I am speech pathologist from Finland, took your class about Feeding Therapy: a sensory-motor approach at Helsinki last May. I am sending you an e-mail, because I met a new client shortly after the class and this case really bothers me. I have asked permission from parents, to send this e-mail and pictures/short video when he's eating. So, this boy is 5 years old, he has had feeding issues since he was baby. Nowadays he eats almost anything but no meat. It seems like he doesn't have enough strength at his muscles to bite. When he eats, he puts lots of food into his mouth, only couple of bites and then he swallows. Looks like he's gagging when eating. He uses only couple of words, can't elevate his tongue without gagging. And when pronouncing for example sound /a/, he gags and tongue goes into "cup." He can't reach his upper alveoli with his tongue. The situation is horrible, I have only met him couple of times and it seems like the posterior tongue-tip would be one problem, maybe also tissue around it. I am writing a paper about him because he's going to see a doctor in September. But if it's possible, I would like to get another opinion - yours :-) Thank you so much, if you have time to answer me.
You are absolutely correct. It looks like he has a type III posterior tongue tie. He probably cannot contract the lateral borders of his tongue. Chewing meat requires much more than just jaw strength, it requires being able to use the lateral borders of the tongue and cheeks together to stabilize the food. That is probably the problem when he is chewing meat. He cannot collect the bolus, and cannot stabilize the bolus on the molar ridge for mastication. He needs to be referred to an otolaryngologist (ENT) or an oral surgeon who understands the correlation between structure and function. Once his frenulum is released you may need to do the lingual exercises for function, BUT you will be able to facilitate the movements he needs for handling more difficult textures. GOOD OBSERVATION!!!!!!