IATP Website copy: Home page
Tongue-tie researchers and clinical experts from around the world comprise the members of the International Affiliation of Tongue-tie Professionals (IATP). Founded in 2009 under the leadership of Dr. Alison K. Hazelbaker in tandem with the first Summit participants, this organization dedicates itself to educating parents and professionals about tongue-tie and its proper assessment and treatment and furthers tongue-tie research by launching multi-center studies and supporting those who wish to formulate and implement new research. The IATP’s current focus centers on standardizing the conceptual definition of tongue-tie, classifying its types, generating both first-and second encounter assessment processes, and issuing policy statements about early assessment, proper treatment and post-surgical therapy and follow-up.
IATP members remain dedicated to two main principles: the prevention of later-in-life problems due to untreated tongue-tie, and the education of all based on both current research and solid clinical evidence.
IATP founding members: Back row: Dr. Greg Notestine; Dr. Isabella Knox; Dr. Jim Murphy; Dr. Mervyn Griffiths; Dr. Eyal Botzer; Dr. Roee Furer. Middle row: Ms. Dale Hansson; Dr. Alison Hazelbaker; Ms. Edith Kernermann (sp?); Ms. Catherine Watson Genna; Ms. Sandra Holtzman. Front row: Ms. Lisa Sandora ?, Dr. Sandra Sullise; Ms. Carole Dobrich. Not pictured: Dr. Elizabeth Coryllos, Dr. David Todd; Ms. Lisa Marasco, Dr.Larry Kotlow, Dr. Shaul Dollberg, Ms. Robin Glass; Dr. Roselina Cosentino; Dr. Brian Palmer, Ms. Monica Hogan, Ms. Bridget Ingle,Dr. Mary Ann O’Hara; Ms. Shari Silady, Ms. Jennifer Tow, Dr. Sharon Vallone, Dr. Virginia Thorley, Ms. Esther Grunis and Ms. Carolyn Westcot.
This website offers its visitors an opportunity to understand the tongue-tie phenomenon, its proper assessment and treatment (Photos and Assessment and Treatment links); look at its various presentations (Photos link); watch actual frenotomies (Photos) and identify a clinical practitioner in or near their geographical area, regardless of where they live in the world (Find a Practitioner link).
If you appreciate the efforts of the IATP and wish to support its mission, there are two membership categories that enable you to do so. For those visitors who are either clinical experts on the tongue-tie phenomenon or tongue-tie researchers, a (Join the IATP link) will enable you to become a Professional member and enjoy the benefits of Professional Membership as follows.
Access to fellow researchers and clinicians via the IATP listserv
Opportunities to join multi-center research efforts and/or to be supported in your own research efforts
Admission to all Winter and Summer Summit meetings and IATP sponsored conferences
Opportunity to educate both parents and professionals using the official policy statements and position papers of this reputable organization
Membership dues categories:
Supporting member: As a Supporting member, your dues help support the educational efforts of the IATP in the form of this website, its publications and its conferences. $25 USD
Associate member: As an Associate member, your dues help support the IATP’s educational and research efforts. As an associate member, you receive a conference attendance discount. $50 USD
Professional member: As a professional member, your dues allow you one vote, access to the IATP listserv and the other IATP members, invitation to all Summit meetings and a discount on conference registration fees. $150 USD
Institutional membership: Businesses and institutions who wish to support the research grant, publications and IATP sponsored conferences may join under this category. $500 USD
To become a member, click on this link (Join link).
Note: The IATP, although not yet a legal not-for-profit organization, engages in its various activities for the purpose of enhancing its main mission of educating parents and professionals and supporting research. It does not now nor will it ever intend to engage in profit-making activities for the sole purpose of earning a profit.
How to Use this Site
The Assessment link takes you to a discussion of the proper assessment of tongue-tie in various age groups. It presents the IATPS recommendations for first encounter assessment during the newborn period and discusses the assessment methods currently used for the more thorough assessment process to be performed by an expert in your area. Classification of tongue-tie also appears on this page along with photos showing examples of the two main classification types.
The Treatment link takes you to a discussion of the treatment options for newborns, children and adults. It presents the pros and cons of the two treatment options of frenotomy and frenectomy, and when to choose each . Drawings of each treatment method enhance the reader’s understanding of these two treatment approaches. (For video footage, please click on the Photos link). As well, this section presents and discusses post-surgical follow-up and therapy options.
The Photo Gallery allows the reader to see how tongue-tie presents differently in each individual. Various tongue-tie types in multiple age groups can be seen in the gallery. As well, the gallery provides video footage for those who wish to see both assessment and treatment in action. Photos and video footage were provided by the members of the IATP.
For IATP Policy statements, IATP Position Papers and various other tongue-tie publications or links to publications about tongue-tie, click on the Publications link. All IATP Policy Statements and Position Papers may be downloaded.
Many IATP members from around the world provided copies of their presentations for the reader’s learning. Please enjoy and learn from them as you stay on our site. These presentations are copyrighted by each individual and cannot be reproduced or downloaded. Soon, the IATP will provide continuing education opportunities, granting continuing education contact hours for various fields for a small fee using these presentations.
To locate a practitioner who will assess and/or treat you or your child’s tongue-tie, click on the Find a Practitioner button located on each page.
Please stay and explore. There is a world of expert information contained within these pages!
Definition of tongue-tie
Despite the generally recognized definition for tongue-tie that has been with us for hundreds of years, tongue-tie’s definition has only recently been formalized by the IATP members. Using a standardize and formalized definition should provide the foundation for a standardized assessment process, one that will yield accurate incidence statistics and enable practitioners around the world to easily diagnose tongue-tie. This standardized and formalized definition will aid research efforts to find answers to some persistent questions that remain about the tongue-tie phenomenon.
The International Affiliation of Tongue-tie Professionals defines tongue-tie as an:
Embryological remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement.
The members of the IATP have universally adopted this definition and use it consistently in presentations, discussion and research. The IATP recommends strongly that all future research be based upon this definition and that practitioners adopt this definition as the basis for their assessments and treatment decision processes.
History of assessment/Prior problems with assessment
In the past, assessment for tongue-tie in any individual has been based on the opinion of the individual performing the assessment. This led to remarkable variations in the numbers of individuals diagnosed as tongue-tied from assessor to assessor. Some practitioners and researchers found as great an incidence of tongue-tie of 75% and some as low as less than 1% based on their opinion of how tongue-tie affects each individual. To date, no universally accepted assessment process is in use despite the fact that several have been formulated and three have undergone research to determine their effectiveness.
Tongue-tie creates functional problems with the tongue, therefore, assessment for tongue-tie should quantify functional deficits, such as the ability of the tongue to sweep the mouth, protrude past the lower gumline and lift to the mouth roof without strain. Past assessments largely used appearance criteria (e.g. the heart shaped appearance of the tongue when protruded or lifted), which missed many tongue-ties and resulted in undertreatment of the condition.
The IATP was formed to resolve this problem. IATP members, all researchers and/or clinical experts, seek to replace this non-evidence-based manner in which assessments and diagnoses are performed by practitioners and researchers around the globe. By formulating an assessment process based on the research evidence, practitioners can assess tongue-tie with confidence and base their treatment decisions on an accurate diagnosis.
The IATP advocates the use of a broad and simple assessment as a preliminary screening during the first 48 hours post-birth. (See Rapid First Assessment for Tongue-tie in the video section) This assessment will flag many more babies than are actually tongue-tied. The flagged babies then will be assessed by a knowledgeable and well-trained practitioner who will perform a more thorough research-based assessment (using X.) At this point, a baby diagnosed with tongue-tie would either be treated by the assessor (if it is in their scope of practice) or will be sent to a practitioner who has expertise performing frenotomy.
A treatment decision rule for newborns involves first determining the manner of functional deficits the infant is experiencing and the degree of impact those deficits have on feeding, breathing and other oral tasks. The IATP recommends frenotomy for any tongue-tied infant who experiences problems with feeding, whether breastfed or bottle-fed and regardless of the presence of nipple pain and/or damage in the breastfeeding mother.
An algorithm that represents the assessment process can be found (here and in the publications section)
Thorough screening and/or assessment can be done with…ATLFF and TAPP
Older Children and Adults
In the early 20th century, most tongue-ties were identified and treated in the early infancy period. Routine assessment and treatment ceased during the 1950s. As a result, there are many more tongue-tied older children and adults Treatment becomes more involved the longer the individual has been tongue-tied. Treatment decision rule for children and adults therefore must take into consideration the totality of that individual’s problems. An older person may require a frenectomy rather than a frenotomy, their recovery period may be longer and they may need to undergo pre-and post treatment speech and/or occupational therapy to completely rectify the issues created by his or her tied tongue.
The Tongue-tie Assessment Protocol (TAPP) by Carmen Fernando, a speech-language pathologist who is an expert on tongue-tie, remains the most thorough assessment process for determining the presence of tongue-tie in older children and adults. Both the Marcheson and Kotlow Classification systems can also be used to diagnose tongue-tie and determine need for treatment in this population of tongue-tied people. (See References).
The IATP recommends that parents of older tongue-tied children and adults seek a knowledgeable practitioner (Find a Referral button here) who can thoroughly and accurately diagnose and treat tongue-tie. In the future, the IATP hopes to be able to recommend a standardized assessment protocol that has withstood the rigors of research.
Several classification systems have been developed throughout the years as a means to create a common clinical and research language for practitioners. Classification provides a standardized shortcut to communication. However, classification can never substitute for assessment because classification develops categories based on broad, general criteria whereas assessment uses specific, detailed criteria for the purpose of accuracy and thoroughness. The way in which tongue-tie presents in each individual varies so greatly that classifying is at best difficult, further making it difficult to categorize. At best, only very general categories can be formulated, using only a few descriptive qualities.
The IATP classifies tongue-tie as either anterior or posterior. An anterior tie presents more forward in the mouth, closer to the tongue-tip or at the tip; a posterior tie resides further back from the tongue-tip, nearer the base of the tongue or under the mucosa at the base of the tongue. Anterior ties are more visibly obvious whereas posterior ties can be missed because they are hard to visualize. (Further underscoring the ineffectiveness of a visual inspection without assessing for function.) A thorough functional assessment, however, easily confirms the presence of both anterior and posterior ties. (See Photos for pictures of anterior and posterior ties.)
The IATP is committed to standardizing classification to ease the discussion and dialectic process. Look to this website for more information about classification in the very near future.
Treating tongue-tie has become controversial in the last 60 years. Although most clinicians recognize the need for treatment, there remains significant resistance among some practitioner groups generally because many licensed health professionals no longer learn about tongue-tie in their training programs. When routine assessment and treatment fell by the wayside, so did proper education about this phenomenon. Although practitioners claim that lack of research that supported routine assessment and treatment contributed to the demise of these practices, it was the rise of the popularity of bottle-feeding that made the more significantly contribution. Along with the rise in artificial feeding by bottle, clinicians lost the skills to properly assess sucking efficiency and effectiveness. Most babies will grow on infant formula fed by bottle and so the perceived need to do proper and thorough assessment of infant suck became a skill mastered by only a few allied health professionals, most notably occupational therapists and lactation consultants.
The notion that any baby who has difficulty with feeding will do best on a bottle and teat with a large hole persists to this day. If a breastfed baby has difficulty sucking at breast, the advice to switch to a bottle constitutes an acceptable and desireable solution to the problem. Recent studies have shown, however, that tongue-tied babies can be compromised feeders whether breastfed or bottle-fed and that bottle-feeding may only serve to complicate and worsen the sucking deficits ad contribute to long-term dysfunction.
The IATP recommends early assessment and treatment of all babies regardless of feeding method.
Two main forms of treatment persist to this day: frenotomy and frenectomy. Frenotomy involves making an incision in the lingual frenum/frenulum to create more tongue mobility. No tissue is removed during this procedure. A frenectomy involves removing tissue from the underside of the tongue and then reconnecting the tissue on either side of the created wound with sutures.
Alternate terms for frenotomy include frenulotomy, division, revision and clipping. A frenotomy can be performed by many different practitioners in various health-care fields: physicians, dentists, oral surgeons, naturopathic doctors, nurse practitioners, midwives, and in some countries, International Board Certified Lactation Consultants. Three different tools for frenotomy are currently used: an electrocautery instrument, laser and scissors. Most practitioners use sterile scissors because they are readily available, inexpensive and easy to keep clean. Lasers, although becoming more popular, are less readily available, more expensive to use and require specialized equipment and training. Electrocautery is used by some practitioners but is relatively uncommon. The advantage of laser and electrocautery includes the ability to cauterize the wound and prevent bleeding. However, only one to a few drops of blood loss occurs with a scissors procedure in the vast majority of treatments. (See Photo section for videos showing each treatment method.)
With any frenotomy method, treatment takes only a few minutes and requires little to no anesthesia. The recovery process is rapid and very few complications arise. Some post-surgical tenderness and stiffness may occur for one to a few days. An over the counter analgesic usually overcomes the slight discomfort. Rarely does an individual develop a bleeding issue. Bleeding is easily counteracted with pressure or cautery using either a chemical agent or electrocautery. Post treatment exercising of the tongue is now a universal recommendation and should be undertaken as soon as possible after surgery. (See Photos for the Tongue Stretching Video
Oral surgeons and Ear, Nose, Throat doctors perform frenectomies. Frenectomies are typically used for older children and adults although the efficacy of frenectomy over frenotomy for this group has not yet been established in the research. Frenectomy requires the use of a general anesthetic although many procedures are now done on an outpatient basis. A scalpel is used to remove the lingual frenum/frenulum and then the wound edges are brought together and sutured. Post-surgical pain/tenderness commonly follows this procedure. Most individuals can minimize discomfort by using a mild analgesic. All individuals receiving a frenectomy will require post-surgical therapy delivered by a speech-language pathologist, or other practitioner who specializes in this form of therapy.
The IATP does not recommend frenectomy for infants unless a properly done frenotomy fails to resolve the problem.
If surgical treatment has been delayed or a particular baby is having feeding difficulty post surgery, a therapeutic regimen should be implemented by a practitioner who specializes in this form of therapy. Often for the breastfed baby, breastfeeding alone resolves any residual muscular imbalances and weaknesses and encourages proper tongue motion. A small percentage of breastfed babies will require tongue strengthening and rebalancing exercises and/or bodywork to resolve soft-tissue restrictions caused by the tongue-tie or developed as compensation for the tongue-tie.
Suck Training, craniosacral therapy, the Beckman Protocol, and other forms of occupational therapy and speech-language or oro-facial myology exercises may serve to resolve these issues. Experienced therapists can be found on this website (Referral page link here).
Research shows that the longer surgical treatment is put off, the more likely the tongue-tied individual will require a pre or post-surgical therapeutic regimen. More extensive therapy will be required for the older child and adult. Surgery then is only part of the treatment process.