Integrated Care in Tongue Tie & Tethered Oral Tissues

Tongue-tie (ankyloglossia) is frequently encountered in breastfeeding dyads, yet its impact extends beyond latch difficulties alone. Restricted tongue mobility can affect milk transfer, maternal comfort, infant weight gain, and the establishment of efficient feeding patterns. This presentation focuses on the functional implications of tongue-tie in the newborn period while placing it within a broader developmental context. Participants will explore how early oral dysfunction may influence feeding, breathing, and craniofacial growth, and why timely recognition matters. Emphasizing functional assessment and collaborative care, this presentation aims to support lactation consultants in identifying oral restrictions, optimizing breastfeeding outcomes, and contributing to informed, interdisciplinary management.

IBLCE Content Outline: I, III, VII
I Development & Nutrition
III Pathology
VII Clinical Skills

Babies over 4months have a developmental advantage over newborns in regards to post-frenectomy rehabilitation when we support their breastfeeding biomechanics holistically. Tongue-tie rehabilitation after sucking reflexes have begun integrating is very possible for a breastfeeding infant. In this presentation, Lauren draws on over 25 yrs of clinical experience supporting older babies who are having all, or some, breastfeeds prior to frenectomy and will outline the importance of helping infants progress their gross motor and fine motor skills (including oral-motor skills) in a holistic approach incorporating manual therapy, movement therapy, positioning and posture, and simple home exercises to support their breastfeeding technique for comfortable and effective breastfeeding long term after frenectomy.

IBLCE Content Outline: I, III, IV, V, VII
I Development & Nutrition
III Pathology
VI Techniques
VII Clinical Skills

This presentation explores the impact of tongue ties on neurodevelopment and upper airway patency in infants. It examines how restricted tongue mobility influences orofacial function, feeding, postural development, reflex integration and autonomic dysregulation. Michelle highlights the cascading effects of tongue ties on cranial nerve function, sensory processing and motor development. Particular focus is given to how oral dysfunction and restrictions may compromise upper airway patency and contribute to compensatory breathing patterns. Attendees will gain insight into assessment techniques, interdisciplinary approaches, and timing of intervention. Emphasis will be placed on supporting optimal neurodevelopmental outcomes through early identification and treatment in early infancy.

IBLCE Content Outline: I, III, VII
I Development & Nutrition
III Pathology
VII Clinical Skills

During the last couple of years there has been an increasing focus on (breast)feeding difficulties due to tongue-ties in infants. Many mothers experience breastfeeding challenges and sometimes an unwanted, and unnecessary, breastfeeding cessation. Some infants even struggle with bottle-feeding. At the same time, an increased focus of tongue-ties being related to (breast)feeding difficulties may also lead to over-diagnosing and/or over-treatment.  In this presentation, Tine will go through the main symptoms of tongue-ties and motoric restrictions in healthy babies that can be connected to or affect the (breast)feeding situation. She will look at the primary assessments that can help evaluate the most likely cause of the symptoms based on (breast)feeding anamnesis, examination of the baby and (breast)feeding observation. She will make suggestions for further treatment and counselling based on the findings. Have you ever seen things get worse after a tongue-tie release? Not all babies are ready for release at the time of the actual diagnosis. Tine will look at factors that contribute to predicting immediate outcomes of a release and suggest recommended pre-release treatment and plans for optimizing the chance of success.

IBLCE Content Outline: I, III, IV, V, VII
I Development & Nutrition
III Pathology
IV Pharmacology & Toxicology
V Psychology, Sociology & Anthropology
VII Clinical Skills

The positive impact of breastfeeding on infants and maternal health has been well documented in literature. Research in the last decade has increasingly highlighted that prolonged breastfeeding positively impacts jaw development and occlusion. After in-utero development, this could be the most potent time to contribute to the “function and form” relationship. What happens next for breastfeeding infants - in comparison to their bottle-fed counterparts - is potentially a superior functional trajectory that impacts breathing and sleep health, eating, speech and even long-term neurodevelopmental outcomes. Promoting and sustaining breastfeeding should remain a public health priority, given its enduring impact on health, quality of life, and healthcare systems across the lifespan. The contribution of oral ties in impeding prolonged breastfeeding needs to be considered in conjunction with other educational and clinical/therapeutic measures. This presentation will demonstrate several outcomes of the surgical intervention and protocol developed at Enhance Myofunction, comparing the treated population and the general population, with breastfeeding duration being one of several comparisons. The findings suggest that this IBCLC-centered, interdisciplinary model may be replicated in other settings to support breastfeeding longevity and optimise functional health outcomes.

IBLCE Content Outline: I, III, IV, VII
I Development & Nutrition
III Pathology
IV Pharmacology & Toxicology
VII Clinical Skills

Oral ties are more than a neonatal curiosity: they sit at the crossroads of feeding, functional movement, facial growth, and long‑term oral and airway health. For many newborns, a restrictive lingual or labial attachment can contribute to breastfeeding challenges such as sore nipples, inefficient milk transfer, and early cessation. Early recognition and collaborative care with lactation consultants, midwives, nurses, physicians, and allied health professionals can help families navigate feeding difficulties while honoring parental goals and infant cues. Emerging research suggests that restrictive oral tissues may influence more than just early feeding. Physiologic patterns established in infancy — from tongue posture and swallow mechanics to breathing and oral motor coordination — ripple into childhood and beyond, dental alignment, airway support, and orofacial development. This presentation brings together current evidence and practical insights so clinicians can confidently identify oral ties, understand their potential functional and developmental implications, and partner with families in compassionate care strategies.

IBLCE Content Outline: I, III, V, VII
I Development & Nutrition
III Pathology
V Psychology, Sociology & Anthropology
VII Clinical Skills

Primitive reflexes play a crucial role in early oral motor development, laying the foundation for essential functions such as sucking, swallowing, and speech production. However, when these reflexes are retained beyond their typical developmental timeline, they can contribute to dysfunctions in speech clarity, feeding efficiency, and overall orofacial muscle coordination. The persistence of primitive reflexes can result in compensatory behaviours that impact articulation, tongue posture, and swallowing patterns, often leading to long-term challenges in oral function. This presentation will delve into the relationship between retained primitive reflexes and the tongue, highlighting their influence on speech and feeding. Through case presentations, we will examine how unresolved reflexes manifest in clinical populations and the impact on oral-motor skills. Additionally, we will discuss the role of oromyofunctional therapy and other intervention approaches in addressing these dysfunctions to promote optimal oral development and function.

IBLCE Content Outline: I, III, VII
I Development & Nutrition
III Pathology
VII Clinical Skills

Treatment of tethered oral tissues in medically compromised infants can be a challenging endeavor. Treatment algorithms continue to evolve in the field of tethered oral tissues and in paediatric medicine. This presentation will perform a deep dive of the most commonly encountered coexisting medical conditions often seen in this patient population. 

After this presentation, participants will be able to:

1. Be able to identify a significant coexisting medical condition that may require a collaborative approach with various medical providers.
2. Understand risk/benefit of providing surgical treatment in the medically compromised infant population.
3. Be confident in how to specifically formulate a comprehensive treatment plan for these infants and dyads, and how to include the medical team.

IBLCE Content Outline: I, III, IV, VII
I Development & Nutrition
III Pathology
IV Pharmacology & Toxicology
VII Clinical Skills

Tongue‑tie can restrict tongue mobility and disrupt an infant’s ability to feed effectively, yet assessment and management practices remain highly variable. A recent systematic review by Necus et al. (2025) highlighted this inconsistency and reinforces a central message echoed across current literature: functional assessment must guide clinical decision‑making. The ICAP Practice Guideline (Smart et al., 2024) similarly emphasises evaluating tongue mobility, latch quality, suck–swallow–breathe coordination, and overall feeding function rather than relying on anatomical appearance alone.  Building on this shift toward functional assessment, emerging work is exploring how peri‑operative exercises can support recovery.  Smart, Grant & Tseng (2024) and Cook et al. (2025) describe how structured, developmentally appropriate pre‑ and post‑operative exercises may support improved feeding function and caregiver confidence following release. Despite this emerging evidence, clinical uptake remains inconsistent, and families often receive variable guidance. This presentation brings together current research and practical insights to explore how functional assessment and evidence‑informed peri‑operative exercises can work together to support infants undergoing tongue‑tie surgery. We will examine what functional assessment looks like in real‑world practice, how exercises may contribute to improved feeding outcomes, and what clinicians can do to provide clear, consistent, and family‑centred support. The aim is to move beyond the release itself and toward a more integrated, functional, and evidence‑informed approach to tongue‑tie care.

IBLCE Content Outline: I, III, VI, VII
I Development & Nutrition
III Pathology
VI Techniques
VII Clinical Skills

The increasing recognition and treatment of infant tongue-tie and tethered oral tissues has contributed to growing clinical complexity and variation in care pathways. Families are frequently required to make decisions about assessment and potential release procedures while navigating feeding challenges, conflicting information, and significant emotional pressure. This presentation explores the role of comprehensive assessment and shared decision-making in supporting families to make fully informed choices that align with their individual goals and circumstances. Rather than positioning surgical release as a predetermined outcome, this presentation focuses on an evidence-informed framework that prioritises clinical reasoning, informed consent, and family-centred care. Participants will examine the full spectrum of management options, including conservative strategies, staged intervention approaches, and surgical release where appropriate. Particular emphasis will be placed on communicating realistic expectations, discussing potential benefits and limitations, and reducing decisional pressure during a highly vulnerable period for families. Drawing on extensive clinical experience supporting families who elect release, delay intervention, or pursue conservative management alone, this presentation provides practical strategies for counselling, communication, and ethical practice. Attendees will gain tools to foster collaborative partnerships with families while maintaining professional integrity and supporting confident, informed parental decision making.

IBLCE Content Outline: I, III, IV, V, VII
I Development & Nutrition
III Pathology
IV Pharmacology & Toxicology
V Psychology, Sociology & Anthropology
VII Clinical Skills

We are facing a rise in surgical intervention of the maxillary labial frenum even though there is uncertainty regarding the definition of normal and abnormal frenum appearance. Many infants undergo surgical intervention for "upper lip tie” (ULT) to improve breastfeeding and prevent future difficulties. However, the effect of ULT on breastfeeding and if surgical correction improves outcomes, is still poorly understood with scant and contradictory data. There are multiple reasons for the limited amount of data including the lack of a standard definition for ULT which has led to ambiguity regarding a normal vs. abnormal frenulum and which may benefit from correction.Dr Weissman will summarize and analyze the current literature on upper lip tie, its impact during our lifespan and utility of therapeutic surgical intervention. 

IBLCE Content Outline: I, III, IV, VII
I Development & Nutrition
III Pathology
IV Pharmacology & Toxicology
VII Clinical Skills

Craniofacial maldevelopment has emerged as a modern epidemic, manifesting as dental malocclusion, airway restriction, and compromised bite mechanics. Neural crest cell (NCC) disruption during important embryonic windows (gestational weeks 4-7) is linked to morphological and functional impairments in modern populations. In this presentation, Scott examines how genetic vulnerabilities (BRAF, SHH, FOXG1), epigenetic modifications (maternal stress, nutritional deficiencies, declining breastfeeding rates), and environmental toxins (heavy metals, air pollution, pesticides) disrupt NCC migration and differentiation, resulting in maxillomandibular hypoplasia, nasal stenosis, and altered fascial composition, similar to Belyaev's domestication syndrome. Deficient Schwann cell populations impair nerve myelination, disrupt primitive reflex integration, and prevent cortical inhibitory control, causing speech delays, attentional deficits, and executive dysfunction. Altered trigeminal proprioception from malocclusion causing hemispheric cortical imbalances that impact arousal and cognition. Rapid human craniofacial gracilization implicates environmental, and lifestyle causes rather than genetic evolution, making this a preventable lifestyle condition. Prenatal therapies for maternal zinc and folate adequacy, stress reduction, and toxin minimisation, along with postnatal primitive reflex rehabilitation and orofacial therapy, may reverse this epidemic and promote lifelong health.

IBLCE Content Outline: I, III, VII
I Development & Nutrition
III Pathology
VII Clinical Skills