Tongue-Tie: Morphogenesis, Impact, Assessment, and Treatment – Order the Book Now!

Tongue-tie: Morphogenesis, Impact, Assessment, and Treatment busts the myths associated with tongue-tie that prevent the re-establishment of routine assessment and treatment of the condition in the early postpartum period. Dr. Hazelbaker provides both the old and new evidence that enables clinicians to properly assess, diagnose and treat this genetic condition that creates so many problems with infant feeding, speech, and orofacial development.

Dr. Hazelbaker presents the embryological and physiological underpinnings of tongue-tie, discusses tongue-tie’s impact, provides information on assessment and classification then rounds out her book with research-based treatment options and guidelines. She weaves in her personal story, having been tongue-tied and being the mother of two formerly tongue-tied children, as well as the stories of many other families into the science, creating both a readable and credible book. Tongue-tie: Morphogenesis, Impact, Assessment, and Treatment is the definitive book on tongue-tie that will serve health professionals and policy-makers worldwide as they endeavor to change the clinical culture surrounding this common but underappreciated problem.

Order the book now by visiting

ILCA Statement on Breastfeeding and Lactation Support During the COVID-19 Pandemic

Statement released: 18 March 2020

All international world health guidelines agree: Breastfeeding should continue and be supported during the COVID-19 epidemic, with appropriate precautions.

Breastfeeding protects infants and young children, particularly against infectious disease.1 When a person is lactating and becomes ill with a virus, they develop antibodies to fight the illness. Those antibodies are then conveyed to the infant through breastmilk, helping to protect the infant from illnesses to which the parent has been exposed.2

According to UNICEF, “Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions.”3

Now more than ever, families need lactation support to navigate infant feeding questions and challenges. According to the World Health Organization, “Breastfeeding counselling, basic psychosocial support and practical feeding support should be provided to all pregnant women and mothers with infants and young children, whether they or their infants and young children have suspected or confirmed COVID-19.”4

Breastfeeding or chestfeeding people at home with mild symptoms of a suspected COVID-19 infection are currently advised by WHO to wear a mask and perform hand hygiene before and after having close contact with the baby, in addition to other guidelines provided here.5

Breastfeeding or chestfeeding people with more severe cases can continue breastfeeding. If severe illness prevents direct breastfeeding, the parent should be supported to safely provide their expressed milk to the infant while continuing appropriate infection prevention and control (IPC) measures.6 If the lactating parent is too unwell to express milk, find resources for the delivery of human milk in WHO’s clinical interim guidance here.

Mothers and infants should be supported to stay together and maintain skin-to-skin care, regardless of suspected, probable, or confirmed COVID-19 status, while using appropriate precautions. See WHO’s interim guidelines, including appropriate IPC, here. 7

Skilled lactation providers in the community setting can consider telehealth when face-to-face care is challenging. ILCA is deeply grateful to health care providers in all settings during this critical time. In some areas and in some cases, delivery of lactation care via telehealth may be a resource. Find telehealth resources for lactation consultants here.

The International Lactation Consultant Association will continue to provide resources to skilled lactation providers during the COVID-19 pandemic. Find your regional guidelines, resources for lactation consultants, and communications tools here:

NOTE: Guidance for families and for those providing lactation support during COVID-19 is evolving. We at ILCA will do our best to keep this information as updated as possible. The information posted here may not reflect the latest news and practice guidance. Please visit our COVID-19 resource page here, review the full guidelines, and observe your local and regional care guidelines.

  1. World Health Organization. (2020).Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) is suspected. Retrieved from: WHO reference number: WHO/2019-nCoV/clinical/2020.4.
  2. Hanson, L. (1998). Breastfeeding provides passive and likely long-lasting active immunity. Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma & Immunology81(6). 523-33. DOI:1016/S1081-1206(10)62704-4.
  3. United Nations Children’s Fund. (2020). Coronavirus Disease (COVID-19): What parents should know. Retrieved from:
  4. World Health Organization. (2020).Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) is suspected. Retrieved from: WHO reference number: WHO/2019-nCoV/clinical/2020.4.
  5. World Health Organization. (2020). Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contact. Retrieved from: WHO reference number: WHO/nCov/IPC/HomeCare/2020.2. 
  6. World Health Organization. (2020).Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) is suspected. Retrieved from: WHO reference number: WHO/2019-nCoV/clinical/2020.4.
  7. World Health Organization. (2020).Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) is suspected. Retrieved from: WHO reference number: WHO/2019-nCoV/clinical/2020.4.


At what point does easy become complex? I recall, from my consultations with Ingram and colleagues when they were formulating the BTAT, that they were looking for a tongue-tie screening process that would take less time for the midwives to perform in the clinic. They then extracted certain elements from the ATLFF™© to make the process easier. Evidently, the BTAT was not enough to enable clinicians to diagnose tongue-tie easily and accurately because they have now augmented their BTAT with the TABBY, the pictorial tongue-tie assessment tool for tongue-tie in breastfed babies.

The TABBY must be used in conjunction with a structured breastfeeding assessment to serve as a frenotomy decision rule. Does it accomplish this task with objectivity and reliability? The authors claim that it does. They suggest that its strengths are “…it is easy to use, and it provides a visual aid to help the assessor be clear about crucial features of the tongue tie…” (Ingram et al., 2019).

Its weakness: “…it cannot be used alone to select infants for frenotomy as it does not include any assessment of feeding, for which a separate evaluation is needed using a structured tool…” (Ingram et al., 2019). So what was intended to be easy has, in fact, become quite complex. Now two or more tools and processes are needed instead of the one process of screening with the ATLFF™©. The ATLFF™© has always accurately screened tongue-tie in infants under six months regardless of feeding method. The ATLFF™© is a stand-alone tool that accurately identifies tongue-tie without having to include other structured assessments. Its scoring rules serve as a built-in frenotomy decision rule. Ingram et al. are reinventing the wheel.

Ingram, J., Copeland, M., Johnson, D. & Emond, A. (2019). The development and evaluation of a picture tongue assessment tool for tongue-tie in breastfed babies (TABBY). International Breastfeeding Journal. 14:31,

We have multiple modules on tongue-tie for your learning pleasure. To learn how to use the ATLFF™© click here. Visit our Education Catalog for all of our offerings.

Whenever I hear the words sleep training, I feel a little uncomfortable. Although I do not know much about the various methods of sleep training, it always seemed to me that letting a baby “cry it out” was cruel and potentially harmful. To become better informed, I listened to a presentation on the subject by Tracy Cassels, Ph.D. Dr. Cassels presented the science on sleep training, thoroughly examining the available research on the subject.

This is what I gleaned from the presentation:

-Many of the studies in support of sleep training suffer from poor methodology, thereby undermining the results.

-Many rely on parent report, which is notoriously inaccurate when the perceived intervention has been deemed to be helpful.

-Sleep training does not improve infant sleep. Babies do not sleep longer or better. Sleep-trained babies continue to awaken at night, and they do not cry for parental attention when they do.

-Infant and child-waking at night is normal. Parents have often been led to believe that it is not.

-Night-waking does not undermine proper cognitive development.

-Sleep training is stressful for both babies and their parents.

As a developmental psychologist, I feel most disturbed by the latter issue. Sleep training causes stress in the baby increasing cortisol levels. Extinction of the crying during sleep training does not decrease stress levels. Babies will continue to experience heightened stress and cortisol levels, even when they are not crying. We have known for some time that chronically elevated cortisol levels negatively affect the developing brain. Add to that the interruption of parent-child synchrony and co-regulation, the risk of long-term emotional regulation difficulties becomes very real.

I have hit just the highlights here. If you have ever been asked to help a parent with their sleep concerns, this presentation is a must-see. You can learn more at and see her presentation at

Dr. Alison Hazelbaker, a global leader in lactation education, announced today the launch of the Hazelbaker Lactation Institute. This online platform intends to teach the art and science of lactation to practitioners and health professionals who assess, treat, support, and advocate for parents and their newborn children.

The digital institute is an extension of Dr. Hazelbaker’s Columbus-based lactation practice and is designed to provide best in class resources and online training for lactation consultants, nurses, and other health professionals who provide lactation support to families. Hazelbaker Lactation Institute gives lactation professionals around the world access to one of the global leaders in lactation without traveling, attending a conference, or participating in an in-person training.

Dr. Hazelbaker specializes in cross-disciplinary services and is a certified Craniosacral Therapist, a Lymph Drainage Therapy practitioner, a Rhythmic Movement Training educator, a certified NOMAS assessor, and an International Board-Certified Lactation Consultant. In 2010, she became a fellow of the International Lactation Consultant Association (FILCA). She has also served as an educator for most of her career, most recently as a graduate-level adjunct professor.

Dr. Hazelbaker is adding the digital institute model to her offerings after 35 years of clinical practice. “I’ve supported a lot of professionals, families, and babies over the years through my clinical practice and educational offerings,” stated Hazelbaker. “My hope is that the digital institute reinforces the importance of the art and science in lactation education, and gives providers an engaging, interactive way to earn their CERPs online.”

The digital institute is launching with seven modules, including Using the Assessment Tool for Lingual Frenulum Function™© (ATLFF™©), Classifying Infant Sucking Problems, and Faux Tie: When Is Tongue-Tie Not A Tongue-Tie? Providers can earn between one and a half to two lactation continuing education recognition points (CERPs) per module.

Democratic Sen. Jeff Merkley and Republican Sen. Lisa Murkowski want to expand the right to pump on the job to millions more workers. Sens. Jeff Merkley (D-Ore.) and Lisa Murkowski (R-Alaska) introduced a bill that would extend the right to pump breastmilk on the job to salaried workers who are excluded under current law. If the proposal passed, employers would be required to provide a clean space and break time to nearly any worker who was pumping following the birth of a child. Merkley said it was a commonsense plan that would fill large gaps in a landmark bipartisan law he championed and passed with Rep. Carolyn Maloney (D-N.Y.) nearly a decade ago. At Hazelbaker Lactation Institute we concur on the importance of this proposed legislation because every baby deserves its mother’s milk and every mother deserves to maintain her milk supply and every breastfeeding dyad has a right to preserve their breastfeeding relationship. Senators propose new protection for breastfeeding workers.