A family finds their way to both of these in the same week. A dentist releases a tongue tie and the discharge sheet mentions bodywork. A lactation consultant suggests craniosacral therapy for a baby who will not latch. A myofunctional therapist's name comes from the orthodontist. Then someone online says one of the two makes the other unnecessary.
They are not substitutes, and they are not two versions of the same idea. They differ on something more basic than technique: one is done to you, and the other is something you do. Everything else — who can receive it, how long it takes, what counts as progress, and what the research can and cannot say — follows from that.
One Is Passive. The Other Requires a Participant.
Craniosacral therapy is a passive, hands-on treatment. The patient lies still. The practitioner applies light contact to the head, spine, or elsewhere, and the intent is to release restrictions. Nothing is asked of the patient, and there is no homework.
Myofunctional therapy is the opposite in structure. As our page on myofunctional therapy for kids puts it, therapy "is not something done to a child — it is something the child practices." Sessions teach a movement or a posture; the change happens in the days between appointments, in short daily practice, repeated for months.
That distinction is not a detail. It determines who is eligible for each, how you would know whether either worked, and how the two can sit side by side in the same plan without competing.
What Craniosacral Therapy Claims
It is worth describing CST the way its own training body describes it rather than the way critics or enthusiasts do.
The approach comes from John Upledger, DO, an osteopathic physician who developed it from work at Michigan State University in the late 1970s and early 1980s. The Upledger Institute defines it as "a gentle, hands-on approach that releases tensions deep in the body," performed with "a soft touch which is generally no greater than 5 grams - about the weight of a nickel." The system it proposes to act on is "the membranes and fluid that surround, protect and nourish the brain and spinal cord," and the claimed scope is broad: to "alleviate a wide variety of dysfunctions, from chronic pain and sports injuries to stroke and neurological impairment."
Two things follow from that description that matter for a family comparing options. First, 5 grams is a genuinely gentle amount of force — this is not spinal manipulation, and parents who picture an adjustment are picturing the wrong thing. Second, the claimed scope is very wide, and wide claims are harder to evaluate than narrow ones. There is no specific functional target in that description you could measure on a Tuesday and measure again in eight weeks.
What Myofunctional Therapy Targets
By contrast, myofunctional therapy has a short, concrete list. ASHA's clinical guidance on orofacial myofunctional disorders frames the purpose this way: "The primary purpose of orofacial myofunctional therapy (OMT) is to create an oral environment in which typical processes of orofacial and dental growth and development can take place and be maintained."
In practice that comes down to four things: where the tongue rests when nobody is thinking about it, whether the lips seal at rest, whether air moves through the nose rather than the mouth, and whether the swallow is organized correctly or pushes forward against the teeth. Each of those is observable. A tongue thrust either is or is not present on an evaluation, and either has or has not changed three months later.
That narrowness is the point. It is also the fair criticism of myofunctional therapy's own evidence base, which we will get to.
The Two Evidence Bases Are Not the Same Shape
Craniosacral therapy: strongest in adult chronic pain, weakest everywhere families are sent
The most favorable review is a 2019 systematic review and meta-analysis in BMC Musculoskeletal Disorders (Haller et al.), which pooled 10 randomized trials covering 681 adults with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain. It found moderate effects on pain intensity and disability compared with sham, with effects still present at six months, and concluded that the data "suggests significant and robust effects of CST on pain and function lasting up to six months." The authors still asked for more trials "strictly following CONSORT."
Read the population list again, though: adults, with pain. Nothing in that review is about a tongue, a latch, a swallow, or an airway.
A 2024 systematic review and meta-analysis in Healthcare (Ceballos-Laita et al.) looked wider, across 15 randomized trials, and reached the opposite verdict. Its conclusion is worth quoting in full because it is unusually blunt for a journal abstract:
The qualitative and quantitative synthesis of the evidence suggest that CST produces no benefits in any of the musculoskeletal or non-musculoskeletal conditions assessed. Two RCTs suggested statistically significant benefits of CST in children. However, both studies are seriously flawed, and their findings are thus likely to be false positive.
The pediatric conditions it assessed were infant colic, preterm infants, cerebral palsy, and visual function deficits, and it found CST ineffective for all four. Two notes on reading this fairly. One is that the review's co-authors include Edzard Ernst, a long-standing and openly skeptical critic of complementary medicine, which readers are entitled to weigh. The other is that his skepticism is not the only thing holding the finding up: the pediatric trial most often cited in CST's favor is a 2019 randomized trial of 58 infants with colic (Castejón-Castejón et al.), and its published abstract reports identical numbers for crying hours and sleep hours at every time point, with the same confidence intervals and the same effect sizes — including negative values for sleep, which would mean less sleep in a paper concluding more. The paper later carried a corrigendum. That is the kind of flaw you can see from the outside.
A third review, a 2024 meta-analysis in Pain Management Nursing (Carrasco-Uribarren et al.) restricted to headache disorders, found CST produced "statistically significant but clinically unimportant change on pain intensity" and no change in disability, with the certainty of evidence "downgraded to very low."
The assessment problem underneath all of it
There is a separate line of research that gets less attention and is arguably more damaging, because it is about the evaluation rather than the treatment. CST assessment rests on a practitioner palpating a rhythm and locating restrictions. Several studies have asked whether two trained practitioners feel the same thing.
In a 1994 study in Physical Therapy (Wirth-Pattullo and Hayes), three physical therapists with craniosacral expertise each palpated the same 12 subjects. The intraclass correlation coefficient for agreement between examiners was −0.02 — essentially no agreement at all. The authors concluded that "therapists were not able to measure it reliably" and that "measurement error may be sufficiently large to render many clinical decisions potentially erroneous."
A 1998 study in the same journal (Rogers et al.) put two examiners on either side of a privacy curtain so they could not see each other, palpating 28 subjects simultaneously at the head and at the feet. Interrater coefficients were .08 at the head and .19 at the feet, intrarater coefficients ranged from .18 to .30, and — the detail that is hard to argue with — the rates palpated at the head and at the feet at the same moment on the same person were different. The conclusion: the results "did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably."
A third 1998 study in JOSPT (Hanten et al.) found that individual examiners were fairly consistent with themselves (0.78 and 0.83) but agreed with each other at 0.22, and allowed the obvious reading: "It is possible that the perception of CSR is illusory." A single practitioner being reliably consistent while disagreeing with every other practitioner is what you would expect if each were measuring something internal to themselves.
Myofunctional therapy's evidence is better, and still modest
Honesty cuts both ways here, and we are not going to pretend our side of this comparison is settled.
For the airway, the most cited work is a 2015 systematic review and meta-analysis in Sleep (Camacho et al.), which found myofunctional therapy "decreases apnea-hypopnea index by approximately 50% in adults and 62% in children" and concluded that it "could serve as an adjunct to other obstructive sleep apnea treatments." Adjunct is doing real work in that sentence. ASHA attaches its own caveat that "more studies are needed to evaluate compliance and the long-term effects of OMT on obstructive sleep apnea outcomes," and on myofunctional therapy for tongue tie specifically its evidence map notes that "the effects of myofunctional therapy alone are unknown." Our comparison of myofunctional therapy and tonsillectomy covers that literature in full, including the honest asterisks on the pediatric recurrence study.
So the fair summary is not "ours is proven and theirs is not." It is that myofunctional therapy has a body of trials aimed at the specific outcomes it claims, of modest size and quality, while craniosacral therapy has a contested body of trials aimed mostly at adult pain and almost nothing aimed at the mouth.
The Tongue Tie Question, Where Families Actually Meet Both
This is the real intersection. Infants released for a tongue tie are routinely referred to both a bodyworker and, later, a myofunctional provider, and parents are rarely told how differently the two are supported.
The AAP's August 2024 clinical report on ankyloglossia addresses it in two sentences. The first names CST outright:
Other treatments supported by some health care professionals include physical therapy, craniosacral therapy, or myofascial therapies. These treatments also are not well studied and often require out-of-pocket costs for families.
The second is about the nearest cousin to CST, and it is more precise:
Although osteopathic manipulation treatment has been shown to be helpful for latching problems in breastfeeding newborns, there is no research looking specifically at its role in helping with breastfeeding problems related to ankyloglossia.
That gap is real and easy to confirm. A search of the indexed literature returns no randomized controlled trial of craniosacral therapy for breastfeeding, infant feeding, or ankyloglossia — not a weak one, not a small one, none. The one indexed paper pairing CST with feeding is a 2016 practitioner perspective in Neonatal Network (Quraishy) describing how CST might be used in the NICU. A perspective article is a hypothesis, not a result.
"Not well studied" is not the same as "disproven," and families should hold that distinction. But it does mean that anyone promising a latch will improve because of craniosacral work is going well past what has been shown. If you want the functional side of what happens after a release — which weeks belong to the provider who performed it, what the research says about stretching and reattachment, and how retraining is sequenced — our guide to what happens after a tongue tie release covers it, and tongue tie therapy covers the before-and-after framing.
One more term worth untangling: the AAP sentence above groups craniosacral therapy with "myofascial therapies," and families often arrive having been told those are the same as myofunctional therapy. They are not, and the names are close enough that the confusion is predictable — we wrote myofunctional therapy vs. myofascial therapy for exactly that mix-up.
Why the Age Question Has Two Different Answers
Here is where the passive-versus-active distinction stops being philosophical and starts being practical.
Craniosacral therapy can be offered to a newborn precisely because it asks nothing of the patient. That is a genuine feature, not a trick: a two-week-old cannot cooperate with anything, so any intervention aimed at a two-week-old has to be passive.
Myofunctional therapy cannot work that way. It needs a patient who can follow a two- or three-step direction, tolerate someone looking in their mouth, watch themselves in a mirror, and manage a few minutes of practice most days. For most children that lands somewhere around ages 6 to 8, earlier for some and later for others.
So if your child is an infant, the honest answer is that a full myofunctional program is not the alternative to craniosacral therapy, because it is not on the table yet. For a baby, the interventions with the strongest support are lactation support and a feeding assessment — which is what feeding therapy for infants is, and what the AAP's own report means when it says that for ankyloglossia, "as always, a team approach to this issue is best." Habit elimination, pre- and post-release tongue mobility work, and feeding-related oral motor support can all begin before a child is ready for an exercise program; the full program waits.
Safety: Ask What Will Physically Be Done
The 2019 chronic pain meta-analysis found no serious adverse events in the five of ten trials that reported safety data, with minor events distributed equally between groups. On the evidence available, light-touch CST in adults is low-risk.
The documented harms involve force rather than light touch. A 2009 case report in Nederlands Tijdschrift voor Geneeskunde (Holla et al.) described a healthy 3-month-old girl who died after cervical and thoracolumbar manipulation by a craniosacral therapist; during "persistent forced deep flexion of the neck and spine" she became apneic and arrested, and the authors — noting this was the second such reported infant death after forced spinal manipulation — advised against the treatment in neonates and infants until effectiveness and safety are established.
A 5-gram technique and forced deep flexion of an infant's spine are not the same intervention, even when both are called craniosacral therapy. The useful conclusion is not a verdict on the field; it is a question to ask before any appointment: what, physically, will be done to my baby? Light sustained contact is one answer. Anything involving force applied to an infant's neck or spine is a reason to decline.
Myofunctional therapy's risks are different in kind and smaller in scale: time, out-of-pocket cost, and a program that stalls if readiness was not there to begin with. That last one is why we will say a child is not ready rather than start something that is going to fail.
How to Decide, and How They Can Coexist
Nothing above requires choosing. The two can run at the same time, and plenty of families do exactly that. What is worth insisting on is that each one carry a target you could check.
Ask what the goal is and how you would know. A myofunctional plan should name the thing it is changing — tongue rests on the palate rather than low in the floor of the mouth, lips seal at rest, breathing goes through the nose during sleep, the swallow stops pushing forward against the teeth — and you should be able to see those reassessed. If a treatment plan's goal is to release a restriction, it is fair to ask how that will be measured, and when you would conclude it had not worked.
Match the provider to the question. If the concern is a specific function — a lisp that has not resolved, an open-mouth posture, a tongue thrust, mouth breathing, snoring, jaw tension tied to a swallowing pattern — that is an orofacial myofunctional evaluation. If the concern is generalized tension or discomfort and you want hands-on care, that is a different question and a different provider.
Put the medical questions first. Neither therapy belongs ahead of a diagnosis. Snoring and restless sleep in a child who has not been evaluated means a physician, not a treatment purchase. A tongue tie decision belongs to the dentist, ENT, or oral surgeon. If a baby is not transferring milk, that is a lactation consultant and a pediatrician today.
Be skeptical of either/or framing. If someone tells you that craniosacral work makes myofunctional therapy unnecessary, they are claiming a passive treatment can install a habit. If someone tells you craniosacral therapy is worthless, they are overstating a mixed literature. The accurate version is duller than both: they do different things, with different amounts of support behind them, and the one with a measurable target is the one you can hold accountable.
If you have been told to do mouth exercises somewhere else and are trying to work out how that fits, our comparison of myofunctional therapy vs. oral motor therapy sorts out that pair as well.
What Bloom Does and Does Not Do
Bloom does not provide craniosacral therapy. Laura Friedman, MS, CCC-SLP, QOM is a speech-language pathologist and Qualified Orofacial Myologist; she is not trained in CST and does not bill for it. We also do not tell families not to pursue it — that decision belongs to you and your pediatrician, and this page is here to make it an informed one rather than to make it for you.
What we provide is the functional half: evaluating tongue mobility, resting posture, lip seal, nasal breathing and the swallow, building the retraining program, and coordinating with the dentist, ENT, lactation consultant, or orthodontist already involved. Sessions run in person at our Dallas office or through online myofunctional therapy nationwide.
Frequently Asked Questions
What is the difference between myofunctional therapy and craniosacral therapy?
The clearest difference is who does the work. Craniosacral therapy is passive and hands-on — the Upledger Institute describes "a soft touch which is generally no greater than 5 grams," aimed at releasing restrictions in "the membranes and fluid that surround, protect and nourish the brain and spinal cord." Myofunctional therapy is an active exercise and habit program the patient performs, targeting tongue resting posture, lip seal, nasal breathing, and the swallow. Nothing is released; a motor pattern is retrained over months of daily practice.
Does craniosacral therapy work?
It depends on what you are asking it to do, and the strongest evidence is in adult chronic pain rather than anything involving the mouth or airway. A 2019 meta-analysis of 10 trials in 681 adults with chronic pain found small to moderate benefits lasting up to six months. A 2024 meta-analysis of 15 trials concluded that CST "produces no benefits in any of the musculoskeletal or non-musculoskeletal conditions assessed," and that the two pediatric trials showing benefit "are seriously flawed." There is no randomized trial of craniosacral therapy for infant feeding, breastfeeding, or tongue tie at all.
Can craniosacral therapy replace myofunctional therapy?
No, for a structural reason. A tongue thrust, an open-mouth resting posture, or habitual mouth breathing is a learned motor behavior, and changing one takes repetition by the person who has it. A passive treatment cannot install a habit, however gentle or skilled, because nobody is practicing anything.
Can myofunctional therapy replace craniosacral therapy?
They are not aimed at the same thing. Myofunctional therapy is a narrow functional program with specific targets and has nothing to say about generalized tension or pain. It also requires something CST does not — a patient who can follow directions and practice, which is why infants are offered CST and are not candidates for a full myofunctional program.
What does the American Academy of Pediatrics say about craniosacral therapy for tongue tie?
It names it directly. The AAP's August 2024 clinical report on ankyloglossia states that "other treatments supported by some health care professionals include physical therapy, craniosacral therapy, or myofascial therapies," and that "these treatments also are not well studied and often require out-of-pocket costs for families." On the closest adjacent therapy it adds that "although osteopathic manipulation treatment has been shown to be helpful for latching problems in breastfeeding newborns, there is no research looking specifically at its role in helping with breastfeeding problems related to ankyloglossia."
Is craniosacral therapy safe for a baby?
Light touch is not where the documented harm comes from — the 2019 chronic pain review found no serious adverse events in the trials reporting safety data. The reported harms involve force: a 2009 Dutch case report described a healthy 3-month-old who died after "persistent forced deep flexion of the neck and spine" by a craniosacral therapist, and its authors advised against forced spinal manipulation in infants. A 5-gram technique is not that. Ask what will physically be done, and decline anything involving force applied to an infant's neck or spine.
Does Bloom provide craniosacral therapy?
No. Laura Friedman is a speech-language pathologist and Qualified Orofacial Myologist, not a craniosacral therapist, and Bloom does not provide or bill for CST. We also do not tell families not to pursue it. What we provide is the functional side: evaluating tongue mobility, resting posture, lip seal, nasal breathing and the swallow, and building a program with targets you can see change.
Want a Target You Can Actually Measure?
If you have been handed a list of therapies and no way to tell which one is addressing what, the useful next step is an evaluation that names the findings out loud. Schedule a free consultation with Laura Friedman, MS, CCC-SLP, QOM — in person in Dallas or online nationwide — for an assessment of what the tongue, lips, breathing, and swallow are actually doing, and a straight answer about whether myofunctional therapy belongs in your plan at all.