What 'Tongue-tie School' teaches healthcare professionals

Fundamentals in Infant Tongue-tie Anatomy, Function & Treatment Considerations

A visible lingual frenulum can prompt urgent questions from families and confident opinions from professionals. Yet anatomy alone rarely explains an infant’s feeding experience. D-Restricted Ltd’s Tongue-tie School is built around a more careful starting point: anatomy provides information, while function provides context.

For professionals supporting infants and families, this distinction matters. Feeding concerns may involve positioning, attachment, milk supply, infant maturity, neurological or medical factors, bottle-feeding mechanics, maternal comfort, family goals and many other influences. A skilled response is not simply to identify a frenulum, but to understand the wider feeding picture and help families make informed choices.

Why tongue-tie education needs clinical reasoning

The term tongue-tie, or ankyloglossia, is used to describe a restrictive lingual frenulum that may affect tongue movement and function. However, terminology, diagnostic approaches and assessment methods are not universally consistent. A 2020 clinical consensus statement highlighted both areas of agreement and continuing uncertainty around the diagnosis and management of ankyloglossia, including disagreement around some commonly used terminology and the limitations of available evidence.

This is one reason that a visual finding should not be treated as a diagnosis in isolation.

For some infant–caregiver dyads, restricted tongue movement may be relevant to persistent feeding difficulty. For others, a frenulum may be visible without causing an apparent functional problem, or feeding concerns may be better explained by other factors. Families deserve neither dismissal nor the assumption that one anatomical finding accounts for every challenge.

A thoughtful assessment therefore brings together a detailed feeding history, observation of feeding where appropriate, infant oral function, maternal or parental experience, growth and milk-transfer concerns, and the wider clinical context. It also recognises the limitations of individual assessment tools. Tools can support structured observation and communication, but they do not replace professional judgement, clinical reasoning or shared decision-making.

This function-based approach is central to Tongue-tie School. The programme considers the relationship between anatomy, tongue movement, oral skills, infant feeding and the wider infant–caregiver feeding dyad, rather than focusing solely on the presence or appearance of a frenulum.

What Tongue-tie School covers

D-Restricted Ltd’s Tongue-tie School is a structured, accredited online education programme for healthcare professionals supporting infants and families. Fundamentals in Infant Tongue-tie Anatomy, Function and Treatment Considerations takes a function-based, evidence-informed approach to infant tongue-tie, exploring oral anatomy and function alongside infant feeding, assessment principles, treatment considerations, conservative management and ongoing support.

The programme is delivered through six self-paced modules and takes approximately 10 hours of study, with additional reading and self-directed learning. It provides 15 CPD points and 8 L-CERPs for IBCLCs, and participants retain ongoing access to the course materials and the Tongue-tie School community support hub.

Oral anatomy and physiology

The first module explores the relevant anatomy and physiology of the oral structures, including the tongue, oral cavity and surrounding structures, and their relationship with infant feeding function.

Understanding anatomy provides an important foundation, but the course encourages practitioners to consider what that anatomy means functionally. What can the infant actually do? How is tongue movement affecting oral skills? What is happening during feeding? And how does this relate to the experience of the infant and caregiver?

Functional considerations over time

The course then considers the potential relationship between oral ties, function and feeding experiences over time. Importantly, this is approached within the context of individual variation and the wider clinical picture.

Feeding is a dynamic process. An infant’s maturity, regulation, oral skills, feeding method and changing developmental needs can all influence how feeding presents. Understanding these factors can help practitioners avoid viewing tongue-tie as a static anatomical problem with a single predictable outcome.

Feeding assessment and differential diagnosis

Feeding difficulties are multifactorial. A baby who slips off the breast, feeds for long periods, coughs during bottle feeding, causes nipple pain or gains weight slowly may need timely support, but these signs are not specific to tongue-tie.

D-Restricted Ltd's 'Tongue-tie School' explores assessment principles, the role of assessment tools and differential diagnosis. This encourages practitioners to consider the whole feeding picture rather than allowing a particular sign or assessment score to become the diagnosis.

This approach is consistent with wider professional thinking around tongue-tie assessment. The University of Bristol, for example, notes that structured assessment tools can assist clinicians, but that assessment should be combined with clinical judgement and discussion with the mother about comfort and perceived feeding effectiveness.

Depending on the individual situation, appropriate support may include skilled breastfeeding or chest/body feeding support, responsive bottle-feeding guidance, review of milk supply, pump or flange support, oral-function support, bodywork where appropriate, or referral to another suitably qualified professional.

The right next step depends on the infant, the feeding relationship, the clinical findings and the family’s priorities.

Body therapies, tongue exercises and sensorimotor oral activities

The programme also considers supportive approaches including body therapies, oral play, tongue exercises and sensorimotor oral activities.

These are considered within the broader concepts of preparation, rehabilitation and ongoing feeding support rather than as isolated interventions. The emphasis remains on understanding why an approach may be appropriate for an individual infant and how it fits within the wider feeding journey.

Frenulotomy: evidence, uncertainty and clinical considerations

Where frenulotomy is being considered, professionals need to understand both the potential benefits and the limitations of the available evidence.

NICE guidance states that there are no major safety concerns identified with division of ankyloglossia and that limited evidence suggests the procedure may improve breastfeeding. NICE also recommends that the procedure should be performed by appropriately trained registered healthcare professionals, with appropriate arrangements for consent, audit and clinical governance.

Research on frenulotomy in young infants suggests that it may reduce maternal nipple pain in the short term for some breastfeeding dyads. However, the evidence for consistent improvement in infant breastfeeding outcomes and longer-term breastfeeding success remains limited. The Cochrane review found a short-term reduction in maternal nipple pain but no consistent positive effect on infant breastfeeding, while also noting the small number of studies and methodological limitations.

A UK randomised controlled trial involving infants with mild-to-moderate tongue-tie found no difference in its primary breastfeeding outcome at five days between early frenotomy and standard breastfeeding support. Maternal breastfeeding self-efficacy improved, however, illustrating the importance of considering both clinical outcomes and family experience.

D-Restricted Ltd's 'Tongue-tie School' encourages professionals to engage with this uncertainty rather than presenting frenulotomy as an automatic solution. A procedure may be one consideration where there is a clear functional concern and persistent feeding difficulty despite appropriate support, but the appearance of a frenulum alone does not establish that an intervention is required, nor can a procedure guarantee a particular feeding outcome.

The programme addresses surgical release methods, risks and clinical considerations, but it is not a surgical skills course. Its focus is on developing the knowledge and reasoning required to understand treatment pathways, informed decision-making, preparation and aftercare within the practitioner’s own professional role and scope of practice.

Assessment and completion

Assessment is designed to support both knowledge acquisition and reflective clinical thinking.

Participants complete six module quizzes, with a minimum pass mark of 80% for each assessment. They also submit a reflective case study based around an infant feeding journey. The case study encourages participants to consider the journey holistically, including initial contact, assessment considerations, potential treatment options, referral pathways, follow-up care and ongoing support for the infant, mother and wider family network.

Successful completion of the required elements leads to a Certificate of Online Attendance and Certificate of Accreditation. The programme is self-paced and on-demand, with an estimated study time of approximately 10 hours, alongside additional reading and self-directed study. Participants also have ongoing access to the Tongue-tie School community support hub while the programme remains available.

The programme is accredited by Advantage and has been awarded 8 L-CERPs by the International Board of Lactation Consultant Examiners (IBLCE), alongside 15 CPD points.

Regulation, professional scope and clinical governance

Education and training are only one part of safe tongue-tie practice. In the UK, all tongue-tie release providers must be registered and regulated by both a professional regulatory body and the appropriate service regulatory body. Importantly, undertaking a tongue-tie training course does not, in itself, give a practitioner the authority to perform a surgical procedure. Any surgical procedure must fall within the scope of practice of the professional regulator under which the practitioner is registered. (Association of Tongue-tie Practitioners, Tongue-tie Training FAQs)

Professional regulatory bodies

There are nine professional regulatory bodies in the UK. However, where surgical tongue-tie release is concerned, the professional regulatory bodies currently applicable are:

• Nursing and Midwifery Council (NMC)

• General Medical Council (GMC)

• General Dental Council (GDC)

The procedure must fall within the scope of the practitioner’s professional regulator in order for them to undertake it. Practitioners must also ensure that they have the appropriate education, training, competence, experience, professional indemnity and clinical governance arrangements required for their role.

This distinction is important. A practitioner may complete additional education in infant tongue-tie, but a course or certificate does not independently extend their statutory professional scope of practice. Practitioners remain responsible for working within the requirements of their professional regulator and their own competence. The ATP specifically highlights this distinction within its guidance on tongue-tie training and regulation. (Association of Tongue-tie Practitioners, Tongue-tie Training FAQs)

Service regulatory bodies

Professional regulation is separate from regulation of the healthcare service in which tongue-tie release is provided. Private practitioners are also required to consider the service regulatory requirements applicable to the location in which they practise.

The relevant service regulatory bodies are:

• Care Quality Commission (CQC) – England

• Healthcare Improvement Scotland (HIS) – Scotland

• Jersey Care Commission (JCC) – Jersey

• Regulation and Quality Improvement Authority (RQIA) – Northern Ireland

At the time of writing, practitioners providing tongue-tie services in Wales are not required to register with Healthcare Inspectorate Wales (HIW). (Association of Tongue-tie Practitioners, Tongue-tie Training FAQs)

The regulatory position therefore involves more than simply completing a course. Practitioners undertaking tongue-tie release need to consider their professional registration, scope of practice, service registration requirements, professional indemnity, training and competence, consent, clinical governance and ongoing professional responsibilities.

The Association of Tongue-tie Practitioners also requires practitioners listed within its directory to be registered healthcare professionals, appropriately insured and regulated for surgical procedures where required by law. The ATP is not itself a regulatory body and does not regulate individual practitioners or services; responsibility for meeting the relevant professional and service regulatory requirements remains with the individual practitioner and service. (Association of Tongue-tie Practitioners)

Practitioners should ensure that they understand and comply with the regulatory requirements applicable to their individual professional registration and service before undertaking tongue-tie division.

Who is D-Restricted Ltd's 'Tongue-tie School' for?

Tongue-tie School has been developed for healthcare professionals supporting infants and families, particularly those working across infant feeding, maternity, neonatal and early-years settings.

The programme is suitable for a range of professional backgrounds, including:

• Registered nurses

• Midwives

• Health visitors

• International Board Certified Lactation Consultants (IBCLCs)

• Lactation consultants and infant feeding specialists

• Healthcare professionals supporting infants and families

• Existing tongue-tie providers seeking to refresh and consolidate their knowledge

The programme is designed to complement existing professional knowledge rather than replace it. Participants bring their own clinical experience and professional perspective, while the course provides an opportunity to develop a deeper understanding of infant tongue-tie, oral function, feeding and treatment considerations within a multidisciplinary context.

Why aftercare begins before a decision

Families often arrive at an appointment having already read conflicting advice. Some may have been told that a procedure will solve every feeding concern; others may feel that their concerns have been minimised. Both experiences can add pressure at a time when feeding may already feel exhausting.

Good aftercare begins with preparation before any intervention is considered.

Professionals can help families understand what is known, what remains uncertain, what support will continue regardless of the decision, and when further review may be appropriate. If a frenulotomy is undertaken, feeding support remains central. A procedure does not remove the need for responsive feeding care or eliminate the possibility that more than one factor may be affecting feeding.

Clear communication also means respecting different feeding goals. Breastfeeding, chest/body feeding, expressing, bottle feeding, combination feeding and changing feeding plans are all decisions that deserve non-judgemental support.

The clinical task is not to direct every family towards a preferred outcome, but to provide accurate information, recognise individual circumstances and support informed decision-making.

Learning that strengthens collaborative care

Tongue-tie work is most effective when it is collaborative.

Midwives, health visitors, neonatal and paediatric teams, GPs, nurses, IBCLCs, infant feeding specialists, speech and language therapists and other professionals may each see different aspects of the same feeding journey. Shared language, appropriate referral pathways and an understanding of professional scope can help reduce duplication, mixed messages and delays in support.

For practitioners, education also creates space for reflection. It is reasonable to hold uncertainty, seek a second opinion and recognise when a concern sits outside one’s scope of practice.

Clinical confidence is not about having a quick answer for every infant. It is about knowing how to gather relevant information, weigh evidence, recognise uncertainty, explain options and remain attentive to the family in front of you.

D-Restricted Ltd's 'Tongue-tie School' community support hub extends this learning beyond the formal modules, providing participants with opportunities for professional discussion, shared experiences, resource exchange and continued connection with colleagues working in infant feeding and tongue-tie support.

A deeper approach to infant tongue-tie education

D-Restricted Ltd developed 'Tongue-tie School' for professionals who want to develop a deeper understanding of infant tongue-tie through anatomy, function, feeding and evidence-informed clinical reasoning.

The Fundamentals in Infant Tongue-tie Anatomy, Function and Treatment Considerations programme does not promote a single pathway for every infant. Instead, it encourages practitioners to look beyond anatomy alone, consider the whole infant–caregiver feeding dyad, recognise the multifactorial nature of feeding difficulties and support families through informed, individualised decision-making.

With six self-paced modules, approximately 10 hours of learning, 15 CPD points, 8 L-CERPs for IBCLCs, module assessments and a reflective case study, the programme provides a structured opportunity for healthcare professionals to develop and consolidate their knowledge.

Further information: Tongue-tie School – Fundamentals in Infant Tongue-tie Anatomy, Function and Treatment Considerations

Every feeding journey deserves to be heard in full. When professionals look beyond anatomy alone, they are better placed to ask meaningful questions, recognise uncertainty, work collaboratively and provide care that is calm, respectful and responsive to the individual infant and family.

References

Association of Tongue-tie Practitioners (ATP) (2025) Tongue-tie Training FAQs. Available at: https://www.tongue-tie.org.uk/tongue-tie-training?locale=en (Accessed: 15 August 2026).

Emond, A., Ingram, J., Johnson, D., Blair, P., Whitelaw, A., Copeland, M., Sutcliffe, A. and Barlow, S. (2014) ‘Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie’, Archives of Disease in Childhood: Fetal and Neonatal Edition, 99(3), pp. F189-F195.

Messner, A.H., Walsh, J., Rosenfeld, R.M., Schwartz, S.R., Ishman, S.L., Baldassari, C., Brietzke, S.E., Darrow, D.H., Goldstein, N.A., Levi, J., Meyer, A.K., Parikh, S.R., Simons, J.P., Walsh, S.A. and Yellon, R.F. (2020) ‘Clinical consensus statement: Ankyloglossia in children’, Otolaryngology-Head and Neck Surgery, 162(5), pp. 597-611.

National Institute for Health and Care Excellence (NICE) (2005) Division of ankyloglossia (tongue-tie) for breastfeeding. Interventional Procedures Guidance 149. London: NICE.

O’Shea, J.E., Foster, J.P., O’Donnell, C.P.F., Breathnach, D., Jacobs, S.E., Todd, D.A. and Davis, P.G. (2017) ‘Frenotomy for tongue-tie in newborn infants’, Cochrane Database of Systematic Reviews, 3, CD011065.