Myofunctional Therapy and Babies

I deliberately avoided this issue when writing my book ‘Why Tongue-tie Matters’ in 2020/21 because of the lack of evidence and my own conflicting thoughts on this. But I often get asked for my opinion and whether I would advise parents to seek out myofunctional therapy so for what it is worth here is where I am at on this. People are free to disagree but not to intimidate me for expressing my own views.

Over the last few years there has been a lot of talk about open mouth breathing in babies and the impact of this on airway development and sleep. Tongue-tie has been implicated as playing a role in this and this is explained in my blog post here

Scary stories abound about children developing all kinds of long-term health issues from this. But the theories are way ahead of the research.

Increasingly information is being shared about ‘oral tension’ and it is no longer considered adequate by some practitioners, to simply divide a tongue-tie to help relieve this tension. It is being suggested that babies should have their upper labial frenulum (commonly referred to as lip tie) and buccal ties (check ties) divided when there is no evidence to suggest this is beneficial in an infant and carries certain risks. See here for more information

Along side this we are also seeing increasing interest in bodywork (cranial osteopathy, cranial sacral therapy, and chiropractic) to release tension in the soft tissues including the fascia to address oral tension and tensions elsewhere in the head, neck, and spine. I have been working with bodyworkers for the last 12 years and have seen for myself the positive impact these therapies can have on babies, particularly those with jaw and neck issues and those babies with the more posterior frenula where bodywork alone can sometimes improve tongue function and avoid a tongue-tie division.  There are several published papers listed at the bottom of this blog on the effectiveness of body work in resolving infant feeding difficulties.

But there is a newer therapy which is now being talked about in relation to babies with tongue-tie called myofunctional therapy (sometimes referred to as oral myofunction therapy or OMT).  I first came across this when I attended an Australian conference on tongue-tie about 7 years ago.  Dr S Zaghi, an American ENT specialising in is sleep disorders, presented some of the cases he had worked with where this therapy had formed part of a program of surgery and medical treatment for children and adults with sleep apnoea. Subsequently Mags Kirk, a speech therapist I have worked with for many years, trained in this therapy in the USA and uses it with the older children she sees.

But what is Myofunctional Therapy?

The Association of Oro Myofunctional Therapists describe the therapy on their website 1/5/2023)

Orofacial Myofunctional Disorders (OMDs) are disorders of the muscles and functions of the face and mouth. OMDs may affect, directly and/or indirectly,  breastfeeding, facial skeletal growth and development, chewing, swallowing, speech, occlusion, temporomandibular joint movement, oral hygiene, stability of orthodontic treatment, facial esthetics, and more.

Most OMDs originate with insufficient habitual nasal breathing or with oral breathing. The subsequent adaptation of the muscles and the orofacial functions to a disordered breathing pattern creates many OMDs. Orofacial Myofunctional Disorders may impact treatments by orthodontists, dentists, dental hygienists, speech-language pathologists, and other professionals working in the orofacial area.

“Correct swallowing depends on a proper relationship between muscles of the face, mouth and throat.”

Correct swallowing depends on a proper relationship between muscles of the face, mouth, and throat. The act of swallowing is one function that depends on the body’s vital balance. To swallow properly, muscles and nerves in the tongue, cheeks and throat must work together in harmony. When a person swallows normally, the tip of the tongue presses firmly against the roof of the mouth or hard palate, located slightly behind the front teeth. The tongue acts in concert with all the other muscles involved in swallowing. The hard palate, meanwhile, absorbs the force created by the tongue.

Because a person swallows 500-1000 times a day, improper swallowing can cause a variety of problems. But it is actually the resting position of the tongue that does the most damage because it is more constant.

OMT is a program used to correct breathing, swallowing, and chewing disorders, normalize freeway space, help stabilize the bite, and eliminate noxious oral habits such as tongue-thrusting and thumb-sucking. OMT stabilizes orthodontic, surgical, and dental results.

In simple terms myofunctional therapy is a program of exercises that target the facial muscles used in chewing and swallowing with the aim of improving muscle strengthen within the oropharynx (which includes the back part of the roof of the mouth, the side and back walls of the throat, the tonsils and the back one third of the tongue).  It also helps to reinforce the proper position of the tongue within the mouth.

So, what is the evidence for this therapy and is it effective in babies with tongue-tie?

Most of the research I could find on the use of myofunctional therapy seems to be in older children and adults and in relation to airway issues, dental issues, or speech.

A systematic review of the use of myofunctional therapy in the treatment of tongue-tie was published in 2022 by María del Puerto González Garrido and her team. The 11 studies included in this review predominantly looked at older children and adults but there were 3 that looked at babies up to 6 months old and these were in relation to breastfeeding.

One was a case report of a 17-day old which found improvements in length of breastfeeds, nipple pain and weight gain with myofunctional therapy (Ferrés-Amat el al, 2016). The baby had a tongue-tie division at 21 days alongside breastfeeding management and myofunctional therapy and was followed up at 38 days and 9 weeks.

The myofunctional therapy used in this case study involved:

The extraoral stimulation exercises are aimed at improving the newborn’s rooting reflex which are exercises that stimulate the masseter muscle (putting pressure with the index fingers and thumb, in a circular form in the area of the masseter muscles), stimulating the rooting reflex in the perioral region (with the thumbs and index fingers, moving forward on the upper and inferior lip in an alternating way and also making movements around the lips and on them with the fingers). The intraoral exercises have the function of stimulating the sucking reflex of the newborn. The areas to be stimulated are the palate, tongue, the inner surface of the cheeks, and the sucking reflex itself (through rotational movements while the newborn sucks the index finger).

But the question is would the baby have shown the same improvements without the myofunctional therapy. Quite possibly given the thousands of similar babies that I and my tongue-tie practitioner colleagues have treated for tongue-tie over many years without using this therapy but with similar positive outcomes.

In one of the other studies a sample of 171 babies with tongue-tie was split into 3 groups (Ferres-Amat et al, 2017):

  1. Breastfeeding support only
  2. Myofunctional therapy and breastfeeding support
  3. Tongue-tie division, myofunctional therapy and breastfeeding support

Babies with feeding issues which responded to 3 sessions of breastfeeding support formed group one (33 babies). Those that didn’t respond to breastfeeding support were referred for myofunctional therapy and had 30 minutes sessions over a one-month period (50 babies). Eighty-eight babies did not respond to breastfeeding support and myofunctional therapy and had tongue-tie divisions. All 3 groups reported improvements in nipple pain, length of breastfeeds and weight gain. But it is not stated when after the intervention’s outcomes were evaluated.

The biggest and most significant difference between the groups was in weight gain and this was better in group 2 that breastfeeding support and myofunctional therapy. But the severity of the tongue-ties was less in this group, than in the group 3 where the babies needed division to show feeding improvement and we do not have nay information on what other factors, beyond the tongue-tie, may have been contributing to the weight issues in any of the babies in any of the groups. For the 88 babies in group 3 division was delayed so they could have the one month of myofunctional therapy first and this kind of delay can lead to deterioration in feeding and milk supply which could explain why this group did not do so well post treatment with weight. So, it is difficult to say that the improved weight gain was down to the myofunctional therapy and if it was why did it not have a similar impact in group 3 that also had division? Interestingly in all groups there was a mixture of exclusively breastfed babies and babies who were mixed fed with breast and formula pre-treatment. Post treatment the biggest shift to exclusive breastfeeding was in group 3 that had the division.

In the third study from the systematic review (Pastor-Vera, et al, 2017) 61 babies aged 0-6 months with breastfeeding problems were included and split into 3 groups as in the Ferres-Amat et al (2017) study. All groups showed improvements in effectiveness of feeding and nipple pain. Over half the babies in the study had a type 3 tongue-tie which may cause milder breastfeeding difficulties than some of the more anterior ties. This study also mentioned the involvement of speech pathologists.

Both studies conclude that not all babies with tongue-tie need division to achieve improved feeding. I and many of my colleagues observe this daily and I would estimate that around a third of all the babies I see respond well to breastfeeding support or breastfeeding support and bodywork, without me needing to do a division. Similar results to those seen in this study may be obtained if you substitute myofunctional therapy for body work. A comparative study between myofunctional therapy and other physical therapies such as body work, speech therapy exercises, physiotherapy, and occupational therapy (used in the USA to address infant feeding difficulties) would be helpful in ascertaining the effectiveness of all modalities and whether myofunctional therapy offers better outcomes than these other modalities.

Myofunctional Therapy – are the exercises passive or voluntary?

Having spoken with my colleague Mags who is a myofunctional therapist, as well as being a speech therapist, it is my understanding that myofunctional therapy requires voluntary control. A baby would need to understand the ‘why’ and the ’how’ of doing the exercises and actively participate. The exercises used in the studies already mentioned were passive exercises. Many IBCLCs and speech therapists will recommend passive exercises to improve rooting and sucking reflexes so could the same outcomes be achieved without the input of a myofunctional therapist?

Robyn Merkel-Walsh, a US Speech Pathologist and Board-Certified Orofacial Myologist, argues that myofunctional therapy, which she practises, is not appropriate in the 0–4-year age group:

The treatment modalities used in orofacial myofunctional therapy to stimulate oral motor responses depend upon age and cognitive status. OMDs should certainly be treated in infants, young children, and individuals with special needs according to the methods of the pediatric feeding specialist. Orofacial myofunctional therapy requires volitional control and self-monitoring; as such, it is contraindicated for infants and toddlers as well as those individuals who cannot actively engage in therapeutic techniques.

Speech therapists/pathologists work with babies who have feeding difficulties providing oral exercises to strengthen mouth muscles and improve tongue movement and chewing technique.

Katie Carney in her blog ( explains how speech therapists use oral motor therapy in babies:

One aspect is oral motor therapy. This type of therapy involves pressure to the muscles in the jaw, lips, cheeks, and tongue. This deep pressure activates the sensory response within the muscle which activates the muscle. In this way we can build strength in the muscle to improve feeding for the infant and prevent or reduce difficulties with speech and feeding as the child grows older. Since the deep pressure is a passive movement (meaning the movement is performed by someone else, not the child) these exercises can be performed on newborns.

Another component of therapy with infants can be maintaining early reflexes necessary for the development of proper feeding skills.

So there seems to be an overlap between the work of speech therapists and myofunctional therapists when working with babies. They both work on the early reflexes of sucking and rooting and apply pressure to stimulate muscles. 

My conclusions

Whilst there may be some evidence that myofunctional therapy can be helpful as part of a programme of division and other interventions in older children and adults with tongue-tie, evidence is currently weak for its application in infants with tongue-tie.  Given that myofunctional therapy in older children and adults is an active therapy with the client fully participating and monitoring their own therapy, then it must be adapted for use in infants to a form of passive exercises. These do not appear to be fundamentally different to the kind of exercises and techniques used by speech therapists with babies with feeding difficulties. Furthermore, no comparative studies have been done, to my knowledge, looking at whether outcomes differ for babies with tongue-ties who see a myofunctional therapist compared to those that see a speech therapist as part of their treatment programme.

My own view is that when it comes to tongue-tie in babies with feeding difficulties, particularly in relation to breastfeeding, the IBCLC is the key professional and an experienced and skilled IBCLC will be able to offer guidance on addressing oral tension via oral exercises and bodywork. This may be alongside division where division is needed. But for more complex cases the oral exercises and oral motor therapy offered by a speech therapist can be invaluable.  Do the passive oral exercises used by myofunctional therapists in babies add anything to this and will they make a significant difference to feeding outcomes? I don’t think we can say without a lot more research.  Furthermore, I haven’t found any research that demonstrates that tongue-tie division in infants with or without myofunctional therapy will prevent long term issues with airway, speech, etc. Studies looking at speech outcomes in babies who have had divisions as babies have thrown up mixed results. I summarised this research in Chapter 7 of my book. See the extract below:

A Japanese paper from 2015 (Ito, et al) looked at the effectiveness of division in five children aged 3-8 years with articulation difficulties. The results were mixed with some early improvement seen in omission and substitutions of sounds in the first 3-4 months post division but ongoing issues with distortion noted at 1-2 years. A study in the USA by Richard Baxter and colleagues (2020) reported in a sample of 37 children aged 13 months to 12 years, that 89% showed improvements in speech at one month but there was no long term follow up. However, both studies are severely limited by their small sample size, the lack of a control group, and the lack of comparison with other interventions such as speech therapy which could be as effective or more effective than surgery.

Interestingly, another small study looking at 59 children aged 2 years one month to 4 years 11 months found no significant differences between those children that had had division, had a tongue tie but had not had division, and those that had never had a tongue-tie (Salt et al, 2020). They measured frenulum structure and function, tongue mobility and speech production and intelligibility. The authors concluded:

‘This study provides preliminary evidence of no difference between tongue mobility and speech outcomes in young children with or without intervention for tongue-tie during infancy. This study assists with clinical decision making and makes recommendations for families not to proceed with surgical intervention for tongue-tie during infancy, for the sole outcome of improving speech production later in life.’

Where does this leave parents?

Should parents invest in myofunctional therapy for their baby with a tongue-tie?

Based on the current evidence we have available there is nothing to suggest that myofunctional therapy will benefit all babies with a tongue-tie or is an essential part of treatment for these babies. Skilled breastfeeding support certainly is essential. For more complex cases where breastfeeding support, tongue-tie division and/or body work are not having the desired outcomes then there is a need to involve additional expertise. Input from a speech therapist or a myofunctional therapist may be equally helpful in these cases. We don’t know. Where any additional therapy be that bodywork, myofunctional therapy or speech therapy is going to be tried before a division of tongue-tie feeding needs to be monitored closely as it can deteriorate in some cases if division is delayed and in these situations breastfeeding can quickly become unsustainable. There is certainly no justification, based on current research evidence, for anyone to be suggesting parents must invest in myofunctional therapy to avoid long term health issues related to airway, speech, and dentistry.


I did a search online for myofunctional therapists who treat babies with feeding issues and found a London based private practice charging £1000 for an assessment and six 30-minute therapy sessions. There is no NHS provision for this therapy that I am aware of, and private provision is scant outside London. Tongue-tie division, lactation support and speech therapy are all available via the NHS. Obviously, there can be issues with access to these services in terms of referral criteria, local provision and waiting times. But clients of mine would be able to access private division and skilled lactation support from me, several sessions of body work from an osteopath, CST or chiropractor, and an assessment and treatment from a private speech therapist (who is also trained in myofunctional therapy) for less than this £1000 for myofunctional therapy alone. I have no idea why a therapy that has yet to be proven in the infant population is so expensive.

Families are currently facing the worst financial pressure for a generation, and I am anxious for those who feel under pressure to spend money on expensive therapies that may not be necessary or beneficial or live up to the claims being made about them. I am acutely aware when I see families and suggest bodywork for their babies that this may be out of their reach. But this is only a fraction of the cost of what some myofunctional therapists are charging and I am also comfortable with the fact that it will be helpful for most for the babies I refer.  At the moment I remain to be convinced when it comes to myofunctional therapy. I will be very pleased to see more research emerge on this so we can better help and support the babies with the more complex feeding problems.


Ferrés-Amat E, Pastor-Vera T, Rodríguez-Alessi P, Ferrés-Amat E, Mareque-Bueno J, Ferrés-Padró E. Management of Ankyloglossia and Breastfeeding Difficulties in the Newborn: Breastfeeding Sessions, Myofunctional Therapy, and Frenotomy. Case Rep Pediatr. 2016;2016:3010594. doi: 10.1155/2016/3010594. Epub 2016 Aug 30. PMID: 27688921; PMCID: PMC5021967.

Ferrés-Amat, E.; Pastor-Vera, T.; Rodriguez-Alessi, P.; Ferrés-Amat, E.; Mareque-Bueno, J.; Ferrés-Padró, E. The Prevalence of Ankyloglossia in 302 Newborns with Breastfeeding Problems and Sucking Difficulties in Barcelona: A Descriptive Study. Eur. J. Paediatr. Dent. 201718, 319–325

González Garrido, M.d.P.; Garcia-Munoz, C.; Rodríguez-Huguet, M.; Martin-Vega, F.J.; Gonzalez-Medina, G.; Vinolo-Gil, M.J. Effectiveness of Myofunctional Therapy in Ankyloglossia: A Systematic Review. Int. J. Environ. Res. Public Health 202219, 12347. Merkel-Walsh, R. (2020). Orofacial myofunctional therapy with children ages 0-4 and individuals with special needs. International Journal of Orofacial Myology and Myofunctional Therapy,46(1), 22-36.

Bodywork references

Hash J (2014) Deformational plagiocephaly and chiropractic care: A narrative review and case report. JOURNAL OF CLINICAL CHIROPRACTIC PEDIATRICS Volume 14, No. 2, March 2014

Davies NJ (2002) Chiropractic management of deformational plagiocephaly in infants: An alternative to device-dependent therapy. Chiropractic Journal of Australia. 2002 Jun;32(2):52-55

Chuang A (2014) Chiropractic treatment of gastro-esophageal reflux disease in a pediatric patient: A case report. JOURNAL OF CLINICAL CHIROPRACTIC PEDIATRICS Volume 14, No. 2, March 2014

Hubbard M (2014) Pediatric cholelithiasis and breastfeeding difficulties: A chiropractic case report. JOURNAL OF CLINICAL CHIROPRACTIC PEDIATRICS Volume 14, No. 2, March 2014

Herzhaft-Le Roy J, Xhignesse M, Gaboury I. Efficacy of an Osteopathic Treatment Coupled With Lactation Consultations for Infants’ Biomechanical Sucking Difficulties. J Hum Lact. 2017 Feb;33(1):165-172. doi: 10.1177/0890334416679620. Epub 2016 Dec 27. PMID: 28027445.

Lessard S, et al (2011) Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Compl Ther Clin Practice Nov;17(4):193-8#

Miller et al (2016) Parent Reports of Exclusive Breastfeeding After Attending a Combined Midwifery and Chiropractic Feeding Clinic in the United Kingdom: A Cross-Sectional Service Evaluation. Journal of Evidence-Based Complementary & Alternative Medicine 2016, Vol. 21(2) 85-91

Vallone (2004) Chiropractic Evaluation and Treatment of Musculoskeletal Dysfunction in Infants Demonstrating Difficulty Breastfeeding J Clinical Chiropractic Pediatrics 2004(Dec)

Hawk et al (2018) Manual Interventions for Musculoskeletal Factors in Infants With Suboptimal Breastfeeding: A Scoping Review. Journal of Evidence-Based Integrative Medicine Volume 23: 1-12

Dobson et al (2012) Manipulative Therapy for Infantile Colic (Review).

L. Vismara , et al (2019) Timing of oral feeding changes in premature infants who underwent osteopathic manipulative treatment, Complementary Therapies in Medicine, Volume 43, 2019, Pages 49-52. (

Chiropractic care for children: Controversies and issues. Paediatr Child Health. 2002 Feb;7(2):85-104. doi: 10.1093/pch/7.2.85. PMID: 20046278; PMCID: PMC2794701.

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