swallowing and digestion: leading to colic, gas, and reflux-like symptoms
- Sleep quality: mouth breathing and poor tongue posture can disrupt restful sleep
- Speech development: tongue movement restrictions interfere with certain sound pronunciation
- Jaw alignment: tension and imbalance of the oral cavity muscles and joints may lead to jaw misalignment and pain
- Body alignment: Fascial tension caused by a restricted tongue can extend throughout the body, contributing to what is often referred to as a midline Torticollis, forward head posture, and overall muscular imbalances are some examples of such issues.
Reflux, PPIs, and Misdiagnosis
Many babies struggling with poor latch and suction swallow excessive air – a condition called aerophagia. This can mimic symptoms of reflux, leading to a misdiagnosis and unnecessary treatment with proton pump inhibitors (PPIs). Unfortunately, these medications often don’t help and can cause serious side effects such as disrupted gut flora and impaired nutrient absorption to name a few.
Instead of medicating the symptoms, addressing tongue function and oral muscle development can often resolve the root problem – naturally and effectively.
Myofunctional Therapy: A Gentle Solution
As a physical and myofunctional therapist, I work with infants facing these challenges. Using a specialized approach known as oral motor therapy, I apply myofascial release techniques to work inside and outside the oral cavity. This gentle, hands-on treatment helps improve tongue mobility, encourages proper oral posture, and supports healthy swallowing and feeding patterns.
I also train parents to continue the work with targeted stretches and exercises at home. Empowering families is a vital part of the healing process.
When Tongue-Tie Release is Needed
In many cases, a frenotomy – a simple procedure performed by a pediatric dentist or ENT – is required to release the tongue restriction. But for best results, oral motor therapy before and after the procedure is essential:
- Before the release: To prepare the tongue and surrounding muscles, improving surgical outcomes.
- After the release: To prevent tongue reattachment and supports full functional recovery.
How My Little Patients Find Me
I feel truly fortunate to work as both a Pelvic Floor Physical Therapist and a Myofunctional Therapist. In my role as a pelvic floor PT, I often work with postpartum moms. Naturally, our conversations extend beyond recovery and often touch on challenges new moms are facing with their babies – such as breastfeeding difficulties, sleep issues, and more.
When a baby struggles with breastfeeding, it’s often a sign of an underlying ankyloglossia issue. I make it a priority to educate new moms about these potential concerns and offer compassionate, evidence-based support. Many of these moms choose to bring their babies to me for further evaluation and treatment.
In addition to hands-on care, I provide educational resources, including posters and a small library of parent-friendly books that explore topics like tongue ties and their impact on breathing, swallowing, brain development, and sleep.
Helping infants with myofunctional issues has become one of the most fulfilling parts of my journey as a Physical Therapist. It’s an honor to support families during such a formative time in their lives.
It Takes a Team – and a Village
As a Physical Therapist trained in myofunctional therapy, my role differs from that of a lactation consultant or feeding therapist (such as SLPs or OTs). Each profession plays a vital role in treating infants for myofunctional issues. A collaborative team approach ensures that each baby receives well-rounded, comprehensive care. After all, it truly does take a village.
Raising Awareness & Improving Access
Some parents of my little patients with myofunctional issues find me through a Google search – but most come to me because I treat their mothers for postpartum concerns.
What if those mothers had never become my patients? Would their babies still have the opportunity for a healthier start in life? Sadly, I’m not sure – and that’s what needs to change.
We must integrate myofunctional education into the core training of medical and dental schools, as well as into physical therapy, occupational therapy, and speech-language pathology programs. Every child deserves the chance to thrive.
Tongue-tie is not just a feeding issue. It can shape a child’s entire developmental trajector – from breathing and sleeping to posture, speech, and beyond. Raising awareness among parents, pediatricians, and policymakers is essential. Screening and therapy should not be privileges; they should be covered by insurance as standard care.
Early identification and intervention can transform a child’s future. Let’s work together to give every baby the best possible start in life.
Bella Kavalerchik, PT, is the founder of Bella Physical Therapy, a private outpatient practice dedicated to providing personalized and comprehensive care. With over 25 years of experience as a licensed Physical Therapist, Bella brings deep clinical expertise and a compassionate approach to her work. She graduated Magna Cum Laude from the Physical Therapy Program at Hunter College in 1996. Throughout her career, Bella has treated a wide range of conditions, including orthopedic, pediatric, and neurological disorders. Her specialties also include the treatment of TMJ dysfunction, headaches, tinnitus, vestibular disorders, and pelvic floor conditions in both adults and children. In 2014, Bella expanded her expertise by becoming a certified orofacial myofunctional therapist—a field that has since become her greatest professional passion. She now works with patients of all ages to address a full spectrum of myofunctional disorders, combining evidence-based care with individualized treatment strategies.