Take Assessment

The following assessment can help you to identify if you or your child may have a tongue or lip tie.

*Adapted from Alabama Tongue Tie Center

First name

Last name

Infant/Feeding Issues (Past Or Present)

Painful Nursing or Shallow Latch

Frequent Spit Up/Reflux

Difficulty Bottle Feeding

Milk leaking around mouth during feeding

Slow or Poor Weight Gain

Excessive gassiness or fussiness

Prolonged Feeding Time (Breast/Bottle)

Clicking, Smacking, Chomping during feeding (Breast/Bottle)

Falls asleep during feeding (short, frequent feedings- seems to not get full)

Head/Neck Tension

Torticolis (Head Tilt or Side Preference)

Child or Adult Issues

Difficulty with Speech (Stutter, Baby Talk, Mumbling, Fast Speech, Lisp)

Speech Delay/History of Speech Therapy

Picky eater, especially with textures (e.g. meat, mashed potatoes)

Slow eater or trouble finishing a meal

Pouches Food or Takes Large Bites

Chokes or Gags on Liquids or Solids

Digestive Issues (Constipation, Upset Stomach, etc.)

Tongue Thrust/Reverse Swallow

Thumb or finger sucking or prolonged pacifier use

Crooked, crowded teeth, or highly-arched palate

Restless sleep (kicking or moving while asleep)

Snores, Open Mouth Breathing, Grinds Teeth at Night

Jaw joint (TMJ) issues (popping, clicking, or pain)

Mouth breathing during the day

Hyperactivity, inattention or behavioral challenges

Enlarged tonsils and/or adenoids

Frequent Headaches or Neck Pain

Recurrent Ear/Upper Respiratory Infections or Sinus Issues

Phone

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