Written By: Dr. Alli Chisholm, PT, DPT

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I don’t remember where I first heard it, but during one of the many TOTS (tethered oral tissues) trainings I took after having my first baby with feeding struggles, a provider said something that I’ll never forget:

“We have to consider the mental health of the baby, too.”

And the context? The over-recommendation of oral tie releases and the way aftercare is handled.

Why This Matters

I remember sitting at my kitchen table as a brand-new mom, laptop open, watching yet another training on tongue, lip, and cheek ties. I had a baby with feeding issues, and I was also a pediatric physical therapist who wanted to maximize how I could help other mamas and babies going through the same thing.

In one video, a provider aggressively lifted a baby’s tongue to the roof of their mouth to “stretch the wound” after a tongue tie release. Over the sound of the baby screaming, the instructor said, “babies at this age don’t feel pain.”

But right in front of us, this baby was clearly telling a different story. Not just uncomfortable… but screaming bloody murder in distress.

Whether you’re a parent or another provider reading this, we all know that crying is a baby’s way of communicating. So why aren’t we listening?

Visually the level of distress seen with many babies during oral tie aftercare, especially when working on “active wound healing” and having fingers in the baby’s mouth to “stretch” the wound.

That disconnect made me pause. I couldn’t reconcile those two ideas. So I started digging deeper into the research. What I found was clear: babies do feel pain. In fact, newborns often feel it more intensely than adults because their nervous systems are still developing. While they may not carry explicit memories of those moments, their bodies remember.

That memory shows up in their nervous system, in how they respond to touch, in how they approach feeding, and in how they experience comfort for years to come.

Hearing that one phrase - “we have to consider the mental health of the baby, too” - gave me permission to question everything I had been taught. It confirmed what I intuitively knew was wrong. From then on, I began changing how I shared information about ties with parents. I started offering gentler solutions, both when deciding if a release was truly needed and in how to approach post-release care in a way that protected babies - and their parents - from unnecessary traumatic stress.

The Hidden Impact of Painful Early Experiences

Diving deeper into how early painful experiences affect infants—especially without comfort or regulation—shows us that these experiences can actually rewire a baby’s stress response.

They may become more sensitive to pain and stress later in life. Repeated painful procedures, like the forced oral stretches often recommended after a release (despite lacking strong evidence), have even been linked to increased fussiness, feeding struggles, and oral aversion.

Let me give you an example with this real parent’s story - when feeding got worse after a release:

I recently started working with the second baby of a family I had supported before. With her first, this mama had been through so much. Naturally, she hoped care for her second baby would be simpler.

But by the time we met, her baby was six months old and still struggling. She had gone to a local pediatric therapy clinic - one known for recommending oral tie releases for nearly every baby who walks through their doors, whether truly needed or not. She told me her baby’s feeding struggles actually became worse after the release.

Not only that, but her little one no longer wanted anything near his mouth. Feeding took an hour per bottle. He no longer voluntarily sucked, and mom was worried about starting solids. The provider she had seen was adamant that the ties were the root issue, yet post-release, things felt even more complicated.

To me, this sounded like oral aversion… a pattern that can develop after unnecessary and traumatic handling during post-release wound care.

This doesn’t mean her baby was doomed. But it did mean he now had a layer of trauma around feeding and oral play that would prolong his challenges. He was not in control of what entered his mouth at that time, which created resistance, stress, and avoidance.

When we tell parents that aggressive oral stretches are “required,” we often miss the bigger picture. These experiences can trigger a baby’s fight-or-flight response. Forcing a mouth open, stretching healing tissue, and ignoring their cries isn’t just uncomfortable - it’s dysregulating. And that dysregulation can snowball into feeding refusal, oral aversion, and more body tension.

So if a baby is resisting, crying, or arching away, it isn’t that they’re “just being fussy.” They’re telling us something isn’t right.

👉 For more on how to recognize signs of oral ties, you may want to read my post: Does My Newborn Have a Tongue Tie?.

A Baby-Led, Nervous-System-Friendly Approach

Instead of painful, forced stretches, there is another way. We can focus on helping babies feel safe and supported while they heal.

That begins with regulation: skin-to-skin contact, deep pressure holds, rhythmic rocking, humming, or co-regulation. These experiences tell the baby’s nervous system, you are safe.

And what does the research actually show to be most effective after an oral tie release (when a release is truly needed)? Functional activities. The kinds of movements and experiences babies naturally do every day, in ways that let them stay in control.

Here are some everyday functional activities that support healing:

Supported breast or bottle feeding
Non-nutritive sucking on a pacifier or finger (when baby invites you in by opening their mouth after you gently stroke their lower lip)
Exploring a teether or toy they can bring to their own mouth, encouraging side-to-side, up-and-down, and in-and-out tongue movements (check out my go-to oral motor play toy here)
Self-soothing through mouthing their fists

Even these small, baby-led moments count as powerful oral play.

Of course, every baby is unique. Please speak with a local or virtual provider who knows your child’s specific situation before making decisions. While I am a medical provider, I do not know your baby’s case, and individualized recommendations matter.

If you’d like someone to talk through your concerns with you, I offer a free 15-minute inquiry call and more than happy to guide you through the questions you have.

The bottom line is this: when we give babies ownership over their healing and focus on safe, functional activities, we reduce the risk of oral aversion and create opportunities for positive oral exploration. And when babies feel safe, supported, and respected, true healing can happen.

👉 For more ideas on supporting comfort and regulation, you may also want to read my post: Head Flattening Prevention 101.

The Big Takeaway

Before making decisions about an oral tie release or aftercare, I encourage you to pause and ask yourself:

Is an oral tie release absolutely necessary, or are there other options?
Am I being told to “just do it” without a clear understanding of risks and benefits?
How can I support my baby’s mental and emotional well-being, no matter which route we take?

Because babies deserve gentle, respectful, and evidence-based care. Their mental health starts from day one, and how we respond to their needs in these early moments truly matters.

Ready to Explore Gentle Options?

If you’d like to explore a gentle, non-invasive approach to supporting your baby with oral ties, you’re in the right place. I work with families virtually to create baby-led, nervous-system-friendly care plans that prioritize feeding success and emotional well-being for both you and your little one.

💞 Click here to schedule your FREE inquiry call to see if working together feels like the right fit.

References & Further Reading

Grunau, R. E. (2013). Neonatal pain in very preterm infants: Long-term effects on brain, neurodevelopment, and pain reactivity. Rambam Maimonides Medical Journal.
Taddio, A., Katz, J., Ilersich, A. L., & Koren, G. (2002). Effect of neonatal circumcision on pain response during subsequent routine vaccination. The Lancet.
Fitzgerald, M., & Walker, S. M. (2009). Infant pain management: A developmental neurobiological approach. Nature Clinical Practice Neurology.
Shah, P., et al. (2022). The impact of early life stress on oral sensory and motor development. Pediatrics & Neonatal Nursing.
Academy of Breastfeeding Medicine (2021). Clinical Protocol #11: Guidelines for the management of ankyloglossia.

Considering Your Baby’s Mental Health During Oral Tie Care