When Feeding Becomes Distressing: Understanding Oral Aversion in Infants with Tongue Tie

Background
Oral aversion is a challenging and often distressing presentation that can be encountered in infants with tongue tie. It is commonly used to describe avoidance of oral stimulation, feeding experiences, or both. However, oral aversion frequently occurs alongside broader feeding difficulties characterised by avoidance, refusal and disrupted feeding interactions. The development and persistence of oral aversion may be influenced by negative oral experiences, as well as sensorimotor, medical, neurodevelopmental and relational factors.

Some infants with tongue tie develop feeding aversion in the context of unresolved feeding difficulties, while others continue to struggle despite undergoing intervention and successful structural release. Understanding the factors that contribute to the development and persistence of oral aversion may help clinicians identify infants at increased risk, determine when intervention is indicated, and recognise additional contributors to feeding difficulties. This knowledge can support multidisciplinary care aimed at reducing feeding distress and improving feeding outcomes.

Approach
This workshop will explore oral aversion through a broader feeding lens, considering how negative oral experiences, sensorimotor, medical, neurodevelopmental and relational factors may contribute to aversion in infants with tongue tie. Participants will explore two broad pathways to oral aversion in this population: aversion associated with unresolved feeding difficulties, and aversion that develops or persists following intervention, including situations where treatment-related experiences may contribute to the development or persistence of oral aversion.

Clinical case examples from breastfeeding, bottle feeding and later stages of feeding development will be used to examine presentations of oral and feeding aversion, the pathways through which they may develop or persist, and factors that may contribute to their maintenance. Discussion will consider implications for treatment decisions, including surgical decision-making, collaborative care and family support.

Outcomes
Participants will develop a deeper understanding of oral and feeding aversion in infants with tongue tie and the pathways through which these difficulties may develop or persist. They will be better equipped to identify infants at increased risk, recognise contributing factors, and incorporate these considerations into clinical reasoning, treatment planning and multidisciplinary care.