The question
Do you have any advice for tongue tie assessment?
Therapist answer
Yes! The good news is we have many resources for TOTs, like an eLearning course for TOTs screening called TOTs 5-Step Screening Tool, as well as a book titled Functional Assessment and Remediation of TOTs.
We also offer a deep dive course that we run regularly for TOTs assessment that is also titled Functional Assessment and Remediation of TOTs, taught by myself, Lori L. Overland, MS CCC-SLP, C/NDT, CLC, FOM, or the both of us.
This course explores the functional assessment of TOTs and reviews current well-respected assessment tools which describe structure. With these tools, we have developed the Merkel-Walsh & Overland TOTs Protocol, which looks at structure, oral motor function, pre-feeding, feeding, and speech.
Check out the training calendar to see when we offer this course next.
Hope this helps!
— Robyn Merkel-Walsh, MA, CCC-SLP, COM®️
Tongue tie assessment: why function matters (not just what you “see”)
Many tools describe structure (what the frenulum looks like), but a strong tongue tie assessment also considers function—how oral structures perform during breastfeeding or bottle feeding, oral motor tasks, and (when relevant) speech. Current pediatric guidance emphasizes tying intervention decisions to symptoms and functional feeding impact, and also notes that surgical release may be overused when comprehensive feeding support and assessment are not part of the process.
Clinical breastfeeding guidance likewise recognizes that ankyloglossia can contribute to nipple pain/trauma and reduced milk transfer in some dyads—so thorough assessment and team-based decision-making matter.
Tongue tie assessment tools clinicians may reference
Depending on your setting and client age, teams may use tools that describe tongue appearance and movement. For example, the Bristol Tongue Assessment Tool (BTAT) was developed to provide a clear, simple measure of severity and is used internationally; it has also been studied alongside other tools (including reference to Hazelbaker/ATLFF in the development work).
A picture-based companion tool (TABBY) was created to support consistent scoring. (As the literature continues to evolve, systematic reviews also highlight variability across tools and measurement properties—another reason to pair tools with functional observation and appropriate referrals.)
Tongue tie assessment training and resources from TalkTools
Self-study tongue tie assessment screening: TOTs 5-Step Screening Tool
For a practical starting point, TalkTools offers the TOTs 5-Step Screening Tool eLearning course. It’s designed to help professionals screen for TOTs, identify common signs and symptoms, and make appropriate referrals to specialists with advanced training.
Book: Functional Assessment and Remediation of TOTs
For deeper guidance, the book Functional Assessment and Remediation of TOTs outlines an evidence-informed approach and includes the Merkel-Walsh & Overland TOTs Protocol, which looks at structure plus functional domains such as oral motor function, pre-feeding, feeding, and speech.
Deep dive tongue tie assessment course: Functional Assessment & Remediation of TOTs
We also offer a comprehensive live course (offered on a rotating schedule) titled Functional Assessment & Remediation of TOTs. This training explores functional assessment, reviews well-respected structural tools, and teaches how to apply the Merkel-Walsh & Overland TOTs Protocol across structure, oral motor function, pre-feeding, feeding, and speech.
Check the Training Calendar for upcoming offerings.
Quick resource list
- Self-study screening: TOTs 5-Step Screening Tool (eLearning).
- Book: Functional Assessment and Remediation of TOTs.
- Deep dive training: Functional Assessment and Remediation of TOTs (live offerings vary by calendar).
FAQ
What does the TOTs 5-Step Screening Tool help you do?
It’s designed to help professionals quickly assess for TOTs and make appropriate referrals to specialists with advanced training.
What does the Merkel-Walsh & Overland TOTs Protocol look at?
It considers structure and functional areas including oral motor function, pre-feeding, feeding, and speech.
Is the remediation content appropriate for every discipline?
TalkTools notes it’s the professional’s responsibility to determine whether applying techniques fits within their scope of practice.