Over the last several decades, there has been a focus on promoting breastfeeding, given the evidence of health benefits and avoidance of infant/maternal morbidity. Some mother/infant dyads have significant difficulty feeding but go without identification of the pathology present. Published research has shown the importance of promptly attending to these problems to avoid premature weaning. Unfortunately, the mechanism of tongue movement and function during breastfeeding (and bottle-feeding) has not been widely disseminated to otolaryngologists. Classic teaching on ankyloglossia oversimplifies the physical examination technique needed to challenge tongue function and may result in an under correction of tongue mobility. The majority of published studies still rely on older methods of diagnosing ankyloglossia and performing frenotomy, potentially blunting the outcomes measured by researchers. Common understanding of infant tongue physiology is critical for future research to be impactful. Increasingly, lactation consultants are bypassing otolaryngologists in favor of treatment by dentists. Given the anatomical location and airway implications of ankyloglossia, we feel it is imperative that contemporary information is disseminated to our field. In this presentation, we will use a combination of high resolution submental ultrasound during breastfeeding and videos of intraoral examinations to demonstrate the unique tongue movements during infant feeding. Various techniques of surgical release of both classic anterior tongue tie and more visibly subtle posterior tongue tie will be shown to demonstrate how to correct pathologic tongue immobility. We will focus on new research studies showing the outcomes of frenotomy including a recently published randomized, controlled trial demonstrating objective improvement of tongue function following frenotomy for posterior tongue tie. This course provides a comprehensive understanding of infant feeding pathology and gives the attendee the tools needed to help these dyads.