Hallie Bulkin

Somewhere along the way, the tongue tie became the whole conversation.

Someone finds it or rules it out, and that's where the feeding check starts and stops.

But we were never trained to treat feeding like one yes-or-no question, right? A breast or bottle feed is muscle skills, reflexes, senses, posture, the routine around the feed, and everything the parent notices after.

The tie is one part of that, and often not the loudest one.

So when a baby's feeding is off and there's no tie, keep looking. Feeding problems don't need a tie to be real.

Which of these 7 do you already check for? Drop them in the comments. 👇

Okay, my own list is calling me out right now.🤣

Every one of these comes from the same place. We care about the kid in front of us. So we rewrite the slide. We chase one more study. We turn a quick question into a whiteboard session. That's not a flaw. It's what happens when you're the clinician who sees what others miss instead of calling a tongue tie mild and moving on.

But there's a part I keep thinking about. A lot of that spiral happens because you're the only one in your building thinking this deeply. No one is there to check your plan with you. So you become a committee of one.

That's why I'm building The Integrated Therapist™. Excited to share more on it soon!

If you could pull one standing commitment off your calendar tomorrow without hurting your clients or your business, what would it be?

I wrote out the whole structure I used to climb out of that dread, and it's up on my Substack now. Comment SUBSTACK and I'll send you the link to read the full article.

The F.A.S.T. Myo Screening gives you a simple framework to guide your observations. It focuses on four key areas: Function, Airway, Structure, and Tongue.

Instead of guessing what to look for, you'll know what to check and what findings may impact treatment.

This is more than a screening tool or framework. It helps you explain your findings clearly to patients, families, and other providers.

When you can say: "Here's what I found. Here's why it matters. Here's what we should do next.", that's clinical confidence and that's what helps build trust, stronger referral relationships, and better care.

Comment FAST below to get the screening tool and start identifying the findings that matter most.

Here's the question I ask before I close any feeding eval:

1️⃣ Did I actually watch this child eat? Not an oral motor screen but a functional feeding observation with familiar food, in a setup that mirrors home.

2️⃣ Did I ask about breathing? Airway status, nasal patency, swallow-breath coordination, sleep. A child working hard just to breathe has nothing left for feeding.

3️⃣ Did family context shape my assessment—or get added on at the end? Goals, mealtime dynamics, caregiver stress. These aren't soft data. They're the plan.

All three need to be there before I draw any conclusions.

What does your eval always include and what do you find yourself skipping when time is short? ⬇️