Book | Workshop Details | ASHA 2018 | About the Experts | EBP |
Attend a Workshop| TOTs Assessment Form 
    TOTs (Tethered Oral Tissues), is a fairly new term coined by Dr. Kevin Boyd. TOTs includes lingual restriction also known as ankyloglossia, but can also be a restriction of the frena of the lips and cheeks, by a band of tissue. There are seven frena in the oral cavity that can be impacted by TOTs.

    The Mayo Clinic has indicated that tongue tie can affect the way an individual eats, speaks, swallows and can interfere with breastfeeding.

    With the topic of TOTs comes some controversy, and speech-language pathologists are often left confused in their own role of diagnosing and treating TOTs.

    Functional Assessment and Remediation of TOTs
    The Book

    TOTs experts Robyn Merkel-Walsh, MA, CCC-SLP and Lori Overland, MS, CCC-SLP, C/NDT, CLC have created a comprehensive, evidence-based program to assist in the identification and functional implications of TOTs.

    The Merkel-Walsh and Overland TOTs Protocol is explained in the new co-authored book, Functional Assessment and Remediation of TOTs (Tethered Oral Tissues).

    This practical speech and feeding program includes a pre- and post-surgical treatment plan to avoid long-term issues, such as scarring and reattachment.

    Buy your book now | Get your signed copy at the 2018 ASHA Convention

    "Tongue on a Shelf" exercise from the book, Functional Assessment and Remediation of TOTs


    Functional Assessment and Remediation of TOTs
    The Workshop

    The live workshop "Functional Assessment and Remediation of TOTs" (0.6 ASHA/AOTA-approved CEUs) explores the functional assessment of TOTs and reviews current well-respected assessment tools which describe structure. With these tools, Robyn and Lori have developed the Merkel-Walsh & Overland TOTs Protocol, which looks at structure, oral motor function, pre-feeding, feeding and speech. Participants learn to use this tool to identify the possible need for a TOTs referral, and the functional impact this diagnosis may have on feeding and speech. Their unique style of “task analysis” is a practical strategy for assessment that is immediately carried over into developing a treatment program for neuro-muscular re-education.

    Participants learn through the concept of task analysis the specific ways in which TOTs impacts the oral motor and oral placement skills for breast, bottle, cup, straw and solid feedings in addition to speech sound production. Videos and live practicums with attendee participation provide therapeutic intervention tasks that participants can implement with their clients immediately. The importance of pre- and post-surgical therapy will be discussed, and surgical techniques will be explored so that therapists may be have a better understanding of the current research across disciplines on an international level.


    Participants will be able to: 

    1. list three forms of TOTs.
    2. identify at least 3-5 functional impacts of TOTs on feeding skills.
    3. list at least 3 speech sounds that may be affected by TOTS.
    4. to list at least 2 professionals that should be consulted if TOTs is suspected after a functional assessment.

    Find an upcoming TOTs workshop near me | Have TalkTools come to me!

     ASHA Convention 2018

    Boston | November 2018

    We love our ASHA family! We had an amazing time at the convention. Here were the presentations by two of our therapists:

    ASHA 2018 Convention – Presentations by TalkTools:

    1. TOTs: A Hot Topic! | WEB HANDOUT HERE 
      1-hour seminar
      Topic Area: Innovations, Debates, and Hot Topics in the Discipline
      Date: Friday, November 16
      Time: 5 - 6 p.m.
      Location: CC/254B (Level 2)
      Session #: 1609
      Presenting Authors: Lori Overland, MS, CCC-SLP, C/NDT, CLC; Robyn Merkel-Walsh, MA, CCC-SLP
    2. SLP's Role in Post-Frenectomy Care for Children Who Present With Feeding Challenges | WEB HANDOUT HERE
      Date: Friday, November 16, 2018
      Time: 10:30 a.m. - 12 p.m.
      Location: CC/Hall C
      Session #: 7657
      Authors: Lori Overland, MS, CCC-SLP, C/NDT, CLC (presenting); Robyn Merkel-Walsh, MA, CCC-SLP (not presenting)
      Here is the poster (click the picture to view it larger):


     About the Experts

    Robyn Merkel-Walsh, MA, CCC-SLP, 

    TalkTools | RobynRobyn Merkel-Walsh, MA, CCC-SLP,has specialized for over 24 years in OPT, myofunctional disorders and feeding disorders. She is employed by the Ridgefield Board of Education, runs a private practice in Ridgefield, NJ, is the board chair of the Oral Motor Institute, and is a member of the TalkTools® speakers bureau. She teaches TOTsAutism and Tongue Thrust courses in addition to multiple webinars on topics including but not limited to lispsoral structureOrofacial Myofunctional Disorderfeeding and clinical parameters for Autism Spectrum Disorder. Robyn has been invited to speak on Oral Placement disorders by Conversations in Speech Pathology, Bergen County Region V, the IAOM, The Apraxia Network, AAPPSPA and the MOSAIC Foundation. Robyn has received specialized training in Oral Placement Disorders, feeding, apraxia, Applied Behavioral Analysis, autism, cranio-facial anomalies, Beckman Techniques and PROMPT and is on track to become an IAOM Certified Orofacial Myologist.

    WHY I BECAME AN SLP... I went to Montclair State College (now University) as a dance major. My first semester wasn't going well as I caught a bad cold that turned into bronchitis and sinusitis. The intense demands of performance classes didn't allow for absences. As an honors student, I never received a bad grade and I was afraid of failing. My aunt Janine was working as an SLP clinical supervisor on campus. I went to meet her to get a care package. I saw her working through the clinical two-way mirror doing speech therapy with a baby. It just hit me that I wanted to help people in that same way. I changed my major that month to Communication Sciences and Disorders and I was on my way!

    MY OPT STORY... Once again, it was my Aunt Janine who taught me about Sara Rosenfeld-Johnson and what was then "Innovative Therapists International" (now TalkTools). I saw Sara teach at the NJSHA convention and I was hooked, even when when my professor told me that blowing horns couldn't help articulation. I already knew it isn't just about the horn, because it is about the hierarchy and the feel of speech. I continued my training with Sara and Lori as well as the great masters including: Bahr, Beckman, Marshalla and the IAOM. I reached out to Sara directly in 1998 because I had been developing a Myofunctional program (SMILE) in my school system because traditional methods weren't working. Sara insisted we meet, and she and her husband Phil agreed to publish my program as long as I agreed to teach it. The rest is history. I've dedicated my entire career to the TalkTools family and our extended family - the people we are able to help through our methods and programs. My role is not only author and lecturer, but most importantly an advocate for evidence based practices that support the work we do. 


    Lori Overland, MS, CCC-SLP, C/NDT, CLC

    TalkTools | Lori Lori Overland, MS, CCC-SLP, N/NDT, CLC is a speech and language pathologist with more than 36 years of professional experience. Lori specializes in dealing with the unique needs of infants, toddlers, pre-schoolers and school-aged children with oral sensory-motor, feeding and oral placement/speech disorders. She has received an award from the Connecticut Down Syndrome Association for her work within this population. Lori consults with children from all over the world, providing evaluations, re-evaluations, program plans and week-long therapy programs. Lori also provides consults to local school districts and Birth-to-Three organizations. Her goal in addressing feeding and speech challenges is to improve the quality of life for both the children she serves and their families. In addition to her private practice, Alphabet Soup, Lori is a member of the TalkTools® speakers bureau. Lori has lectured on sensory-motor feeding disorders across the United States and internationally. She teaches TOTsFeeding and Down Syndrome courses in addition to her pre-feeding webinar. Lori holds degrees from Hofstra University and Adelphi University and has her neurodevelopmental certification and is a certified lactation counselor.

    It’s crazy… but I was a pre-law major undergrad. After two semesters of required classes (still not sure how biology is related to pre law) and introduction to justice research, writing and reasoning, I was closed out of an introduction to judicial process course (that I am sure would have been equally boring and just as much writing!). One of my friends was registered for an introduction to speech and hearing sciences class that fulfilled an elective requirement. Needing to fill my schedule, I reluctantly signed up for the course.  The professor was the most entertaining and interesting speakers I had thus far in college. One class led to another and before I knew it I had a dual major, and the unintended major was much more appealing. When my “future” sister in-law, who was coincidentally an SLP, invited me to spend the day observing her practice, I was hooked. It was easy to give up reading law briefs to work with children!

    MY OPT STORY... 
    The phone rang and a woman introduced herself as Sara Rosenfeld-Johnson. Sara said, “I never get reports from Speech Pathologists that talk about feeding, do you want a job?” 'Who is this crazy lady,' I thought. I thanked her and graciously declined the offered, wondering who would offer a job to someone they had not met. Sara was persistent and talked me in to a co-treat session with this child we were sharing. 

    My journey as an SLP, at that time, was filled with more questions than answers. Some of my frustrations included how I should work with children who did not have the underlying motor skills to support intelligible speech (and could not look, listen and imitate the sound) and WHY I was asked to write language goals to increase the length of utterance in a child who was unintelligible to the uncued listener. Sara was the first therapist I met who was looking at underlying motor skills. Many years before she defined OPT, she was asking the question "Where does your mouth have to be to make the sound?" and looking at the underlying motor skills to support intelligible speech. I DID take the job the “crazy” lady (who became my good friend and mentor!) offered me, and it changed the way I evaluate and treat my clients. It opened the door for me to apply similar task analysis to the motor skills used for safe, nutritive feeding and allowed me to figure out why so many of my clients were picky or problem eaters. This career has always been more of a marathon than a sprint, and the day I hit the finish line I will retire!



    American Academy of Breastfeeding Medicine (AABM). (2016). Protocol # 11: Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad.

    American Academy of Pediatric Dentistry (AAPD) Council on Clinical Affairs (2015). Guidelines on management considerations for pediatric oral surgery and oral pathology. Clinical Practice Guidelines, 279-288.

    Amir, L.H., James, J.P. & Donath, S.M. (2006). Reliability of the Hazelbaker assessment tool for lingual frenulum function. International Breastfeeding Journal, 1(3).

    Bahr, D. (2010). Nobody ever told me (or my mother) that! Everything from bottles and breathing to healthy speech development! Arlington, TX: Sensory World.

    Baxter, R. (2018). Tongue Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More. Alabama, GA: Alabama Tongue-Tie Center.

    Baxter, R. & Hughes, L. (2018). Speech and Feeding Improvements in Children After Posterior Tongue-Tie Release: A Case Series. International Journal of Clinical Pediatrics, 7(3), 29-35.

    Boshart, C. (2015). Demystifying the tongue tie: methods to confidently analyze and treat a tethered tongue. Ellijay, GA: Speech Dynamics Inc.

    Burkhart, N.W. (2015). Ankyloglossia: Are You Paying Attention?

    Chauney, K.K., Arora, V.K., Thakur, R. & Narula, I.S. (2011). Perio-esthetic surgery: Using LPF with frenectomy for prevention of scar. Journal of Indian Soc Periodontics, 15(3): 265-269.

    Chu, M.W. & Bloom, D.C. (2009). Posterior ankyloglossia: a case report. International Journal of Pediatric Otorhinolayryngology, 73(6):881-3.

    Cioffi Izu, S., Harumi Itamoto, C., Pradella Hallinan, M., Ulson Pizarro, G., Tufik, S., Pignatori, S. & Raimundo Fujita, R. (2010). Obstructive sleep apnea syndrome (OSAS) in mouth breathing in children. Brazil Journal of Otorhinolayringology, 75(5).

    Coryllos, E., Genna, C.W. & Salloum, A.C. (2004). Congenital tongue-tie and its impact on breastfeeding. American Academy of Pediatrics.

    de Castro Rodrigues,R.L., Marchesan,I.Q., Gusmao,R.J. de Castro Rodriguez, A. & Berretin-Felix, G. (2014). Characteristics of altered human frenulum. International Journal of Pediatrics and Child Health Care, 2, 5-9.

    Daggumati S., Cohn, J.E., Brennan, M.J., Evarts, M., McKinnon, B.J. & Terl, A.R. (2019).  Speech and language outcomes in patients with ankyloglossia undergoing frenulectomy: a retrospective pilot Study. OTO Open, 3, 1,1:1-4.doi:10.1177/2473974x19826943.

    Devishree, Kumar-Gujjari, S. & Shubhashini, P.V. (2012) Frenectomy: a review with the reports of surgical techniques. Journal of Clinical Diagnosis and Research, 6(9):1587-1592.

    D’Onofrio, L. (2019). Oral dysfunction as a cause of malocclusion. Orthodontics & Craniofacial Research.

    Elad, D., Kozlovsky, P., Blum, O., Laine, A. F., Po, M.J., Botzer, E.& Sira, L. B. (2014). Biomechanics of milk extraction during breast-feeding. Proceedings of the National Academy of Sciences, 111(14), 5230-5235.

    Emanuel, M. (2017). Developing considerations with TOTs: tummy time. Presented at: Connecting the Dots in TOTs. New York, N.Y.

    Emanuel, M. (2016). Oral restrictions.

    Fernando, C. (1998). Tongue tie - from confusion to clarity: a guide to the diagnosis and treatment of ankyloglossia. Sydney, Australia: Tandem Publications.

    Ferret-Amat, E., Pastor-Vera, T., Ferres-Amat, E., Mareque-Bueno, J., Prats-Armengol. J. & Ferres-Padro, E. (2016). Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol. Journal of Oral Medicine and Pathology, 1:21 (1):39-47.

    Fisher, S.E., Frame, J.W., Browne, R.M., et al. (1983) A comparative histological study of wound healing following CO2 laser and conventional excision of canine buccal mucosa. Arch Oral Biol, 28, 287-291.

    Forienza, G., Paradise-Black, N.M., McNamara, E.G, & Sullivan, S.E. (2010). Ankyloglossia: exclusive breastfeeding and failure to thrive. Pediatrics, 125 (6); e1500-e1504.

    Francis, D.O., Chinnadurai, S., Morad, A., Epstein, R.A., Kohanim, S., Krishnaswami, S., Sathe, N. & McPhetters, M. (2015). Treatments for ankyloglossia and ankyloglossia with concomitant lip tie. Effective Healthcare Program: Comparative Effectiveness Review, US Department of Health  

    Geddes, D.T., Kent, J.C., Mitoulas, L.R. & Hartmann, P.E. (2008). Tongue movement and intra-oral vacuum in breastfeeding infants. Early Human Development, 84(7): 471-7.

    Genna, C.W. (2016). Supporting sucking in infant breast feeding infants. (2nd Ed.) Burlington, MA: Jones and Bartlett Learning.

    Genna, C.W. (2002). Tongue tie and breastfeeding. Leaven, 38(2): 27-29.

    Genna, C.W. & Coryllos, E.V. (2009) Classification of Ankyloglossia.

    Genther, D. J., Skinner, M. L., Bailey, P. J., Capone, R. B., & Byrne, P. J. (2015). Airway obstruction after lingual frenulectomy in two infants with Pierre-Robin Sequence. International journal of pediatric otorhinolaryngology, 79(9), 1592-1594.

    Ghaheri, B. (2017). Aftercare.

    Ghaheri, B, (2015). The importance of active wound management following frenectomy.

    Ghaheri, B. (2014a). Diagnosing tongue-tie in baby is not a fad.

    Ghaheri, (2014b). Rethinking tongue-tie: anterior vs. posterior is irrelevant.

    Ghaheri, B. (2014c). How to assess a baby for tongue-tie or lip-tie.

    Hari Iyer, V. & Sudarson, S. (2015). A comprehensive treatment protocol for lingual frenectomy with combination of laser and speech therapy. International Journal of Laser Dentistry, 5(1): 12-21.

    Hazelbaker, A. (2010). Tongue-tie: Morphogenesis, Impact, Assessment and Treatment. Columbus, OH: Aidan and Eva Press.

    Horton C.E., Crawford H.H., Adamson J.E., Ashbell T.S. (1969). Tongue-tie. The Cleft Palate Journal, 6: 8–23. PMID 5251442.

    Huang, Y.,Quo, S., Berkowski, J.A. & Guilleminault, C.S. (2015). Short lingual frenulum and obstructive sleep apnea in children International Journal of Pediatric Research, 1:1, ISSN: 2469-5769.

    International Affiliation of Tongue-Tie Professionals (2011). Classification.

    International Lactation Consultant Association (ILCA). (2011). Position paper on the role of IBCLC. Morrisville, NC: ILCA.

    Ito, Y., Shimizu, T., Nakamura, T. & Takatama, C. (2014). Effectiveness of tongue-tie division for speech disorders in children. Pediatrics International, 57:2, 1442-200.

    Kassing, (2008). Breastfeeding and craniosacral therapy: when it can help. Low Milk Supply. 

    Khaimar, M., Pawar, B. & Khaimar, D. (2014). A novel pre-surgical technique for the management of ankyloglossia. Journal of Surgical Technique Case Reports, 6(2): 49-54.

    Kotlow, L. (2001). Infant reflux and aerophagia associated with maxillary lip-tie and ankyloglossia. Clinical Lactation, Vol. 2-4, 25-29.

    Kotlow, L. (2014). Lasers in Pediatric Dentistry. Dental Clinics of North America. 48:4.

    Kotlow,L. (2015). TOTS-tethered oral tissues: the assessment and diagnosis of the tongue and upper lip ties in breastfeeding. Oral Health

    Kummer, A. (2016). To clip or not to clip? That’s the question. Presented at the annual convention of The American Speech and Hearing Association, Philadelphia, PA.

    Kummer, A. (2005). To clip or not to clip? That’s the question. The ASHA Leader, 10:6-30.

    Kupietzky, A. & Botzer, E. (2005) Ankyloglossia in the infant and young child: clinical suggestions for diagnosis and management. Pediatric Dentistry, 27:1, 40-46.

    Levine, R. Vitruk, P. (2015b). Enhanced hemostasis and improved healing in CO2 laser assisted soft tissue oral surgeries. Implant Practice US 8(3). 34-37.

    Mayo Clinic (2016). Diseases and conditions: tongue-tie (Ankyloglossia).

    Marchesan, I.Q. (2012). Lingual Frenulum Protocol. International Journal of Orofacial Myology, 38, 89-104.

    Marchesan, Irene Queiroz. Lingual Frenulum: Classification and Speech Interference. International Journal of Orofacial Myology, Nov. 2014,

    Martinelli, R.C.C., Marchesan, I.Q., Honório, H.M., & Berretin-Felix, G. (2018). Tendency of tongue positioning during crying in infants with and without lingual frenulum alteration. International Journal of Developmental Research, 8, 14672.

    Martinelli, R.L.C., Marchesan, I.Q., & Berretin-Felix, G. (2012). Lingual Frenulum Protocol with Scores for Infants. International Journal of Orofacial Myology, 38, 104-113.

    Meaux, A., Savage, M., & Gonsoulin, C. (2016). Tongue ties and speech sound disorders: what are we overlooking? Presented poster at the Annual ASHA Convention, Philadelphia, PA.

    Messner, A.H. & Lalakea, M.L. (2000). Ankyloglossia: controversies in management. International Journal of Pediatric Otorhinolaryngology, 54(2):123-31.

    Merdad H. & Mascarenhas, A,K. (2013). Ankyloglossia may cause breastfeeding, tongue mobility, and speech difficulties, with inconclusive results on treatment choices. Journal of Evidence-Based Dental Practice, 10(3):152-3.

    Merkel-Walsh & Overland, L.L. (2017). TOTs: the functional impact on feeding and speech (joint lecture).
    Presented at: Connecting the Dots in TOTs. New York, N.Y.

    Merkel-Walsh, R. & Overland, L.L. (2017) Functional assessment of feeding challenges in children with ankyloglossia. Poster presentation at the American Speech Language and Hearing Association, Los Angeles, CA.

    Merkel-Walsh , R. & Jahn, A. (2014). Teaming up to correct tongue-tie. The ASHA Leader,19.

    Merkel-Walsh , R. & Overland, L. (2018). SLP's Role in Post-Frenectomy Care for Children Who Present with Feeding Challenges. Poster presentation at the American Speech Language and Hearing Association, Boston, MA.

    Merkel-Walsh, R. (2011) Systematic Intervention for Lingual Elevation (SMILE). Charleston, SC: TalkTools.

    Mills, N., Pransky, S.M., Geddes, D.T. & Mirjalili, S.A. (2019) What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum. Clin Anat. Retrieved from:

    Northcutt, M. (2009). The lingual frenum. The Journal of Clinical Orthodontics, 43(9):557-565.

    O’Callahan, C., Macary, S., & Clemente, S. (2013). The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding. International journal of pediatric otorhinolaryngology, 77(5), 827-832.

    Opara, P., Gabriel-Job, N. & OPara, K.O. (2012). Neonates presenting with severe complications of frenotomy: a case series. Journal of Case Reports, 6, 77.

    Ostapiuk, B. (2006). Tongue mobility in ankyloglossia with regards to articulation. Ann Acad Med Stetin. 2006;52 Suppl 3:37-47

    Overland, L. & Merkel-Walsh, R. (2013). A sensory-motor approach to feeding. Charleston, SC: TalkTools.

    Paladino, L. (2017). IBCLC as a team leader for the assessment and management of the nursing infant with lip and tongue tie. Presented at: Connecting the Dots in TOTs. New York, N.Y.

    Price-Emanuel, M. (2017). Benefits of bodywork.

    Priyanka, M., Sruthi, R., Ramakrishnan, T., Emmadi, P., & Ambalavanan, N. (2013). An overview of frenal attachments. Journal of Indian Society of Periodontology, 17(1), 12–15.

    Raghevendra-Reddy, N., Marudhappan, Y., Devi, R. & Narang, S. (2014). Clipping the (tongue) tie. Journal of Indian Soc Periodontal, 18 (3); 395-398.

    Ricke, L.A., Baker, N.J., Madlon-Kay, D.J. & DeFor, T.A. (2005). Newborn tongue-tie: Prevalence and effect on breast feeding. Journal of American Board of Family Practice, 18(1), 1-7

    Schuster, J.L. (2014). ‘Just a snip,” I was told, but that was just the start of my troubles. Health Affairs: Washington Post.

    Segal, L. M., Stephenson, R., Dawes, M., & Feldman, P. (2007). Prevalence, diagnosis, and treatment of ankyloglossia: Methodologic review. Canadian Family Physician, 53(6), 1027–1033.

    Sethi N., Smith D., Kortequee S., Ward V.M. & Clarke S. (2013). Benefits of frenulotomy in infants with ankyloglossia. Int J Pediatr Otorhinolaryngol, 77(5): 762-5.

    Siegel, S.A. (2017) Advancements in diagnosis and laser surgery of ankyloglossia from infancy to adulthood: impacts on breast feeding, feeding, speech and airway. Presented at Connecting the Dots in TOTs. New York, N.Y.

    Siegel, S.A., (2016). Aerophagia induced reflux in breastfeeding infants with ankyloglossia and shortened maxillary labial frenulu (Tongue and Lip Tie). International Journal of Clinical Pediatrics, 5(1):6-8.

    Srinivasan, A., Al Khoury, A., Puzhko, S., et al. (2018). Frenectomy in infants with tongue-tie and breastfeeding problems. Journal of Human Lactation.

    Taylor, P. (2011) Benefits and drawbacks of frenectomy. Retrieved from:  

    Vallone, S. (2014). Chiropractic care for the breastfeeding dyad. Leaven, 39(6): 126-127.

    Vitruk, P. et al. (2017). Oral soft tissue laser ablation and coagulation physics. Color Atlas of Infant Tongue-Tie and Lip-Tie Laser Frenectomy. Pan Sophia Press.

    Walsh F. & Kelly D. (1995). Partial airway obstruction after lingual frenotomy. Anesth Analg, 80;1066-1067

    Wigdor, H., Walsh, J., Featherstone, J.D.B., et. al. (1995). Lasers in dentistry. Lasers Surg Med, 16, 103-133.

    Wilson, J. M. (Ed.) (1978) Oral-motor function and dysfunction in children. Conference proceedings, May 25-28, 1977. Chapel Hill: University of North Carolina.

    Yang, H.M., Woo, Y.J., Won, S.Y., Kim, D.H., Hu, K.S. & Kim H.J. (2009) Course and distribution of the lingual nerve in the ventral tongue region: anatomical considerations for frenectomy. Journal of Craniofacial Surgery, 20(5):1359-63.

    Yousefi, J., Tabrizian Namani,F., Raisolsadat,S.M.A., Gillies,R., Ashkesari, A. & Meara, J.G. (2015). Tongue-tie repair: z-plasty vs. simple release. Iranian Journal of Otorhinolaryngology, 27(79):127-135.


    NEW research on identification and prevalence of TOTs
    Kotlow Article  "The Breastfeeding Dilemma: Misdiagnosed TOTS or Just Ignoring their Existence?" May, 2019:

    Links to More Information:



    script type="text/javascript" src="//" data-dojo-config="usePlainJson: true, isDebug: false">