49 - Before the Release: What Parents Need to Know Before Saying Yes (Carissa Guiley)

Ever wondered whether a tongue tie release is really the fix everyone says it is — or why some babies seem to struggle even after the procedure? In this week’s episode of Doula Talk, Deb is joined by Carissa Guiley, a speech-language pathologist and IBCLC, to unpack the truth about therapeutic readiness and why slowing down before a frenectomy can make all the difference.

Together, they explore how nervous system regulation, body tension, and oral reflex development shape feeding — and why rushing straight to surgery sometimes backfires. You’ll learn what true readiness looks like, how to build the right care team, and why supporting the whole baby leads to calmer parents, better feeding, and happier little humans.

If you’ve ever felt pressured to “fix” feeding fast — or wondered why the latch still isn’t right — this episode will bring clarity, compassion, and a whole lot of nervous-system soothing.

Key Takeaways:

• A tongue tie release is not a magic wand — preparation matters just as much as the procedure
• Babies with dysregulation or body tension often need therapy and bodywork first
• Feeding gets harder temporarily after release — readiness prevents setbacks
• A knowledgeable, collaborative team makes all the difference
• This is not an emergency — slow, steady, supported care wins

Guest: Carissa Guiley, MS, CCC-SLP, IBCLC

Founder of Nourish Therapy and The Nourish & Grow Collective

Supporting families and professionals in holistic, evidence-based infant feeding care

Find Carissa at nourishfeedingtherapy.com and on Instagram @nourish_feedingtherapy

Resources Mentioned:

• Chrysalis Oral Facial Professional Directory: Search for TOTS Training® Professionals in your area.
• International Consortium of Ankylofrenula Professionals: Find a Tongue-Tie Professional.
• Doula Deb’s First Year Support Program: Ongoing, compassionate guidance for families navigating feeding, sleep, and early parenthood
• Rooted Rest Sleep Course: Gentle, attachment-centered foundations for better sleep

If you’re feeling overwhelmed or unsure where to start… you don’t have to do this alone.

Transcript

Carissa (00:00)
a tongue tie is always associated with a level of dysfunction and how babies use their mouth, it might not solve their problems just because we have the tongue tie release. So there are a lot of reasons why we need to take a step back and slow down.

Deb (00:05)
Mm-hmm. Yeah.

Carissa (00:15)
and really support these families more holistically.

Deb (00:15)
Mm-hmm.

Deb (00:24)
Hey friends, welcome back to Doula Talk. I am so glad you're here. Today we're diving into a topic that so many families walk into completely unprepared. And honestly, it is not your fault. We are talking about tongue ties, but not just what is a tongue tie. We are going deeper into something called therapeutic readiness, which is basically the idea that before

we rush into a frenectomy which is a tongue tie release, we need to slow down, understand the whole baby and actually prepare their body and nervous system so the procedure is safer, more successful long Joining me today is returning guest Carissa, a speech language pathologist, IBCLC, the founder of Nourish.

Therapy and the creator of Nourish and Grow Collective, where she supports therapists working with infants and tethered oral tissues. She is one of my favorite people to talk to about feeding because she blends deep clinical knowledge with so much compassion for families who just want feeding to feel easier. In this conversation, we talk about why rushing straight into a tongue tie release can sometimes backfire.

how nervous system regulation plays a huge role in feeding, why babies often need therapy and body work before release, what readiness actually looks like, and how to build a collective care team so you're not left piecing things together from Google at 2 a.m. And yes, we also talk about the emotional side because

when feeding is hard, everything feels harder. So grab your tea, and let's walk through this together. Because sometimes the most supportive thing we can do as parents is slow down before we jump ahead.

Deb (02:09)
hi Carissa, thank you so much for being here. Welcome back

Carissa (02:13)
Hi, thank you. Glad to be back.

Deb (02:15)
Yeah, so I know things have been growing and shifting in your world since our last time together, so I would love to hear what's going on with you right now.

Carissa (02:25)
Yeah. Well, when we met last year, I had just moved my practice from Eastern Washington to the Kitsap Peninsula. And so I just celebrated one year in the area. I have a brick and mortar feeding clinic in downtown Palsbo. And I've just really gotten to know this community, both providers and families, and really thankful to be here and love doing this work.

Deb (02:37)
Yay!

Awesome. Well, thank you so much for all you do in the community. I've sent several clients to you and it's been really helpful for them. So today we're going to talk about the readiness for a frenectomy or tongue tie. So let's start with, you know, just somebody who has no idea what tongue tie is just so that we're all on the same page and then we'll kind of jump into that.

Carissa (03:09)
Yeah, so a lot of times when families come to see me, they may have heard the term tongue tie floating around on the mommy Facebook groups, but they don't actually know what that means. And so basically we all have a band that connects our tongue to the floor of our mouth. And as babies are growing in the womb, that is how the tongue takes shape is it peels off the floor of the mouth and this band recedes back.

Deb (03:18)
Mm-hmm.

Carissa (03:33)
And so it's normal anatomy for babies to have a band that connects the tongue to the floor of the mouth. But in about 10 % of the population, that band is still tight and restrictive when babies are born. And that's going to limit the range of motion of their tongue. And the tongue is the driving force for feeding, breastfeeding, bottle feeding. And if we have limited range of motion, then that might start to wreak havoc beginning with feeding skills.

Deb (03:46)
Hmm.

Mm-hmm.

Carissa (04:00)
And so that's often how families end up in feeding therapy or seeking lactation services for a tongue tie.

Deb (04:00)
Mm-hmm.

Yeah, okay, so then, you know, say that it gets flagged at the hospital or their home and they're like, feeding isn't going great. I've heard tongue tie. And then the referral is made to just like go get the release. And so now there's like kind of this backing up that's happening. And you know, lot of it's the buzz in the doula world of like, okay, we need to do body work. And then the frenectomy

and then more body work. So can you, and that's like the therapeutic readiness, right? So can you tell us why that is and how that's developing now that that's best practice?

Carissa (04:34)
Right.

So I'll start by saying that tongue ties have been around for centuries, like we have it documented. So it's not like a new procedure, but we had in the last century, like a decline in breastfeeding as formula became really popular and bottle feeding became ⁓ status quo. And then in the last couple of decades, breastfeeding has had a resurgence. And with that new

revelations of the challenges that moms face with breastfeeding. And so we've seen an increase in research on tongue ties and breastfeeding, as well as tongue ties and other domains that we'll get into later. And so an increase in the procedure being done in order to preserve breastfeeding relationships. So what we're seeing is an uptick of the procedure being done.

Deb (05:11)
Mm-hmm.

Mm-hmm.

Carissa (05:27)
But with that and the changing landscape in tongue ties and management, we're also seeing it swing the other way where we're too hasty with doing a tongue tie release and now families aren't necessarily getting the result that they were hoping for. And so you're right. Families might have a tongue tie diagnosed in the hospital. Maybe it's even clipped in the hospital by the attending pediatrician. It might be diagnosed in their pediatrician's office.

Deb (05:41)
Right.

Mm-hmm. Mm-hmm.

Mm-hmm.

Carissa (05:53)
where they're

sent directly to a provider who does the tongue tie procedure. Oftentimes it is a dentist, it can be an ENT, it can also be a pediatrician. But what we see when families are directly sent for the procedure without considering readiness is that they don't get the desired outcome. And so that may mean that the tongue tie is not released thoroughly.

And so we're not getting the optimal range of motion for the breastfeeding skills or the bottle feeding skills. It might mean that they experience reattachment or just sub optimal range of motion again. ⁓ and because a tongue tie is always associated with a level of dysfunction and how babies use their mouth, it might not solve their problems just because we have the tongue tie release. So there are a lot of reasons why we need to take a step back and slow down.

Deb (06:30)
Mm-hmm.

Mm-hmm. Yeah.

Carissa (06:48)
and really support these families more holistically.

Deb (06:48)
Mm-hmm.

Mm-hmm. Yeah, and it's just like ringing a bell with both of my experiences with my children because back then it really you know wasn't understood or not fully practiced yet of bodywork and understanding that like just because you release it doesn't mean the tongue knows what it's doing because it's been compensating this whole time and doing what only range of motion it had available

Carissa (07:09)
Right.

Deb (07:11)
And what a difference it would have made to have the feeding therapy afterward, especially with my daughter, because I ended up pumping with her for months and months because I just I was like, I don't even know what else to do. So I guess we're just not breastfeeding. Like that sucks. Yeah. And I've seen that with a lot of families in the last couple of years of, you know, some babies, you clip it and they're like, oh, it was magic. And, know, it was instantly great.

Carissa (07:24)
Good night.

Deb (07:38)
But that's not, that was like a small fraction of the families. Usually it's like really working on learning how to use it properly. Yeah.

Carissa (07:46)
Right. Yeah.

So with the uptick in like awareness and education around tongue ties and acceptance of tongue tie procedures, we're seeing it done too hastily. And so

Deb (07:58)
Mm-hmm.

Carissa (08:01)
One of the things that I find is that parents don't have access to this education about what all the other pieces are. And so even in my practice, I specialize in tethered oral tissues. And so a lot of families come to me looking for that diagnosis or looking for that second opinion. And when I say, as a speech pathologist, I can say,

Deb (08:08)
Right. Yeah.

Carissa (08:23)
yes or no, there is a tongue tie, but that's not the end game. It's not like, okay, we've diagnosed it and now the next step is to go off and get it cut. It's like, we have these other steps I tell parents, we're not holding you back from achieving your goals. This is a part of it, the therapy, the bodywork. We are moving you in the right direction. We're not putting up a roadblock to you achieving those goals of feeding.

Deb (08:27)
Yeah.

Right.

rate.

Mm-hmm.

Right, it's kind of like you're skipping forward but then you know it's going to hold you back eventually if you're not doing the back foundational work. Yeah so ⁓ what are some of those red flags for readiness then or that they're not ready for a clip right away.

Carissa (08:56)
Right. Yeah.

Yeah.

So.

the primary driver is going to be how baby's nervous system is functioning. so babies with oral dysfunction often have nervous system dysregulation. so the simplest way to put that, the baby's colicky, right? And he cries all the time. And sometimes parents don't recognize even that their babies are dysregulated because they're feeding them 10, 12, 15, 20 times a day and they're just

Deb (09:17)
Yeah. Oh yes, they're so sad. Yes.

Carissa (09:35)
constantly latched on the breast and just that might feel normal especially for a first-time parent. Yeah.

Deb (09:35)
Right, yeah, it's the only way they can stay regulated. Yeah.

Yeah, they don't know any different.

Carissa (09:46)
So you may have a baby that's just like really difficult to soothe or they have to be constantly latched to the breast, to the bottle, to the pacifier. You know, these might be babies that are swaddled 24-7, like we swaddling with their arms at night, we swaddling with their arms for the daytime naps. Those are babies that if their nervous system is in that much overdrive, then there's most likely some dysfunction in how they're using their mouth.

Deb (09:58)
Mm-hmm.

Mm-hmm.

Mmm, that is so key.

Carissa (10:13)
Yeah, it's this whole cycle. know, babies, I tell parents, your baby is hardwired to suck. That is natural. ⁓ When we are stuck in a state of fight or flight, that is putting a roadblock on our ability to access reflexes. And the reflexes are what drive that hardwiring for sucking. And so entanglement of babies who have really poor regulation, they have really disorganized reflexes for feeding, and they

Deb (10:21)
Yeah.

Hmm.

Mmm.

Carissa (10:42)
just can't properly use their mouth. And so if we go and do a tongue tie release on that baby, it doesn't change how they're using their tongue. They're still disorganized. They're still having a difficult time with soothing.

Deb (10:54)
Totally.

Totally. my gosh. I've never put those two things together, but I've always said those things to parents like babies who struggle with this struggle with this and I've just I've seen it but I didn't realize that they were like Okay. Okay. That's makes so much sense Wow

Carissa (11:07)
Thank

Those are

also babies that are more likely to have an overactive gag reflex.

So the gag reflex is a window into how babies are functioning from a nervous system standpoint. And if they have a hyperactive gag, they're going to have more difficulty taking a pacifier. They may have more difficulty latching onto a bottle. And in order to protect that gag, they may have a shallow latch where they just have these pursed lips on the nipple because they can't have anything further back.

Deb (11:44)
Yeah.

Carissa (11:45)
And sometimes they gag at the breast and that can be very hurtful for mom. When your baby is gagging at your breast and you're trying to feed them.

Deb (11:49)
Yeah.

yes, you're like, I know you're not doing it on purpose, but ow.

Carissa (11:57)
Thanks.

So if we can't, if baby has an overactive gag reflex, then they most likely are having difficulty doing the things their tongue needs to do to be effective feeders. And so we talk about like the taco tongue, the front of that needs to be able to roll up tight as if they were sucking on a pacifier. And the body of the tongue needs to do this wave-like motion as they're stripping and pulling towards the back of the throat. And if we have a very strong gag reflex,

Deb (12:12)
Hmm.

Carissa (12:26)
are not working on those skills and getting stronger with taco tongue and wave tongue.

Deb (12:33)
Okay, so if they can't do that with the restriction, what would be slowing down and preparing for the release look like? And what are things do you look for to be like, okay, now they're ready for that release?

Carissa (12:48)
in.

So we're doing feeding therapy and I call it body therapy, but it's basically just taking a very holistic whole body approach to how we're treating babies. So for example, I'm not recommending that we gag babies when they have a hyperactive gag reflex. We need to be looking bigger picture at the nervous system. If we have a baby who can't use their tongue to make that taco tongue and the wave-like motion, those are hardwired reflexes.

Deb (13:06)
Right?

Carissa (13:18)
A feeding therapist is looking at how do we access those reflexes? How do we strengthen that brain-body connection so that they have the motor plans and it's just like automatic like it should be?

Deb (13:31)
Mm-hmm.

Carissa (13:32)
And so we're stepping back out of the mouth to address the body. And another part of that, when we have reflexes that aren't firing, it could be a number of things. So the one thing I mentioned already is the nervous system, but also fascial tensions.

Deb (13:47)
Hmm.

Carissa (13:48)
That tongue tie is fascia tissue, which runs from the tongue as one giant sheet of tissue through the body. And when it is tight, there are fascial restrictions that impact how baby moves outside of the mouth. And so that could be shoulders up into the earlobes. It could be a baby that has their ear tilted to their shoulder.

Deb (14:03)
Mm-hmm.

for sure.

Carissa (14:10)
It could be a baby that only can turn their head in one direction. So as this tension is impacting the rest of their body, that starts to put compression on those nerves that are responsible for the feeding reflexes. And so now we have body tension as another piece of the puzzle that needs to be addressed not only to help babies use their mouth optimally, but in order for them to be a good candidate for

Deb (14:14)
Mm-hmm.

Mm-hmm.

Carissa (14:39)
release because that tension is mirrored in the mouth and will increase baby's risk for reattachment.

Deb (14:44)
Mm-hmm.

Okay, so you're addressing the tension in the body in other ways. And is that through, what do you do? Where are parents going for this?

Carissa (14:55)
Yeah.

So you're looking for providers who are trained in tethered oral tissues. And this could be, know, we need somebody who's doing the body work. So that's addressing the fascial tensions. That's addressing the nervous system. We need someone who's addressing the therapy. So the strengthening that's going to be the oral strengthening, the body strengthening. And then of course, these are babies who are breastfeeding bottle feeding. So we also need a lactation provider on the team to be supporting the dyad

Deb (15:03)
Okay.

Carissa (15:26)
ad through, you know.

weight gain, milk supply, comfortable latch, efficient feeding, et cetera. So the tricky part for families is we don't have like one discipline that does this thing and one discipline that does that thing. So we need a body worker that is going to be like a pediatric specialized chiropractor, a cranial sacral therapist, a physical or occupational therapist, and a myofascial release specialist.

Deb (15:39)
Yeah.

Carissa (15:53)
have someone with overlapping credentials, but most importantly is that they are an infant provider who is trained tethered oral tissues.

Deb (16:01)
Okay,

so it could be any of those people as long as they understand the tethered oral tissues. Okay, so it's not like a perfect combination, but like it's kinda, you know, cause right now I think it's access that parents don't, first they don't know that this is something they need to do and then it's finding a provider in their area. So any of those would be good. Okay.

Carissa (16:09)
right.

right for the body

work, body therapy. The other piece of that is the oral motor and the feeding piece. And so that might be a IBCLC lactation consultant who's specialized in tethered oral tissues, a speech language pathologist or occupational therapist who both have the licenses, feeding therapist. And again, it needs to be the oral therapy piece, but also the body therapy piece.

Deb (16:54)
Mm-hmm.

Carissa (16:55)
So somewhere in our team, we need to be blending the body and oral. There are provider directories. And so I will often direct families to a website, chrysalis oral facial has a directory.

Deb (17:00)
Okay.

Carissa (17:12)
This is TOTS training for providers, multidisciplinary providers. And so it doesn't matter if you're looking for a lactation consultant in your community, a bodywork provider, a feeding therapist, you'll find providers across disciplines on that directory.

Deb (17:27)
awesome. Okay, well, perfect. I'll grab that and I'll put that in the show notes for everybody to to find their providers. That's great. So after they have their body work and their lactation support, what's next?

Carissa (17:42)
So when your team feels like Baby is a good candidate for a tongue tie release and after bodywork and therapy it still looks like an appropriate referral, then we start to make that plan. And so this is a baby that they're better regulated. We've addressed the neck, the shoulder, the oral tension.

We're working on body strengthening. So your therapist is working on postural strength. We're working on really good tummy time skills, breathing skills, oral strength. The gag reflex is...

not a hyperactive, we have good strength in the cheeks, supple floor of the mouth. So it's really individualized to the mom and the baby. So, you know, for example, there may be a baby who has a softer suck, but mom has a really robust milk supply. And we're not worried about weight gain. We're seeing things come along and we might be able to give on this criteria to help them move through the process.

Deb (18:40)
Mmm.

Carissa (18:41)
a mom who is a just enough or with her milk supply and baby's just getting, you know, just barely hanging on to their growth curve. That may be a baby where we just don't have any wiggle room. They need to have a strong suck before we go for the release. And part of that is because feeding gets worse before it gets better. So when we cut something, there is going to be a period of weakness and just slower to regain that strength. And so we

Deb (19:01)
Yeah, yeah, I've seen that.

Yeah.

Carissa (19:10)
don't want to put an infant into a position where we're now concerned about their weight gain and we're concerned about mom's milk supply and we're throwing them into this tailspin of needing to you know triple feed now or supplement or whatnot.

Deb (19:24)
⁓ Yeah,

and a lot of them have just got out of the triple feeding. So to feel like they've done this procedure and now go back to that can just feel like a huge hit.

Carissa (19:35)
Sometimes families come to me and they've been at this for six weeks. ⁓ know, the triple feeding, they did the tongue tie release, things aren't getting better. And it's like, when I come on the scene, this is ground zero, like we're starting over. But for them, they want to be at the end. This has already been months of working towards something. And that can be really disheartening.

Deb (19:39)
Yeah.

Right.

Yeah,

absolutely. Okay, so say they're ready. are, you know, all the therapists and everybody says, yep, it's time to do this. How would a family prepare for the actual procedure and like the recovery? What does that look like?

Carissa (20:11)
So

the team should be helping families prepare. And so I give families in my practice an idea of what to expect when they go to the consultation, what to expect during and immediately after the procedure. And I also give families an idea of what that first week after the procedure is going to look like. One thing that can be challenging still in the evolving field of tethered old that we don't have standardized protocols for wound care.

Deb (20:35)
Yeah.

Carissa (20:36)
And so I try to help families depending on where they're going and who I'm working with in the community, but just helping them prepare for the actual aftercare that's a part of the procedure and making sure families are emotionally ready to do four weeks of wound care because that's a big commitment and it can be difficult for families.

Deb (20:49)
Yeah.

Mm-hmm. Right.

Yeah, well, and even just seeing your baby go through something that you're like, it's surgery, you it's gonna hurt. And then there's this wound and it does not look cute. It's actually pretty scary looking when you see like what that wound actually is looking like normal to be healing.

Carissa (21:19)
Well, I tell families the first 48 hours is the hardest, and then it gets a lot easier. So just kind of preparing yourself for that. And then having the support makes a world of difference. When families have someone, they can check in with me, they can check in with their chiropractor, they can, of course, check in with the surgeon that did the procedure. And we're all coming together and supporting this family, then I think it's a lot easier to cope.

Deb (21:22)
Mm-hmm.

Mm-hmm.

Yeah, yeah, you have several points to check in and get that support where as they're healing, you can see those in, you know, they're building those skills and getting better and that is that you're not alone in it. That's so huge.

Carissa (22:00)
Right, and I try to stagger visits because I know that most of my

release providers want to see the family in office at one week. And so we have the body worker seeing the family within a couple of days of the procedure. I'm seeing the family before the end of the first week. The dentist sees them at seven days. And then we're staggering a second week. So we're really trying to have the right support so that the tongue tie doesn't reattach.

Deb (22:07)
Mm-hmm.

Carissa (22:24)
And so sometimes after the procedure when babies have new range of motion, they're not quite sure how to use it yet. And so they're going to tighten up.

Deb (22:32)
Yeah.

Carissa (22:36)
Right? When they latched the breast and this tongue is just flapping, they're going to pull those shoulders in and try to control their tongue by tensing up their body. That is absolutely what we don't want because that is when the mouth starts to get tight and we worry more about those tissues contracting and reattaching. And so that's where we need body work in right away. So baby doesn't develop new tension and compensations. We need feeding therapy to happen right away. So baby is learning how to reign in and use this new range of motion.

Deb (22:36)
Mm.

Mm.

interesting.

Mm-hmm.

Hmm.

Yeah, that's so key because I've seen the babies, it almost looks like a separate entity from themselves. Their tongue is just flapping around. I mean, with both my kids, they did that. It was like this this new little thing that was just like all around their mouth, just blah, blah, blah, blah, blah. And they had no idea what to do with it.

Carissa (23:22)
Yeah, parents often say like, I've never seen their tongue do that before. Like their tongue is always out of their mouth now. They're just exploring it.

Deb (23:30)
Yeah, yeah. And so some of the things that you would be doing with babies would be like doing exercises to kind of teach the tongue what to do. Okay.

Carissa (23:40)
Right, so

dentists are giving stretches and that is helping with directing the wound healing, but your feeding therapist is giving exercises and that is for strengthening and habilitating those muscles.

Deb (23:47)
Mm-hmm.

got it, okay. And that's what really helps the feeding ultimately. Not necessarily just there's no tissue because they have no idea what to do with it. Okay.

Carissa (24:06)
Right. Yeah, we

want to teach them how to use it. We want to strengthen those muscles. And we're also looking for getting that tongue to live in the roof of the mouth. So.

Deb (24:16)
Mm-hmm.

Carissa (24:18)
Tongue ties are about breastfeeding and bottle feeding, perhaps when parents first come in. But as a speech pathologist, I'm also sharing with families the impact that tethered oral tissues has on the way the mouth grows, the way that we breathe, the way that we sleep, the way that we speak. And so one of my goals for families is that we're also achieving that tongue posture where it floats up and lives in the roof of the mouth with lips closed.

Deb (24:31)
Mm-hmm. Yeah.

Mm-hmm. Yeah, and that is so important for, facial structure and like you said, sleep and regulation and the gag reflex. Yeah. OK, so when parents are tackling all of this, one of the things I hear most is that they hear one thing from a pediatrician and another thing from the lactation and another thing from a therapist.

Carissa (24:53)
Right.

Deb (25:07)
How do we know if they're up to date because they're all saying different things?

Carissa (25:11)
It can be really hard for families to navigate what the best course of treatment is when providers on their health team are not in agreement. And so we will find that pediatricians perhaps are not up to date on the most current practice in how to manage tethered oral tissues. And so that might mean a provider is suggesting that tongue ties are not impacting feeding. It might mean that your pediatrician is sending you directly to go have the tongue tie released.

Deb (25:20)
Yeah.

Mm-hmm.

Carissa (25:37)
end.

same with other providers on your teams. You might work with a feeding therapist who doesn't have training or a lactation consultant who doesn't have training. And so that's where I'm suggesting that we really pursue providers who, their website, their bio, you see that they do have specialized training in this area because it is an advanced area of practice. ⁓ Nobody learned about tongue ties in their training, be it a pediatrician, a speech pathologist, a lactation consultant. It's something that you have to have an interest in persuing

Deb (25:57)
Mm-hmm.

Yeah.

Carissa (26:08)
suing after your credentials.

Deb (26:11)
Hmm.

Yeah, that's actually really key that a lot of parents that I work with, they're like, well, yes, the pediatrician and they said that they don't even believe in tongue ties. And I was like, what do you mean believe in them?

Carissa (26:25)
Right,

right. This isn't Santa Claus, it's science. Right.

Deb (26:28)
Right. It's an actual piece of tissue. What are we talking about? And and I

sometimes I have to be like well, you know, let's consider how much training they've had and also like Is is this a problem for us? Is this a problem for feeding if it is then we need to seek more more help with it Whether your pediatrician understands what that is or not

Carissa (26:52)
Yeah, but I understand the difficult position that that puts families in. If we have a pediatrician over here that's saying, you know, that's pseudoscience, it's not real, don't do a tongue tie release, and then you've got your feeding therapist over here who's recommending you go have this procedure. And I see families who live in that tension. And that's not fair. That's not fair to parents.

Deb (26:58)
for sure.

Yeah.

for sure. it sucks

and it's such a tender time as well. You're just trying to figure everything out. I just want to feed my baby. That's it. Yeah.

Carissa (27:19)
⁓ So, there

is also, and Deb, I forgot to mention this as a resource for families, there is an organization called the International Consortium of Ankylofrenula Professionals.

Deb (27:31)
Well, that's a mouthful.

Okay.

Carissa (27:32)
I know, ICAP for short. But that is another

global community of specialists that work in the tongue tie space. And you can find a provider directory for folks who are up to date and actively involved in just moving this forward with what we're considering best practices or standard of care in managing tongue ties

Deb (27:52)
Yeah, okay, that's a great resource. We'll put that in the show notes. So all of this is really great information. I want to talk about how you go about, you know, getting to that decision and understanding like if we are not doing the pre work, what are you seeing in babies who don't do that pre work?

Carissa (28:13)
I mean, it's usually, it's not optimal. So like one of the things I'll see when breastfeeding is not going well and there's a tongue tie as part of the picture, maybe family is exclusively bottle feeding and they plan on going back to breast after the tongue tie release. Babies get better at what they've been practicing.

Deb (28:19)
Okay.

Mm-hmm.

Carissa (28:35)
And so we might have a baby that is now having breast refusal because they've been practicing with the bottle and we haven't actually focused on breastfeeding as part of their prehab. And so one of the things I work with families on is if the goal is to breastfeed, let's get baby back to breast before the tongue tie release. And it might not be efficient, but we're practicing that skill. It needs to be comfortable. And so

Deb (28:46)
Right.

Mm-hmm.

Right.

Carissa (29:04)
Oftentimes I tell families like, might not get it perfect because there's still a tongue tie and we're gonna plateau with therapy and body work, but we should be moving forward. And so that might mean using a nipple shield. And then maybe a week later, we've pulled the nipple shield and now they're directly latching at the breast, but they're still not transferring efficiently. I mean, we're making forward progress. We don't wanna just completely do away with breastfeeding and then expect a baby to breastfeed after we've changed their anatomy.

Deb (29:13)
Mm-hmm.

Okay.

Right, yeah, and I think that's some of the expectations they have is that the surgery is just a magic button that, okay, we're gonna do this and everything will be better, which would be nice.

Carissa (29:39)
Yeah.

Yeah.

Or say we have a baby who has a really strong hyperactive gag reflex and they go get a tongue tie release without any prehab. Now we have oral aversion. We have a baby that you have to put your fingers on their mouth multiple times a day to stretch their wound. And that is a bear for families when your baby has a strong gag. And now they want nothing to do with oral exercises. And so we have to be working on this before the procedure. ⁓

Deb (29:58)
Mmm.

Yeah, yeah.

Mm-hmm.

Right.

Carissa (30:13)
for the success.

Or torticollis, these babies that have a lot of neck and shoulder tension and asymmetries, that tension in the body is reflected or mirrored in the floor of the mouth. And those are the babies that I worry about the most who are going to reattach. Those may be babies that have like deep red creases in the front of their neck or in their armpits because they're so tightly wound and we never want to open up.

Deb (30:19)
Hmm.

Mm-hmm.

Mmm.

Carissa (30:41)
And so, yeah.

Dentists have their lane, right? Their scope as the surgeon to perform that procedure. These are nuances that the other part of the team specialize in. And so we can't go from pediatrician to dentist and just like live happily ever after. That's where we really need to be depending on one another and what it is everyone brings to the team to see this family thrive.

Deb (30:49)
Right.

Right.

Mm-hmm.

Yeah, and actually that's kind of what is leading to what you're building right now, right? Why don't you tell me a little bit about this? ⁓

Carissa (31:19)
Yes!

Yes, so I have new business that I'm launching in 2026 called the Nourish and Grow Collective. And it is an online community for infant therapists, speech pathologists, occupational and physical therapists who support infant dyad infant feeding. And so it is a place for community and connection among private practice owners and a place to build clinical and business skills to support families.

Deb (31:27)
Nice.

That's awesome.

Yeah. And I think that's one of the missing pieces in the landscape right now is, they go from pediatrician or lactation consultant straight to the surgery and then they hear body work and then that's the end of it. Parents are just sent off into the wind.

Carissa (32:03)
Right.

Deb (32:03)
So that's

amazing.

Carissa (32:05)
I would say Deb, if there's one person, like families need a quarterback.

Deb (32:09)
Mm-hmm.

Carissa (32:10)
their providers and so the lactation consultant makes the most sense. know, if families have feeding issues, they're going to a feeding professional. And so a lactation consultant to have deep relationships with other providers in community will know like this is a baby who really needs pediatric chiropractor. This is a baby who really needs occupational therapy or you know, cranial sacral or speech pathologist. So we really need our lactation consultants to be knowledgeable and tethered role tissues and also to be

Deb (32:18)
Mm-hmm.

Mm-hmm.

Carissa (32:39)
developing those relationships in the community. So families aren't having to go to Google and piece meal together all these different things and just hoping that it's the right thing.

Deb (32:45)
Right. Yeah.

Yeah, And then they, need to have somebody to tell them the importance of it and be like, this is, this is the way to do it to get the optimal results. Yeah. Okay. So if there's a family listening and they're like, gosh, this is exactly what I need. what would be the first thing you would tell them to do?

Carissa (32:59)
right.

The first thing I would do is find a lactation consultant in your community who has training in tethered oral tissues. and ask about body work, ask about body therapy and, you know, who they're working with for their releases and just get to know what the process entails.

Deb (33:28)
Mm-hmm.

Yeah. Okay, so if people want to learn more, where do they find you and how do they get connected with you?

Carissa (33:35)
Yeah. So ⁓ I practice in Poulsbo, Washington, which is on the Kitsap Peninsula. And I see families here in my practice. You can find me at nourishfeedingtherapy.com. And then you can also find me on Instagram for families. That's nourish underscore feeding therapy. For providers, that's nourishandgrow.collective.

Deb (33:57)
Awesome, perfect. Anything else you want to share with us before we wrap up?

Carissa (34:02)
It will get better. That's the first thing I tell families when they when we had that first phone consult is like, it will get better. ⁓ Please don't rush off to have a tongue tie release. This is not an emergency procedure. We need to back up, take a deep breath and really look at how to support families from the ground up.

Deb (34:04)
Yes, this is really hard. Yeah.

It will, yeah.

Yeah.

Yep, number one, feed the baby. Number two, figure out what's going on. Yeah. Yeah, and even if people are choosing like breastfeeding is not working for me, this is still something to work on. Do you agree? Yeah.

Carissa (34:40)
Absolutely.

Yeah, this is foundation. This is the foundation of oral motor development. And so the muscles you eat with you speak with and feeding is a developmental continuum of its own. That's not fully mastered until kids are two or three years old. And so if we're compensating now, they're going to struggle to keep compensating as they continue to progress textures and get onto table foods and eat the family meals. And so.

Deb (34:50)
Mm-hmm.

Carissa (35:11)
We don't want to keep kicking the can. We want to address things right now to help them developmentally.

Deb (35:18)
Yeah,

yeah, that's so key. That's perfect. Well, thank you so much for being here. It has been lovely.

Carissa (35:25)
I'll see you next time.

Deb (35:29)
Alright, let's slow it down for a If you are listening to this episode because you're in the thick of feeding challenges or you're staring down the possibility of tongue tie release, I just want you to know you are not behind, you're not missing something obvious, and you are definitely not failing. stuff is so complex. But here are the big takeaways I hope you leave with today.

First, tongue ties are real, but a release is not always a magic wand. it doesn't mean you did anything wrong. It just means the body, the nervous system, and the feeding relationship often need support first. Second, if your baby is tense, dysregulated, constantly needing to be latched to soothe, struggling with gagging, or asymmetries, those may be signs they aren't quite ready yet.

A calmer, more regulated baby usually has a smoother recovery and better feeding outcomes afterwards. Third, preparation matters. Bodywork, feeding therapy, lactation support, and most importantly, teamwork. It's not about gatekeeping care. It's about helping your baby access the reflexes and movement patterns they were born with. So the release actually helps instead of adding stress.

team that is trained, collaborative, and up to date. If your gut says something is off, trust that. Ask the questions, advocate for your baby. You are allowed to do that, and it's important that you do. And finally, oftentimes this is not an emergency. Feed the baby, care for yourself, build your support system. Then you can make thoughtful,

informed decisions. I want to thank Carissa so much for sharing her wisdom, her heart, and her passion for caring for families with instead of pressure. And to all of you listening, you are doing such important, loving work, even on the messy days. want to connect with Carissa, you'll find her at Nourish Therapy in Polsbo, Washington, as well as online through Nourish Feeding Therapy.

and the Nourish and Grow Collective for Professionals. And I will make sure to link all of that in the show notes for you. If you found this episode helpful, please share it with a new parent who needs reassurance that they don't have to rush into decisions, that slow, steady, supported care counts. You are doing beautifully. I'm cheering for you and I will see you next time.