Tongue Tie 101 For SLPs: What Is Our Role?


0.25 ASHA CEUs


Course Type


Ankyloglossia, or tongue tie, has recently become an area of discussion and sometimes controversy for SLPs. To ignore it, or not to ignore it? To refer for surgical procedure, or not to refer? To accept speech that "sounds okay" in the presence of tongue tie, or to emphasize precise speech production? To delve deep enough to see if there is far more than meets the eye, or to leave it to other professionals to make the decisions?

This course will shed light on these dilemmas. Participants will get an overview of the consequences of tongue tie as related to infant feeding issues, dental concerns, emotional and social aspects, phase one swallow considerations, and most importantly the speech connection! Participants will be introduced to assessments and various techniques used to release the lingual frenum. Offered for 0.25 ASHA CEUs - 2.5 contact hours. The Illinois Early Intervention Training Program has approved this course for 2.5 hours of EI credential credit in the area of Intervention.

Run Time: 2:30:13

Course Overview:

  • Introduction
  • Possible Consequences
  • Putting Ourselves in Their Place
  • Assessing, Grading Systems, and Case Examples
  • Swallowing and Tongue Tie
  • Case Studies
  • Helpful Desscriptions and Assessment Tools
  • Surgical Options
  • What is Our Role and Responsibility As An SLP?

The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found in the Presenter & Disclosures area.

Course Format:

Video PowerPoint presentation with author narration and downloadable handout.

Course Objectives

  1. Understand the link between ankyloglossia and certain types of speech disorders.
  2. Define and describe ankyloglossia in its many forms.
  3. Describe the deleterious effects of tongue tie on normal oral motor functions including the preparatory stage of the swallow process.
  4. Utilize the QTT "quick tongue tie assessment" for tongue tie.
  5. Become familiar with two types of formal assessments.

Presenter & Disclosures

Sandra R. Holtzman, MS, CCC-SLP, COM, QOM, is an ASHA certified speech-language pathologist who has specialized in orofacial myology for more than 30 years. She is a certified orofacial myologist and a member of the International Association of Orofacial Myology (IAOM). Sandra is presently serving on both the Board of Directors and the Board of Examiners of the IAOM.

Sandra has addressed SLPs, dental professionals, and other specialists across the United States on the connection between orofacial musculature and speech disorders, tongue-tie (ankyloglossia), thumb and digit sucking habits, mouth breathing, and other topics. In 2000, Sandra established Neo-Health Services, Inc., which provides continuing education workshops, therapy for orofacial myofunctional disorders and other speech-language disorders, and supplies oral myofunctional products. She is the author of Orofacial Myology: From Basics to Habituation (aka the "Myo Manual").

Speaker Disclosures:

Financial — Sandra Holtzman is a presenter of online CE courses sponsored by Northern Speech Services; receives royalty payments.

Financial — Sandra Holtzman is the author of the text "Orofacial Myology: From Basics to Habituation"; receives royalty payments.

Financial — Sandra Holtzman is the owner of Neo-Health Services, Inc; ownership interests.

Nonfinancial — Sandra Holtzman has no relevant nonfinancial relationships to disclose.

Intended Audience/Accreditation

This program is offered for 0.25 ASHA CEUs (Intermediate Level; Professional Area).

Intended Audience

  • SLP

ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.

ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:

  • Current ASHA Member
  • ASHA Certificate of Clinical Competence (CCC) Holder
  • Licensed by a state or provincial regulatory agency to practice speech-language pathology (SLP) or audiology
  • Credentialed by a state regulatory agency to practice SLP or audiology
  • Credentialed by a national regulatory agency to practice SLP or audiology
  • Engaged in a Clinical Fellowship under the supervision of an individual with their ASHA CCC
  • Currently enrolled in a masters or doctoral program in SLP or audiology

If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.

Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.

Additional accrediting agencies by which Northern Speech is an approved CE provider:

  • California: NSS is approved as a provider of continuing education by the California Speech-Language Pathology & Audiology Board. Provider #PDP4. Online CEU limits may apply; please contact SLPAHADB for current online CEU acceptance policies.
  • Iowa: NSS is approved as a provider of continuing education by the Iowa Board of Speech Pathology and Audiology Examiners. Provider #169.
  • Kansas: NSS is approved as a provider of continuing education by the Kansas Department of Health and Environment. Provider #LTS-S0005.
  • Florida: NSS is approved as a provider of continuing education by the Florida Speech-Language Pathology and Audiology Board. Provider #SPA-026.
  • New Jersey: NSS is approved as a provider of continuing education by the New Jersey Department of Education. Provider #1654.

Frequently Asked Questions

Customer Support: Please phone 888.337.3866 or email

Course Completion Timeframe:

You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.

However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.

Content Access:

Access to course materials and content does not expire, even after completing the post test. You may continue to review course material by logging into your NSS account, clicking the My Online Courses tab, and then viewing your desired course.

Certificate of Completion:

On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.

ASHA CE Registry Submission:

During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

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What is an Online Course?

Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.

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Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online. Please note that courses offered for university students are not applicable for CEUs.

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You may browse all online courses by clicking the Continuing Education tab above, then Online Courses. Once you find a course, click Enroll Now, and you will be asked to either log into your existing Northern Speech account or create a new online account. Once you’ve entered your account information and provided your credit card payment, your course will be immediately available to you.

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Testing requirements:

Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.

Number of CEUs offered:

We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.

State licensing boards and online CEUs:

NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.

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Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page. Most courses include closed captioning.

Course handouts:

Most of our online courses provide a link to download the accompanying handout as a PDF file. 

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Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.

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Course Cancellation Policy:

A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded. 

Special Needs:

Please click here for any special needs requests, and we will do our best to accommodate them. 

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"The course was well organized."  J.C. (Jan. 2022)

"I loved the presenters passion and really value the information on a person level as all 3 of my children were born tied."  S.B. (Dec. 2021)

"I liked all of the picture examples ad explanations." A.S. (Dec. 2021)

"All of the course was beneficial! I'm really glad you reviewed that article in the end. I'm sure I read that at some point-and sadly, it was the extent of my knowledge.  It was all information that I always wondered about and searched for, but couldn't find."  S.O'N. (Nov. 2021)

"I've never understood the significance of the short frenum to non-speech performance such as swallowing. I haven't given tongue tie enough attention in my evaluations. I will be much more careful in my future examinations. Excellent exposure to the topic of tongue tie. Pictures and videos very helpful"  L.S. (Nov. 2021)

"The discussion about use of standardized assessment tools to present the results to Drs ( and insurance companies )to report the degree of tongue- ties in need of Frenectomy was beneficial for my daily practice.  I liked the descriptions of photos and videos of children and adults with different types of tongue-ties and lip-tie and problems they can cause."  T.D. (Oct. 2021)

"Diagnosing of tongue ties based on visual and functional assessments. Practical information on how to evaluate and treat clients with tongue tie."  M.M. (Oct. 2021)

"I have a feeding and language evaluation for a 22 month old on Tuesday. Her mother has concern for lip and tongue tie. Clearly, this course will be very beneficial in my evaluation procedures and treatment with this client, as well as others on my caseload. My graduate school professor strongly felt as though frenectomies were performed too frequently. I am thankful for this course to give me a different perspective and new considerations toward the procedures. I will definitely use my knowledge gained in this area moving forward. The presenter gave clinically relevant and research based information. The content was heavily clinically based and therefore can easily be applied in daily practice." S.F. (Sept. 2021)

"The prevalance of a tongue tie and its effect on lots of skills was helpful." L.D. (Aug. 2021)

"Explanation of the varying degrees of tongue tie & specific tests to determine the need for surgery were helpful for my daily practic.  Videos and photo support during the presentation were good." K.T. (Aug. 2021)

"The course was so thorough on the topic of tongue ties and provided ways to assess and determine if there is a tongue tie." C.M. (Aug. 2021)

"The importance of a thorough assessment and impact of tongue-tie will help my daily practice." C.J.-C. (July 2021)

"Excellent photographs and examples to help SLPs be more comfortable with the wide range of positions of the frenulum. Great data driven information and case studies which show the importance of considering surgery or not." A.F. (July 2021)

"I am just finishing the Myo one year course with Hallie Bulkin and she mentioned you several times so I wanted to get the benefit of your course. This was a great overview. The descriptions with pictures of tongue ties, the definitions, the assessments were all very clear and concise." H.S. (June 2021)

“I really enjoyed all of it and will review and study the material so that I can better serve the children I see in my practice.” – J.B. (Mar. 2021)

“It was very thorough, the instructor was clear and highly knowledgeable. I took this course as a refresher as I took an in-depth course with Sandra before. Her expertise is essential to our field to be effective with our clients. The visuals and thorough examination of the lingual frenulum (areas of attachment, size, and appearance) were for me the best part.” – R.T. (Feb. 2021)

“The presenter was thorough and comprehensive, and the information is immediately applicable.” – R.I. (Jan. 2021)

“The information on what to look for in the functioning range of motion needed for speech and feeding.” – P.B. (Dec. 2020)

“I enjoyed that it provided information to look for and how it may affect them, especially for those with less extreme tongue tie. It confirmed my previous beliefs on recommending for treatment even for those with some mobility but reduced or restricted and how I can phrase it when going back and forth with insurance companies on behalf of the clients. Also, the activities that you included to help after the procedure.” – T.W. (Nov. 2020)

“I enjoyed the description of the characteristics and description of the function. I have been seeing many of these characteristics in the children I have been treating as an SLP. However, I have felt that I lacked in my ability to describe what I am seeing. This was the only course that I could find discussing oral ties. And that was accepted by ASHA for credit. I feel that our field is seriously lacking in this area. I appreciate the research and time put into this subject area.” – N.D. (Oct. 2020)

“I liked the visual examples of the different types of tongue tie and assessment measures.” – S.S. (Aug. 2020)

“I appreciated every section as I was unfamiliar with this topic and wanted to learn more. Two particular areas of benefit were the explanations of all the different types of Ankyloglossia and associated problems and the last section that helped me understand what my role is.” – C.J. (Jul. 2020)

“I have had an interest in tongue-tie for the last few years and am constantly looking for ways to improve my care of these patients. This course is by far the best I have taken in terms of practical knowledge about tongue tie and how to accurately assess. I have two patient's coming into my office this week who will benefit from me having viewed this course today!” – C.F. (Jun. 2020)

"The whole course was incredible! Knowledge of assessments and how it is up to us as SLP's to determine and disseminate accurate information about Ankyloglossia are very important topics for discussion as we work with students in the schools. I liked how orderly, clear and organized the information was presented. Perfect course!" – J.G. (May 2020)

"Risk factors and structural/functional anomalies to look for, and assessment protocols/examples were the most beneficial. The presenter's passion for this topic is apparent and she is able to keep you engaged. I very much so appreciated the photographs which allowed the listener to visualize the characteristics that were described." – N.S. (Apr. 2020)

"Very practical/clinical information synthesized with research findings! I will use these assessments going forward." – J.G. (Mar. 2020)

"I very much appreciated the basic terminology descriptions, education on how to assess for tongue-tie, and treatment considerations." – S.W. (Feb. 2020)

"I loved the photos of a wide variety of tongue tied examples and videos demonstrating function and exercises. I liked the protocol given to aid SLPs in what to do to help individuals with ankyloglossia." – B.C. (Feb. 2020)

"The assessment and intervention protocols for Ankyloglossia...actually all of the presentation was beneficial. Since I work with infants and toddlers, I intend to add observation/assessment for tongue tie as a part of all of my early treatment." – Y.H. (Jan. 2020)

"I appreciated the assessment tools and knowing which ones work best for which age groups. I liked the pictures and video examples. The treatment following surgery was very brief. I would have liked more information about what sessions look like post surgery." – S.K. (Dec. 2019)

"All of the information in the course is relevant to my daily practice. I do oral motor assessments in the NICU daily and have struggled with the less than obvious tongue ties. The course was very informative. I liked that the pictures and videos were used to augment descriptions." – G.P. (Dec. 2019)

"I like that this course provided information that I can use in my practice starting ASAP. It provided enough information to make me feel confident that I can now recognize a tongue tie from a variety of criteria." – A.M. (Nov. 2019)

"I was very impressed with how comprehensive the presentation was. The presenter kept me engaged, and a lot of interesting information was given. I liked the case studies and photos that helped me visualize what I was hearing. I was very happy with the course." – N.T. (Oct. 2019)

"This course clearly indicated that SLPs can be the key person when determining whether or not to release the tongue tie. I appreciate the clarification that it does not need to be the dentist or the ENT to 'make the call.' I now feel more empowered to reach out to other professions when I believe intervention/release is needed." – R.C. (Oct. 2019)

"The illustrations and videos were wonderful as were the reference to research in several areas, including whether to use anesthesia or not. Going over assessment was also very helpful and knowing where I can ask questions and obtain assessments is reassuring beyond this short course." – A.H. (Sept. 2019)

"The speaker was very clear, organized, and provided excellent visual and video examples to support the information that she was sharing. Outstanding job!" – S.S. (Aug. 2019)

"Thoroughly enjoyed the presentation. It was always an area I was least knowledgeable in and would refer to the doctor. I've only referred to snip 2-3 cases of the more than dozen I've seen. So now I feel more 'armed and ready' when I see another case. Thank you!!" – B.P. (Aug. 2019)

"I really appreciated understanding more about the appearance and speech consequences of tongue tie and the fact that we have a critical role in diagnosing it." – M.C. (July 2019)

"Very informative and useful in my current practice with pediatric patients. I would love to know more about the therapy for tongue tie after surgery, though." – S.S. (June 2019)

"It was helpful to see normal lingual frena compared to ankyloglossia. It was also helpful to see the different criteria for diagnosing." – E.B. (June 2019)

"I really enjoyed the speaker; she was very informative and you can tell she is passionate about this topic. I liked the pictures and different assessments." – K.K. (May 2019)

"I liked the discussion of diagnostic factors to consider as well as the impact it can have on speech production. I have many parents ask me about tongue tie and its impact, and I feel better able to assess it myself and give reliable answers to their questions." – J.F. (Apr. 2019)

"I like that the course was very complete with many slides to show actual examples of what to look for during oral exams for tongue tie." – P.S. (Mar. 2019)

"The whole course was informative. Ms. Holtzman was thorough with her examples, studies, and real life applications of material. I appreciate all the examples, pictures, and videos provided." – S.P. (Feb. 2019)

"Sandra Holtzman, MS, CCC-SLP, C.O.M. was an excellent presenter. She was very knowledgeable and provided specific and helpful tools." – C.M. (Jan. 2019)

"I loved this seminar. The research studies cited are very interesting. I am looking forward to following up on these studies and reading more in depth about this topic. This seminar was exactly what I needed at this moment. It covered all questions/concerns I had regarding tongue tie and my approach with patients/families. I feel much better equipped to visit with patients, families, and doctors on this subject. Thank you, Ms. Holtzman!!!" – S.J. (Dec. 2018)

"Really great online course with amazing information to guide SLP on best practices for treatment and assessments with infants, pediatrics and adolescents." – A.C. (Nov. 2018)

"The whole inservice was very beneficial. I wish I would've taken this course sooner. This was very thorough and very well presented. Very organized and practical." – D.J. (Oct. 2018)

"Holtzman's discussion of form and function with examples and descriptions was most beneficial to my daily work in the schools. My observations during the oral mechanism exam will be more definitive and conducted with more confidence after viewing this course, thank you." – B.P. (Aug. 2018)

"I loved that she discussed maxillary lip-tie. I have a student who presents with this and I now have more knowledge to share with the parent to support my recommendations. I appreciated how each of the sections were broken down and information was presented in a clear manner. I loved this course!" – S.P. (July 2018)

"I really liked the topic of assessment tools. Also, there were a lot of pictures and videos supporting the information, which I found helpful." – P.B. (May 2018)

"All of the information on identifying a tongue tie was beneficial. The photos were extremely helpful." – R.S. (Apr. 2018)

"I really appreciated the pictures which demonstrated ankyloglossia beyond the "typical" as well as the discussion of assessment procedures." – C.G. (Mar. 2018)

"Differentiating the assessment tools available for tongue tie was most beneficial. I like that the course gives the basics, which some courses do not. Some others assume a high level of knowledge already. I was expecting more about treatment techniques, though." – T.T. (Feb. 2018)

"The info was hands-on and understandable with good examples." – R.B. (Jan. 2018)

"All of it was beneficial!? I desperately needed this information and will be using this information. I like that the speaker spoke slow enough for retention of the material and gave a lot of examples." – M.R. (Dec. 2017)

"I found the discussions regarding tongue tie to breastfeeding and swallowing very beneficial. I liked that there were many pictures and videos to illustrate the topics discussed." – L.C. (Nov. 2017)

"I appreciated going over the location of frenulum attachment (tip of the tongue vs base of the tongue) and how a tongue tie could impact feeding, mumbling, articulation, self-esteem, etc. I like how I could watch it at my leisure." – L.L. (Oct. 2017)

"I felt that the course was great (especially learning the outcomes of the limited but important studies that have been done regarding tongue tied individuals). I like how I could go at my own pace and even re-enter a section where I left off." – A.H. (Aug. 2017)

"The discussions on noticing that the frenulum may be embedded submucosally and how to work on tongue ROM post surgery were most beneficial. I expected more therapy tips post-surgery, though." – C.B. (July 2017)