Feeding Therapist & IBCLCs: Understanding Their Roles in Breastfeeding, Bottle Feeding, and Pre/Post Frenectomy Support

When a baby experiences feeding difficulties, it can be difficult for parents to know where to turn for help.

Two professionals commonly involved in infant feeding care are International Board Certified Lactation Consultants (IBCLCs) and feeding therapists, often Speech-Language Pathologists (SLPs) or Occupational Therapists (OTs) with specialized training in infant feeding and swallowing.

While their areas of expertise may overlap, IBCLCs and feeding therapists bring different perspectives to the feeding team. In many cases, babies benefit from having both professionals involved.

Understanding the difference can help families find the right support for concerns related to breastfeeding, bottle feeding, oral function, swallowing, transitioning to solids, and feeding before or after a tongue-tie or lip-tie release (frenectomy).

What Is an IBCLC?

An International Board Certified Lactation Consultant (IBCLC) is a healthcare professional who specializes in the clinical management of breastfeeding and lactation.

IBCLCs support the breastfeeding parent, baby, and feeding relationship. Depending on their professional background and practice setting, they may provide support in hospitals, clinics, private practices, birth centers, or through virtual care.

An IBCLC may help with:

• Latch and positioning: Helping families find comfortable, effective breastfeeding positions and supporting an effective latch.

• Milk supply: Evaluating concerns related to low supply, oversupply, milk transfer, and milk production.

• Pain with breastfeeding: Helping identify possible contributors to nipple pain, breast pain, engorgement, or feeding discomfort.

• Pumping: Supporting flange fit, pumping schedules, milk expression, and maintaining milk production.

• Bottle feeding: Helping families introduce bottles, use responsive feeding techniques, and navigate the transition between breast and bottle.

• Breast health: Providing education regarding nipple integrity, plugged ducts, engorgement, mastitis, and when medical evaluation may be necessary.

• Milk transfer and weight gain: Looking at how effectively a baby transfers milk and collaborating with the baby's medical team when growth is a concern.

• Possible tethered oral tissues: Recognizing signs that may warrant further evaluation of oral structure and function and referring to appropriate providers when indicated.

• Pre- and post-frenectomy feeding support: Helping protect breastfeeding, milk supply, and the feeding relationship when a release is being considered or has been completed.

An IBCLC's primary area of expertise is lactation and breastfeeding management. When concerns extend beyond breastfeeding into oral-motor function, swallowing, feeding skill development, or more complex bottle-feeding difficulties, collaboration with a feeding therapist may be beneficial.

What Is a Feeding Therapist?

A feeding therapist is typically a Speech-Language Pathologist (SLP) or Occupational Therapist (OT), sometimes a Physical Therapist (PT), who has additional training and experience in pediatric or infant feeding.

For babies, feeding therapists evaluate how the mouth, tongue, jaw, lips, and other systems work together during feeding. Depending on their professional discipline, training, and scope of practice, they may also assess swallowing safety, sensory responses, positioning, and overall feeding development.

A feeding therapist may help with:

• Sucking and oral-motor function: Evaluating tongue, lip, and jaw movement and how those movements affect feeding.

• Suck-swallow-breathe coordination: Supporting babies who cough, choke, gulp, lose milk, become overwhelmed, or have difficulty coordinating feeding.

• Bottle-feeding difficulties: Evaluating nipple flow, positioning, feeding efficiency, oral function, and the baby's behavioral responses to the bottle.

• Feeding efficiency and endurance: Helping determine why a baby takes a long time to eat, fatigues during feeds, or struggles to consume an appropriate volume.

• Swallowing difficulties (dysphagia): SLPs with appropriate training can assess and treat swallowing difficulties and determine when additional medical or instrumental evaluation may be warranted.

• Feeding aversion or refusal: Helping babies who cry, arch, turn away, clamp their mouths, or demonstrate stress around feeding.

• Transitioning to solids: Supporting development of biting, chewing, tongue lateralization, cup drinking, and other age-appropriate feeding skills.

• Oral function and tethered oral tissues: Evaluating how tongue mobility and oral function may be affecting feeding and collaborating with other providers when a structural restriction is suspected.

• Pre- and post-frenectomy therapy: Addressing functional feeding concerns before a procedure and helping babies develop more effective movement patterns following a release when therapy is indicated.

  
  

A feeding therapist does more than simply look inside a baby's mouth. The goal is to understand how the baby actually functions during feeding.

IBCLC vs. Feeding Therapist: What's the Difference?

Although there can be overlap, the easiest way to think about the difference is:

An IBCLC primarily focuses on lactation, breastfeeding, milk production, milk transfer, and the breastfeeding relationship.

A feeding therapist focuses on the baby's feeding skills, oral function, coordination, swallowing, and feeding development.

For many families, these two specialties work best together rather than as an either/or choice.

When an IBCLC and Feeding Therapist Work Together

Some babies benefit from collaborative care.

For example:

Baby has difficulty latching:An IBCLC can evaluate positioning, latch, milk transfer, and maternal factors, while a feeding therapist can evaluate whether the baby's oral function or feeding skills are contributing to the difficulty.

Baby is struggling with bottle feeding:Both professionals may help with positioning, nipple selection, flow rate, and responsive feeding. A feeding therapist can further evaluate oral-motor function, suck-swallow-breathe coordination, swallowing, and feeding skill development when difficulties persist.

Baby has a suspected tongue tie:Rather than looking at appearance alone, the team should consider function. An IBCLC may evaluate how breastfeeding and milk transfer are affected, while a feeding therapist may assess oral movement and feeding skills. When appropriate, the family can then be referred to a qualified medical or dental provider for further evaluation.

Baby is preparing for or recovering from a frenectomy:An IBCLC can help protect breastfeeding and milk supply, while a feeding therapist can address functional feeding patterns and oral-motor skills before and after the procedure.

A frenectomy creates an opportunity for increased mobility, but release alone does not automatically change a baby's feeding pattern. Some babies benefit from additional feeding support to learn how to use that mobility effectively.

Which Professional Should You See?

Consider starting with an IBCLC if your primary concerns involve:

• Painful breastfeeding

• Difficulty latching

• Milk supply

• Milk transfer

• Pumping

• Breast health

• Breastfeeding positioning

• Transitioning between breast and bottle

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Consider a feeding therapist if your baby:

• Coughs, chokes, or frequently gulps during feeds

• Has difficulty coordinating sucking, swallowing, and breathing

• Frequently leaks milk while bottle or breast feeding

• Has persistent clicking or difficulty maintaining suction

• Takes an unusually long time to finish feeds

• Becomes fatigued during feeding

• Refuses or becomes distressed around the bottle

• Has difficulty progressing to solids

• Has concerns related to oral function or tongue movement

• Has a history of feeding or swallowing difficulties

• Needs feeding support before or after a frenectomy

And sometimes, the best answer is both.

Infant Feeding Support at The Mouth Rehab

At The Mouth Rehab, our Speech-Language Pathologists provide specialized infant feeding evaluations and therapy for babies experiencing difficulties with breastfeeding, bottle feeding, oral-motor function, swallowing, bottle refusal, feeding development, and pre- and post-frenectomy care.

We believe infant feeding care should look at the whole baby—not just the tongue, the bottle, or the latch.

Our clinicians collaborate with IBCLCs, pediatricians, ENTs, dentists, bodywork providers, and other members of a baby's healthcare team when appropriate to help families understand why feeding is difficult and determine the next steps.

If you're unsure whether your baby would benefit from an IBCLC, feeding therapist, or both, contact The Mouth Rehab. We can help you determine which type of support may be the best place to start.

Feeding your baby shouldn't feel like something you have to figure out alone. We're here to help you understand what's happening and create a plan that works for your baby and your family.