
Tongue-Tie 101: Fundamentals of Assessment and Breastfeeding Management Lecture Pack
If you're new to tongue-tie, want to brush-up on your knowledge of fundamental skills or just can't get enough of our amazing speakers, then this package is for you! This lecture pack provides you with an amazing package of tongue-tie essential skills for anyone working with breastfeeding families. Join our expert speakers to learn more about tongue-tie assessment and differential diagnosis, the impact of tongue-tie on the fascial system, how to provide anticipatory guidance and post procedure support for families with an infant undergoing frenotomy, counseling skills to help with the mental health implications of a breastfeeding journey disrupted by tongue-tie and how to help when a family chooses not to release a tongue-tie.
*Please note that this package comprises several presentations from GOLD Learning Tongue-Tie Symposiums 2020 to 2022. If you have previously purchased and viewed the lectures through those packages, you will not be able to claim another accreditation certificate again.


Meg is the mother of three breastfed boys and lives with her husband and children in QLD, Australia. She is an International Board Certified Lactation Consultant (IBCLC) in private practice and works with parents to help them reach their breastfeeding goals. She has a degree in psychology and her prior work was is in counselling and sexual health. She was a La Leche League Leader (breastfeeding counsellor) for seven years before becoming an IBCLC. Meg is the author of two books including, "Boobin' All Day...Boobin' All Night. A Gentle Approach To Sleep For Breastfeeding Families". She has published articles in numerous parenting magazines and websites. She was also filmed for a short documentary, "Lactaboobiephobia", based on one of her blog posts which was released in 2016.
Topic: Breastfeeding With A Tongue Tie. How Can We Help When A Tie Revision Is Not Possible? - [View Abstract]
Topic: Exclusively Breastfeeding Triplets-Case Studies - [View Abstract]
Topic: Social Media Backlash – Addressing Emotionally Charged Responses - [View Abstract]
Topic: What to Do When the Laid-Back Breastfeeding Position Doesn’t Work…Self Attachment, the Flipple Technique and the Koala Hold All With a “Hands Off” Approach - [View Abstract]
1. List the positions that tend to work best for babies who are having trouble latching
2. Explain how planning with the family helps leads to better outcomes.
3. Discuss possible challenges that might arise and how to best support families through them if.
Breastfeeding a child with a tongue can be very straightforward with no challenges for mother or baby, or can bring numerous challenges and problems. There are circumstances when a tongue tie procedure is not possible or the parents choose to avoid having the procedure, yet want to continue to breastfeed if possible. There are ways that we can help! This presentation involves practical tips and suggestions for health care professionals on how to best support families in this situation including how to best cover different possible outcomes, forming plans and working through challenges.


Catherine Watson Genna BS, IBCLC is an International Board Certified Lactation Consultant in private practice in New York City. Certified in 1992, Catherine is particularly interested in helping moms and babies breastfeed when they have medical challenges and is an active clinical mentor. She speaks to healthcare professionals around the world on assisting breastfeeding babies with anatomical, genetic or neurological problems. Her presentations and her writing are enriched by her clinical photographs and videos. Catherine collaborates with Columbia University and Tel Aviv University Departments of Biomedical Engineering on research projects investigating the biomechanics of the lactating nipple and various aspects of sucking and swallowing in breastfeeding infants. She is the author of Selecting and Using Breastfeeding Tools: Improving Care and Outcomes (Praeclarus Press 2009) and Supporting Sucking Skills in Breastfeeding Infants (Jones and Bartlett Learning 2008, 2013, 2017) as well as professional journal articles and chapters in the Core Curriculum for Lactation Consultant Practice and Breastfeeding and Human Lactation. Catherine served as Associate Editor of the United States Lactation Consultant Association’s official journal Clinical Lactation for its first seven years.
Topic: Breastfeeding Strategies for Tongue-tied Infants - [View Abstract]
Topic: Critical Assessment of Apparent Tongue-Tie - [View Abstract]
Topic: Introduction to Cervical Auscultation - [View Abstract]
Topic: Lactation Support for Infant Biomedical Challenges - [View Abstract]
Topic: Organization of tongue movements before and after frenotomy for posterior tongue-tie: an Ultrasound analysis - [View Abstract]
Topic: Positioning and Latch for Breastfeeding - [View Abstract]
Topic: Ultrasound Analysis of Sucking: Tongue-Tie and Confounders - [View Abstract]
Topic: Using Breastfeeding Supplementers - [View Abstract]
1. Describe the kinematics (organization of tongue movements in space and time) of normal breastfeeding.
2. List validated assessment tools to identify ankyloglossia.
3. List 4 conditions that can be confused with tongue-tie.
Tongue tie is one potential cause of breastfeeding difficulties, but most authorities fear that frenotomy is overused. This presentation explores research on the role of the tongue during normal breastfeeding; briefly reviews validated assessment tools, and proposes other management, structural and medical issues that impact tongue mobility and feeding.


Leslie has been providing lactation support in Central New Jersey for over 18 years - as a La Leche League (LLL) leader since 2002, an IBCLC at Mercer County WIC from 2014 to 2016, and as a private practice IBCLC since 2011.
Leslie grew up in New York and New Jersey. She graduated from Cook College/Rutgers with a BS in Biochemistry, and from Rutgers University/UMDNJ with a PhD in Biochemistry and Molecular Biology. Leslie's difficulties with early breastfeeding, the help she received from LLL, and challenges with returning to work laid the foundation for her understanding of the importance of skilled and compassionate lactation and infant feeding support.
Topic: Getting Feeding Back on Track After Tongue-Tie Release - [View Abstract]
Topic: Untangling the Big Picture of Tongue-Tie Assessment - [View Abstract]
1. Explain the process for assessing infant oral structure and motion and its impact on feeding.
2. List the components of a complete assessment that extend beyond the oral cavity.
3. Describe the ongoing assessments that are needed through the course of care to allow for adjustments in the care plan.
IBCLCs assess chest/breast and bottle feeding skills, and infant’s oral and body structures and motions that contribute to, or inhibit, the process of feeding as well as post-feeding comfort. When infants present with feeding dysfunction, the root of the issue is often tight frenulum (ties), or asymmetric/tense muscles/fascia, or both. IBCLCs help families navigate the differential assessment of feeding dysfunction, and at the same time support the family’s feeding and milk supply choices. This presentation will examine the bigger picture of assessment when ties are suspected. Because a narrow focus on only the oral cavity can negate other contributing factors, initial and follow-up assessments need to include not just what is going on in the infant’s mouth, but also take into account the infant’s body as a whole, family dynamics, feeding goals, and the creation of a manageable plan for the family. IBCLCs aid with oral/body exercises, referrals for oral evaluations and/or bodywork, help with pre/post frenotomy oral skills, and more - helping to adjust the care plan as infant feeding skills and parent goals grow and change. Developing the skill of big picture assessment is crucial in order to determine the best course of clinical care, meet the families needs, and allow for the best possible outcome.


Dr. Ankita Shah is a leading Airway Focused Dentist. She is also the President of the India Airway Co-LAB Chapter initiated by AAPMD, New York & The Breathe Institute, Los Angeles. Dr. Ankita is also the only Indian Ambassador to be trained by the renowned ENT & Sleep Surgeon Dr. Soroush Zaghi. The Tongue Tie & Sleep Institute headed by her focuses on providing a comprehensive, holistic and multidisciplinary approach to all problems Tongue Tie, Airway & TMJ. She wishes to change the way in which medicine has approached problems in the past and provide patients with a redefined experience to dentistry.
1: Explain the foundations of anatomy and fascia that are necessary when diagnosing TOTs
2: Describe how fascia impacts posture, facial development and tongue
structure, function & mobility through different age groups
3: Explain the role of a fascial tongue tie release
What are tethered oral tissues and what is the role of fascia? Fascia is a thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. How is the fascial system connected to TOTS? The condition of tongue-tie and lip-tie exists on a continuum with variable visibility and symptoms differently across the body through different age groups. Some restrictions, mainly anterior or “classic” tongue tie, are highly visible and easier to detect. However, “posterior” or submucosal tongue-ties are often more challenging to diagnose. Through this session, we will explore a detailed dissection of what is fascia and how the concept of tongue ties has evolved and changed with the role of fascia and its impacts with TOTS. It takes a village of specialists to treat this challenging problem. We will learn how we can help prevent a vicious circle of problems if treated early with a holistic integrative approach.


Christine Staricka is a Registered, International Board-Certified Lactation Consultant and trained childbirth educator. As the host of The Lactation Training Lab Podcast, her current role focuses on training and coaching current and aspiring lactation care providers. Christine created and developed The First 100 Hours© concept, an early lactation framework designed to support lactation care providers with the knowledge and mindset they need to help families optimize early lactation. Christine worked as a hospital-based IBCLC for 10 years and has over 20 years experience providing clinical lactation care and support. She provides clinical lactation care to families at Baby Café Bakersfield and serves as its Director. Christine recently completed 6 years of service on the Board of the United States Lactation Consultant Association (USLCA.) She holds a Bachelor's Degree from the University of Phoenix. She has been married for 27 years, lives in California, and is the proud mother of 3 amazing daughters.
Topic: Tongue-Tied and Troubled: A Breastfeeding Journey at Risk - [View Abstract]
Topic: Your Responsibility to the WHO Code: Evaluating Real-World Scenarios for Compliance - [View Abstract]
1. Describe 3 characteristics of a lactation scenario involving tongue-tie which can trigger stress or strong emotions in the mother or lactating parent
2. Describe 3 behaviors which can be indicators of a need for screening for postpartum mood disorders
3. List 4 areas for questioning and counseling that lactation care providers should use to address common stressors in a lactation scenario involving tongue-tie
A suspected or diagnosed tongue-tie can throw a breastfeeding journey into immediate peril, with concerns over the baby's well-being most often discussed and debated. However, without an appropriate and intentional strategy for supporting the mother, the breastfeeding journey risks meeting an untimely, unplanned, and/or unsatisfactory end. The mental and emotional toll such a complex lactation situation can take on parents is wide-ranging in its effects, and it is critical to provide personalized and comprehensive counseling to restore a sense of empowerment and control to the mother as she makes continual decisions on how and whether to proceed with lactation and breastfeeding. Additionally, it is vital that indications of postpartum mood disorders are recognized and addressed as early as they appear. Lactation care providers can benefit from a clear framework for their fundamental responsibility to safeguard both the mother and child in a breastfeeding dyad. In this presentation we will explore ideas and themes that can guide the lactation care provider to ask the right questions at the right times in the specific context of tongue-tie so that they can offer effective counseling and care.


Dr. Agarwal went to medical school at All India Institute of Medical Sciences, AIIMS, in New Delhi, which is the premiere institution for medical training in India. After which, he came to the United States for his Pediatric Residency at the University of Texas Medical Branch at Galveston. Subsequently went on to join the Pediatric Nephrology fellowship at University of Florida at Gainesville. Under the program, he also conducted bench research at Ohio State University. Dr. Agarwal worked on the Eastern Shore of Virginia for eight years in general pediatrics before moving to Arizona to establish Agave Pediatrics in 2005. Over the years Dr. Agarwal has developed his own style of practicing pediatrics, which is strongly supportive of natural ways of taking care of children and emphasis on breastfeeding. During his practice, he realized that one of the biggest impairments in breastfeeding was the presence of labial and lingual ties. Having performed some procedures during medical school, he re-educated himself about the procedure and started performing them in 2007. In the last 15 years, Dr. Agarwal has performed more than 18000 frenotomies. Now, along with a busy clinical practice, he has made it his goal to spread the awareness about the issues related to labial and lingual ties to pediatricians, lactation consultants, doulas, midwives -everybody who helps mothers with the process of breastfeeding and in taking care of children with feeding and speech difficulties.
1: Explain the details of pre-frenectomy anticipatory guidance.
2: Describe post frenectomy management of pain, and exercises that may decrease the incidence of reattachment
3: Describe the nuances of care for the dyad, and the importance of individualizing care for the best possible results post frenectomy."
Frenectomy has become an increasingly more common procedure since the resurgence of interest in breastfeeding. Patient selection and anticipatory guidance provided to the family are key to success in reaching their goals. An honest discussion about the indications for doing the procedure and providing them with resources preemptively help in establishing trust and the future success of the procedure. After the procedure the care of the baby and the site are very intimidating to families and support at that time is vital to the success of the procedure. The post procedure experience can vary widely and to an extent depends on the family’s readiness. It is very important that post procedure be discussed before the procedure and support given after the procedure. Ultimately, the pre and post procedure interventions make the experience wholesome and conducive to successful breastfeeding.
Accreditation
CERPs - Continuing Education Recognition Points
Applicable to IBCLC Lactation Consultants, Certified Lactation Consultants (CLCs), CBEs, CLE, Doulas & Birth Educators. GOLD Conferences has been designated as a Long Term Provider of CERPs by IBLCE--Approval #CLT114-07. This program is approved for 6 CERPs (5 L-CERPs & 1 R-CERP).
CMEs - Continuing Medical Education Credits for Physicians & Nurses
The AAFP has reviewed the activity and deemed it acceptable for AAFP credit. Term of approval is from 09/09/2024 to 09/09/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity is approved for 6 AAFP Prescribed CME credits.
Nursing CEUs - Nursing Contact Hours
This nursing continuing professional development activity was approved by the American Nurses Association Massachusetts, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation for 6 Nurse Contact Hours. Nurse Contact Hours are valid until 09/09/2026.
Upon completion of this activity, GOLD participants will be able to download an educational credit for this talk. Please note:
- Credit awarded commensurate with participation.
- Requires completion of a 3-question post-test. Learners must score 100%.
- Requires completion of an evaluation form.
If you have already participated in this program, you are not eligible to receive additional credits for viewing it again. Please send us an email to [email protected] if you have any questions.
Additional Details
Viewing Time: 4 Weeks
Tags / Categories
(IBCLC) Clinical Skills, (IBCLC) Education and Communication, (IBCLC) Infant, (IBCLC) Pathology, (IBCLC) Techniques, (Prof) Physician / OBGYN, Breastfeeding the Tongue Tied Infant, Frenotomy & Tongue Tie Treatment, Tongue & Lip Tie Assessment, Tongue-tie, Lip Tie & Structure
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