In recent years the number of breastfeeding problems that are attributed to tongue or lip ties in the infant has increased dramatically. Are there really so many more babies with ties now than there were a few years ago? If so, why? Was it previously under diagnosed? Is it currently over diagnosed? We will review the current evidence, develop new assessment skills to differentiate ties from other causes of persistent nipple pain and latch difficulties, and create sample care plans to meet the needs of each unique family.