Report By Fiona Rea, IBCLC, ALCI Council, July 2025.

Session 1 of this conference was Symptoms, Diagnosis, and Holistic Approaches and was broken into 3 talks.

Tina Greve IBCLC Midwife Spoke on Assessing All Factors in the Needs of Feeding infants

Below is a summary of Tinas Key Points on Breastfeeding Challenges and Assessment

🔹 Symptoms Are Often Misunderstood

Babies with unresolved feeding issues are often dismissed or misdiagnosed.

Crying for hours daily at 9 months is not normal and this suggests deeper issues.

Eliminating foods like cow’s milk may ease symptoms, but doesn’t address root cause  (e.g. tension, oral dysfunction).

🔹 Tension Patterns vs Tongue Tie

Many babies have tension patterns from birth trauma, in-utero position, or difficult births (e.g. vacuum extraction).

Tongue-tie (ankyloglossia) is often misdiagnosed or missed entirely, looking under the tongue is essential.

Release procedures (frenotomy) are sometimes incomplete or ineffective if tension isn’t also addressed.

Differentiating between structural (tongue-tie) and functional (tension) issues is crucial.

🔹 Birth History Matters

The baby’s birth story (position, intervention, trauma) influences function.

Malpositions like posterior or breech can affect head and neck alignment, leading to compensatory tension.

Babies from multiple births or with low intrauterine space may show restricted movement and feeding difficulties.

🔹 Functional Assessment of Feeding

Look at the baby’s behaviour at the breast, not just whether the latch “looks good.”

Evaluate:

      •   Jaw movement

      •   Chin and cheek contact

      •   Tongue movement (side-to-side, lift, cupping)

      •   Vacuum strength during sucking

      •   Ability to swallow and transfer milk

🔹 Positioning and Latch

Proper positioning and support can significantly improve feeding without surgery or devices.

Tina demonstrated with a case study where improved positioning alone led to rapid weight gain (300g in a week).

Chin needs to be well anchored on the breast; nose free doesn’t guarantee a good latch.

🔹 Clinical Observations Are Essential

 Parents often sense “something’s not right” but the lack language to explain it.

 Many babies previously assessed as “normal” were later found to have significant oral or structural issues upon thorough examination.

🔹 Interdisciplinary Support

Bodywork (e.g. chiropractic, osteopathy) may be critical in resolving tension.

Frenotomy should not be the first step but it is one part of a broader treatment plan.

🔹 Feeding Alternatives & Tools

 Alternative methods like finger feeding with a supplementer can be better than bottle for some babies.

Bottle feeding should match the baby’s capabilities; paced feeding helps mimic breastfeeding rhythms.

Focus on what the baby can do rather than only on limitations.

🔹 Breastfeeding Counselling Principles

Preserve milk production as without it, breastfeeding isn’t sustainable.

Work with the baby’s current abilities and build up gradually.

Adjust expectations and positioning depending on what the baby can tolerate.

Track improvements through observation and parental feedback.

Stefano Colasanto , DDS, DO, Orthodontist spoke about Postural Symptoms and Functional Impacts of Tongue Tie and Expectations in Adults
This presentation focused on the broader systemic effects of tongue tie, particularly in older children and adults. The speaker outlined four foundational concepts for understanding these effects: posture, routines, and three key functions — breathing, chewing, and swallowing.

1. Posture as a Compromise:
Posture is described as a continuous best compromise with gravity, changing from moment to moment.
Our brain constantly adjusts posture to maintain this balance in the most efficient way possible.

2. Routines and Habits:
Daily habits (e.g., screen time, sleep position, phone use, driving, sports) shape posture.
These routines contribute to chronic postural adaptations over time.

3. Three Foundational Functions:
Breathing: Ideally nasal. Mouth breathing disrupts posture and function.
Chewing: Influenced by number of teeth and side-dominance.
Swallowing: The oldest and most frequent function—occurring 2,000 times/day.
A disordered swallowing pattern significantly affects cervical spine alignment.
Incorrect tongue movement during swallowing can cause postural imbalances, including neck compression and cervical curvature changes.

4. The Role of the Hyoid Bone and Digastric Muscles:
Tongue tie restricts hyoid mobility, altering muscle function and forcing compensatory movements.
The temporal and mandibular bones shift to compensate, creating compression in the cervical spine.
Symptoms can include dizziness, neck pain, and a "buffalo hump" appearance in posture.

5. Visual Evidence:
Demonstrations using pre- and post-release photographs and body angle measurements show significant improvements in posture and dental alignment.
Tongue tie release and myofunctional therapy lead to measurable changes, including decreased forward head posture and improved oral rest position.

6. Assessment Tip:
Temporarily confusing the brain with a sensory spray under the tongue can simulate the effects of tongue tie release, showing immediate postural improvements.

7. Conclusion:
Swallowing patterns deeply affect posture.
Untreated tongue tie can lead to chronic systemic compensations.
Myofunctional therapy combined with release offers promising results even in older patients.

This presentation concluded with encouragement to maintain an open mind and consider comprehensive functional assessments, including posture and habitual function, in managing tongue tie.

Justin Roche MD IBCLC & Kate Roche BSc, MISCP, IBCLC Spoke about 12 Weeks to 12 Years –

Treating Toddlers and Older Children with Tongue Tie – Clinical and Surgical Considerations

Why Toddlers Get Missed or Return for Treatment

Missed as infants: Often due to good milk supply or bottle feeding masking symptoms; weight gain is not a reliable indicator of oral function.

Incomplete or reattached releases: Some had anterior-only releases, early reattachment, or suboptimal healing. It's hard to judge the original release without immediate post-op images.

Short-term vs long-term outcomes: Early improvements may mask persistent dysfunction, which can re-emerge as issues with sleep, feeding, behaviour, or development.

Long-Term Effects of Untreated or Poorly Treated Tongue Ties

Feeding and food aversions: Early compensations interfere with chewing, gagging, and moving to solids.

Sleep-disordered breathing: Snoring and poor sleep impact behaviour, emotional regulation, and school readiness.

Oral and facial development: Lack of tongue-to-palate contact affects craniofacial growth and neuromuscular development.

Motor and sensory challenges: Impacts core stability, movement coordination, proprioception, and balance. Early asymmetry or dominance can signal missed developmental milestones.

Behaviour and regulation: Dysregulated nervous systems can lead to misdiagnoses like ASD or ADHD, when in fact the root cause is physiological.

Therapy and Pre-Surgical Work with Toddlers

Functional therapy focus: Encouraging optimal use of the tongue and mouth in everyday activities, especially with food.

Family involvement: Parents are coached to provide frequent, functional practice throughout the day.

Making therapy fun: Using games, food play, and sibling modelling to increase participation.

Habit interruption: Essential before surgery—e.g. thumb sucking, lip compression—must be addressed to ensure effective healing and long-term success.

Surgical Techniques and Conscious Sedation

Staged surgeries: For older children, anterior release first, followed by posterior once therapy has increased mobility.

Conscious sedation: Enables a calm, safe environment where children can relax, making surgery easier and more effective.

Pain and anxiety management: Distraction tools (e.g. TV, games, cold spray) help during cannulation; children often remember only the fun parts, not the surgery.

Safety considerations: Bleeding risks (e.g. midline veins) are anatomical, not always due to technique. Practitioners must be trained and prepared to manage bleeding with pressure, suturing, and clear protocols—relying on emergency services is not a viable first plan.

Key Messages

Tongue tie issues don’t end in infancy—toddlers and children can show persistent or late-onset symptoms.

Functional outcomes matter more than just anatomical correction.

Multidisciplinary, individualised approaches are crucial.

Therapy must be engaging and tailored to family life.

Surgical safety, preparation, and appropriate follow-up are essential.