How can we help when a tongue tie procedure is not possible? By Meg Nagle IBCLC Reviewed by Dr. Vanessa Stitt

GOLD Learning Online Tongue-tie Symposium 2020
Date: September 14, 2020

Meg starts with listing her objectives- to describe the positions that tend to work best for babies who are having trouble latching, to explain how planning with the family helps leads to better outcomes, and to discuss possible challenges that might arise and how to best support families through them.
Factors that may lead to a tongue release not being possible or preferable are geographical, financial, cultural or personal preferences, or availability of services, especially in the light of COVID. Listening to the parent’s individual and personal preferences around feeding is paramount.
Meg describes the different symptoms of ties -the most common being infant’s inability to initiate and maintain a deep latch, to drain the breast efficiently and effectively, and maternal nipple pain. She explains colic appears to be linked to ties because digestion starts in the mouth and so ties can affect that first step in digestion, but that more research is needed.
Meg describes IBCLCs as detectives, not magical! It is up to IBCLCs to figure out what is going on with the breastfeeding dyad, and address these issues by offering different options to mom. She describes how to put the pieces together with four cardinal questions– how does it feel for you? Is your baby settled during feeding? Does your baby effectively and efficiently drain the breast? What are you feeling concerned about?
Meg states that there are many different tongue-tie assessment tool kits, and how this can lead to conflicting advice, but emphasizing the importance of symptoms, not just the oral assessment. She advises against the use of the term “mild” or “severe” tie, and the term”the latch looks fine” as being unhelpful. There is either a restriction causing issues with feeding, or not. How she asks the question of maternal nipple pain is important -is breastfeeding going to be sustainable in the context of this pain, or not?

• Latching and positioning – videos show babies diagnosed with tongue-tie. Video one shows a shallow latch, basically nipple feeding or straw feeding. Video two shows a baby struggling to initially latch, and difficulty maintaining suction. She suggests that we take the least invasive approach first.
• Techniques – Meg reminds us that laid back breastfeeding, self attachment and side lying has an evidence base (Genna 2015). The more hands on flipple technique is a second line option, with more maternal input. She has found that the half-koala/football upright hold, with a pillow providing baby some support at the back, in combination with self attachment or flipple can help. The best positioning is what works for the breastfeed dyad – offer different options. Supply lines like SNS can come in different options including homemade options. A plan should include short term and longterm goals, with reassessment and follow up. This plan must be formed by asking questions – are you feeling that you can continue to breastfeed as things are going now? Is getting a release an option if things don’t improve? Do you feel as though this plan that we’ve made is working for you? Outlining the different possible outcomes are also important – how does mom feels about these outcomes?
• Evidence, research and the internet – Meg makes the point that the internet often acts as a “broker” between parents and healthcare professionals. Linking with local release providers to keep up to date on current research is recommended. Giving parents up-to-date clinical evidence about the procedure is paramount.


Dr Vanessa Stitt September 2020.

Vanessa received a bursary of €50 from ALCI to virtually attend the GOLD Learning Online Tongue-tie Symposium 2020.

ALCI 2020 Conference Online

The Association of Lactation Consultants of Ireland (ALCI) will be hosting its annual breastfeeding conference online this year, to enable members to update their knowledge and skills while staying apart to stay safe.  The conference will go live on Saturday 26th September and is free to all ALCI members (join here) .  This date as always will coincide with the beginning of National Breastfeeding Week which takes place from 1st to 7th October.  There is a fantastic line up of speakers including Lyndsey Hookway IBCLC and Sleep Consultant.


Lyndsey is a co-founder of the Holistic Sleep Coaching Programme as well as renowned author of the book Holistic Sleep Coaching.  Lyndsey, an international Speaker has worked with infants and children for almost 20 years, and regularly teaches health, lactation and childcare professionals.  Lyndsey is a passionate believer in gentle responsive parenting that never compromises on infant mental health or feeding.  Lyndsey will present a live webinar on helping families with sleep issues while supporting responsive feeding and attachment.


Other speakers include Anne Fallon who will present the topic of Supporting Traveller Women in Ireland to Breastfeed; Denise McGuinness and Marie Conway will provide an update on the findings of The Latch On Study; Carol Smyth will present a case study on the establishment of breastfeeding in a baby with  Congenital Arhinia and Caoimhe Whelan will present on Supplementing at the Breast/Chest exploring the why, when and how.


During the online conference participants will be welcome to submit questions and time will be allocated at the end of each session for answers.  ALCI anticipate a lively interactive conference, with a difference and encourage as many members as possible to join on the day.  Following each webinar there will be a live interactive session to generate discussion and promote interaction and participants are encouraged to settle in with a drink of their choice to enjoy the catch-up.   The conference will be recorded and made available for a further week to ALCI members to review.


Similar to other years, three Annual Scholarships will be awarded; one to a first time IBLCE candidate from a non medical background, one to a first time IBLCE candidate from a medical background and one to a recertifying candidate. Each candidate will receive a €150  book fund and € 250 towards the cost of the exam.


In a year like no other, ALCI are proud be offering online education to members, while staying apart to stay safe.


Email with any queries.