Celebrating our most popular post: ‘Dentist sheds light on tongue tie in infants’

This week on Our Milky Way, we are reposting our most popular article since the blog’s birth back in 2012: an interview with Greg Notestine, DDS on tongue tie published in May 2015 . The tongue-tie controversy continues to grow; in fact, Clinical Lactation dedicated its entire September 2017 issue to the issue.

For more on tongue-tie on Our Milky Way, read:

An overview of tongue tie with Dr. Evelyn Jain, MD, FCFP, FABM

UF Center for Breastfeeding and Newborns helps mothers reach breastfeeding goals

Viva la nipples

Thanks for your readership!


When a chef learns how to shuck an oyster in culinary school, she is unlikely to be receptive of new shucking methods presented thereafter. Ohio-based dentist Dr. Greg Notestine, DDS uses this analogy to explain many physicians’ refusal to learn about tongue and lip tie treatment as it relates to infant feeding problems and beyond.

“Because they weren’t taught in medical school, their minds are really, really closed to learning something new and that’s kind of true in anything,” he says. “We just close our minds once our formal education stops.  It’s human nature to do what we are taught.”

In a way, Dr. Notestine continues, he and others who practice frenotomy regularly are “rebels confronting the medical industry… because more women want to breastfeed.”

Discovering tongue tie in infants

In dental school, Dr. Notestine learned about tongue tie as it relates to children and adults, but never as it relates to infant feeding difficulties.

His introduction to tongue tie in infants was through La Leche League. His sister led a group where a mother of a three week old infant wasn’t breastfeeding as comfortably as her previous two children had. Dr. Notestine’s sister asked him if he would check the baby’s mouth. When he noticed a very obvious tie, his sister and the mothers expected he would release it.

“When you have seven crying women in your office, you better do something,” he says. “I was scared to death.”

So Dr. Notestine consulted his anatomy book and found that infants possess the same parts of the 80 year old mouth, just much smaller.

And then, “I cut it,” Dr. Notestine reports. “Immediately the breastfeeding got better.”

The influence of formula companies

After this experience, Dr. Notestine called the family’s pediatrician and obstetrician wondering why they hadn’t treated the child.

“We don’t do that anymore,” he remembers them replying.

Before the 1940s, tongue and lip ties were treated regularly, but as formula companies began to heavily influence doctors, the desire to treat ties for breastfeeding success diminished greatly. As a result, physicians learn almost nothing about the mouth in relationship to feeding in medical school today, Dr. Notestine explains.

Other than breastfeeding, tongue and lip tie can influence speech, dental hygiene, and oral-facial development which can lead to narrowed airways and sleep apnea.

These short or tight frenums, or frenulums, which also may include the cheek attachments–restrictions now referred to as Tethered Oral Tissues (TOTS)– should be examined at birth, Dr. Notestine explains.

TOTS are birth defects that require treatment, he goes on.

“A physician would not hesitate to recommend releasing webbed fingers or toes even though the person could in many cases lead a totally normal life functionally with this defect, it just wouldn’t be too pleasant cosmetically.Therefore it gets treated,” Dr. Notestine says.

Planting seeds

For 30 years, Dr. Notestine’s been on a quest to educate physicians about frenotomy as a simple intervention to help breastfeeding difficulty.

Dr. Notestine has also tried to become involved with the medical school just a couple miles down the road from his office with little welcoming, he says. Last year though, the school hired a female dean. She sent a few senior students interested in pediatric work to observe Dr. Notestine in action. The students were awed.

“At least I’ve planted seeds in their minds,” he says.

Dr. Notestine also lectures at Linda Smith’s Lactation Consultant Exam Prep Course yearly. Because there are usually three to four breastfeeding babies in the course, Dr. Notestine is able to offer a hands on learning experience for participants. Treating babies in the class allows participants to feel what they have been reading and hearing about up until this point in their studies.

Recently, Dr. Notestine spent time with second year medical students as part of an elective course where he briefly discussed the mechanics of a baby’s mouth and how proper function is necessary for proper milk removal.

“The entire idea of oral-facial muscle development depends on breastfeeding,” he explains. “You don’t use the same muscles with a bottle, so if we can help physicians learn the value of breastfeeding then perhaps they’ll look at why it’s not successful when it’s not successful… It’s not always the mom’s fault.”

Treating ties with the laser

For 25 years Dr. Notestine successfully performed releases with sharp scissors.  Now to release tongue and lip ties, he uses a relatively low level laser that seals the nerve endings and blood vessels along the way. The laser stimulates some pain, but as with most mouth wounds, heal quickly. Sometimes he uses topical anesthetic or injects local anesthetic. With the laser, the wound penetrates only a few cell layers deep whereas other methods can go as far as 100 cell layers deep, Dr. Notestine explains.

All babies fuss while they are restrained for the 30 to 60 seconds it takes to perform the release, but they calm down in one to two minutes. Then they go straight to the breast with their new “freedom,” Dr. Notestine reports.

Post-op care involved with the procedure includes sweeping and pressing on the tissue to prevent regrowth of the frenulum in its troublesome positioning. Dr. Notestine admits this post op care can be unpleasant for parents and infants, but he finds most parents are receptive because the alternative is repeat surgery.

Laser treatment offers parents psychological relief because there is less blood loss involved than other methods. This is especially true in the case of the posterior release.

Babies often develop very tense faces, necks, shoulders and backs while they struggle to feed with these oral restrictions.  Dr. Notestine recommends body work such as chiropractic care craniosacral therapy (CST), massage, acupressure and others to help restore overall muscle balance.

Having built “little networks all over the place,” Dr. Notestine receives 30 to 40 calls per day from families seeking help with suspected TOTS.

“I can’t treat them all immediately, I still have a general dental practice to run”, he says.

Dr. Notestine understands that breastfeeding challenges are time sensitive, so he refers out to a small handful of doctors he has trained in the area if necessary.

Most of his referrals come from Lactation Professionals, perinatal workers, or from satisfied moms of children that Dr. Notestine previously treated. There are a few pediatricians in his area that recognize the defect and refer to him.

Because his office experiences such high volumes and mothers usually want to share their detailed stories from the beginning, it can be stressful and difficult to accommodate so many patients.

Dr. Notestine and his staff encourage mothers to email him, or to simply make an appointment and share the details then.

This year, Dr. Notestine was recognized for his contributions to tongue and lip tie at a Dr. Kotlow seminar in Brunswick.

Learn more about Dr. Notestine’s work here.

Speech language pathologist and lactation specialist embraces creative problem solving, collaboration and interdisciplinary teamwork

Not long ago, Lillian Scott, MS, CCC-SLP, CLC, a Speech Language Pathologist at Baptist Health in Lexington, Ky., saw a mother and her four month old baby for feeding difficulties including maternal breast and nipple pain. Scott reports that the mother sought out help from other community lactation specialists; still, her pain continued.

“It came as a challenge to me,” Scott begins. If this mother has already sought out information and support, why does she still have lesions on her breasts? She wondered.

Ultimately, Scott discovered that the baby latched shallowly onto the breast, so she worked with the couplet to find a more comfortable position. In the meantime, Scott knew she needed to tend to the mother’s sores; that’s when she consulted a specialist from the wound care team at Baptist. The wound specialist suggested the mother keep the lesions moist, rather than attempt to keep them mostly dry as she had been doing. Eventually the mother healed, and she and her baby went on to breastfeed comfortably.

Scott’s recollection exemplifies wonderfully the importance of creative problem solving, collaboration and interdisciplinary teamwork within maternal child health care, all methods Scott has embraced in her journey to serve families.

Before becoming interested in lactation and breastfeeding, Scott was a special education teacher where she focused on the various needs of children when things don’t go as planned in school. When she became a speech pathologist and transitioned to work in the NICU with Amber Valentine, MS, CCC-SLP, BCS-S, IBCLC as her mentor, she started to question infant feeding methods for fragile babies and mothers when things don’t go as planned after birth.

Her work today focuses on helping Baptist Health transform and evolve its NICU to reflect the latest evidence in health care improvement, like adopting a team-based and allied health approach.

Scott often consults research coming out of The University of North Carolina at Chapel Hill and follows the work of Louisa Ferrara, a pediatric speech and swallowing disorder specialist at Winthrop University Hospital.

She works to change NICU culture by engaging in positive conversations with her co-workers and sharing education opportunities.  

Scott presented at ROSE’s 6th Annual Breastfeeding Summit: Health Equity Through Breastfeeding, where she reviewed the challenges presented when mothers and babies endure traumatic separation after birth. She talked about what to do when breastfeeding isn’t appropriate due to babies’ skill level. Skin-to-skin is almost always first on the list, because it regulates body temperature and respiration rates, naturally sedates mother and child, among a slew of other benefits.

When babies advance and begin to show feeding cues but still might not be able to sustain a full feed, recreational nursing– where baby engages in non-nutritive sucking– is encouraged. Mothers then pump to ‘empty’ the breast. This practice allows bonding between mother and child to continue, and prompts mothers’ bodies to continue to produce milk.

As baby continues to rehabilitate and demonstrates readiness to breastfeed entirely, usually sometime between 32 and 37 weeks gestation when the the suck-swallow-breath pattern and respiratory stability begin to mature, Scott encourages more frequent feedings.  

After completing The Lactation Counselor Training Course, Scott says she gained new perspective on feeding difficulties. While her work once focused on the infant, Scott says she gained appreciation for understanding the mother too.

“I was mind-blown all week,” she says. “Why didn’t I have this education before?”

As she works toward becoming an IBCLC, Scott completed The Milk Mob Community Breastfeeding Supporter training.

“I love The Milk Mob and having access to the resources to better help my clients,” she says.   

Scott also celebrates inclusion in her practice as an Ally to the LGBTQ community, officially credentialed through OutCare Health, a nonprofit dedicated to providing cultural knowledge to medical and other care providers. Tomorrow, Scott will present about breastfeeding at the University of Louisville which will be recorded and included on OutCare Health’s website as part of its evolving health certificate.

In March 2018, Scott and colleagues will present about breast wound care at a state language pathology conference.

NAPPLSC rejuvenates a community of excellence

What happens in an environment void of the need to convince others that racial health inequity exists?

The National Association of Professional and Peer Lactation Supporters of Color (NAPPLSC) put it to the test in August this year at their inaugural, unprecedented The Amazing R.A.C.E.: Rejuvenating A Community of Excellence event, just before the ROSE Summit in New Orleans.  Participants included individuals vested in improving maternal child health as well as organizations like the Carolina Global Breastfeeding Institute who put forth a challenge on social media to raise scholarships for People of Color (POC) to attend the R.A.C.E.

Healthy Children Project’s Cindy Turner-Maffei attended The Amazing R.A.C.E. with Zoë McInerney of The Academy of Lactation Policy and Practice (ALPP).

Turner-Maffei calls the R.A.C.E. “something incredible.”

“I’ve never experienced anything like it before,” she says.  

Fashioned after the reality TV show The Amazing Race, NAPPLSC’s Clifton Kenon and Nekisha Killings–designers of The R.A.C.E–  challenged 39 participants to come up with an unmet need for breastfeeding and develop a plan to address the need. In slightly less than 24 hours, teams were required to share a Powerpoint presentation of their proposal that met a realistic budget to implement.

Already a complex task, participants were up against other elements on their race through the city:

  • Sorted into balanced groups (individuals of varying professional backgrounds and of different ethnicities,) competitors were allotted $25 per team member to cover everything they might need in the following 24 hours: food, public transportation, other incidental expenses. Participants could not spend any of their own money, and they needed to keep record of all expenditures. NAPPLSC’s Membership Chair, Brenda Reyes, acted as the Financial Manager and conducted audits.
  • The event took place from 5 p.m. on August 22 to about 4 p.m. on August 23 when team presentations began, so participants raced through the night. The event closed out with a celebratory event sponsored by HealthConnect One that included bowling, food and refreshments.
  • About every two hours participants were challenged with side-tasks, like creating a media piece that showed predatory marketing in an hour and writing a grant proposal. If these tasks were satisfied, fake money was added to their final project budget.

“It was so intense,” Turner-Maffei emphasizes.

NAPPLSC President Felisha Floyd, BS, CLC, IBCLC, RLC points out that the intensity present at the R.A.C.E. reflects the environment POC work and live through everyday.

“Our communities are in crises,” she stresses.  

Weaving heavy realities into game format made for dynamic energy, excitement and an element of mystery, Killings describes.

Members of the winning team were: Camie Goldhammer, Khyrej Jones, Nikia Fuller-Sankofa and her daughter, Chauntel Norris, and McInerney. NAPPLSC hasn’t shared the rubric for deciding on the winning team.

Over one month after the event, NAPPLSC Executive Director Stacy Davis reports that she’s still receiving emails from participants expressing their appreciation.

Killings noticed competitors’ elation to be around like-minded professionals, their excitement for what is to come and the gratification of realizing what they could create together.

Some have shared that the R.A.C.E. was life-changing.

Turner-Maffei reflects on the valuable process: “Part of my learning was realizing where my strengths are and knowing where to cede. I had to to refrain from sharing opinions. I’m not from this community. While I may know what works in general, the other folks in my group are the experts.”

She wonders, “How do I put my needs and skills out there so I can be truly useful?”

The R.A.C.E. helped Turner-Maffei realize the value of letting go of her perception of what is real and to be willing to accept another perception of reality.

Floyd considers her experience as a competitor life-changing too.

“It’s pretty amazing how quickly you can come up with ideas and really facilitate solution driven strategies under pressure,” she says. She points out though, that outside of the R.A.C.E., POC don’t always benefit from the team component.

In a true act of allyship though, Floyd recognizes the Carolina Global Breastfeeding Insititute’s challenge to organizations of privilege to sponsor POC as “profound and reassuring.”

“The beauty of that call out was that it was a wonderful example how an organization can act as an ally without being solicited,” Floyd explains. “We saw an amazing impact.”

Initially, NAPPLSC planned to issue three scholarships to The R.A.C.E.; ultimately they were able to award 15 full scholarships.

Floyd goes on, “In the field of lactation we all can find that common thread. We are all here to support families.”

Competitors entered the R.A.C.E. with similarities, but over 24 hours, they formed lifelong friendships.

For instance, one of Turner-Maffei’s team members had a grandchild born within 30 minutes of her newest granddaughter.

“I feel bonded to these women for life!” she exclaims.

Davis reiterates that participants got to know one another “on a totally different level.”

Floyd laughs, “I can only imagine if we had more time, we could have solved the world’s problems.”

Improving access to culturally and linguistically appropriate services for Limited English Proficiency (LEP) community

Lorena Quiroz-Lewis remembers fondly the first seven years of her life in Ecuador. She recalls going to her Abuelita’s house every Sunday for dinner where women and children gathered to comb hair, talk about their husbands and breastfeed their babies.

“I remember walking around to several of my Aunts and looking down at the bundles held in their arms as they nursed their babies with no shame, breasts out, laughing loudly at something one of them said…Getting scolded for not bringing our Tias the chicken soup, and listening to them discuss how tightly they had their fajas (garters) and showing off the excellent job they had done in tightening their stomachs,” Quiroz-Lewis reminisces.

When Quiroz-Lewis became a mother after moving to the Mississippi Delta, her experience lacked any of the warmth and comfort she felt in Ecuador.

She found herself at a hospital where staff treated her a “substandard human” without health insurance.

Quiroz-Lewis tells part of her birth story:

“[I was] scared witless about giving birth naturally, even though I had been in labor for two days with no medications. In the end, the fear [hospital staff] instilled in me– of tearing my baby’s shoulders off, breaking her arms– I had a c-section. My baby was taken from me, bottle fed while I recovered, and all my dreams of having a natural birth and nursing my baby with little interventions were gone.”

Upon her arrival home, Quiroz-Lewis struggled to breastfeed; breasts bleeding and beset with an unexplained fever, she landed back in the hospital for days. It wasn’t until her mother, father and sisters arrived that she felt truly taken care of.  

“For the week they were there, they took care of me, my baby, my husband and my home,” Quiroz-Lewis says. “This is why I treasure women and the importance of our culture, our tribes, because they saved my life and the life of my child. They nursed me back to health.”

Still trying desperately to put her daughter to breast, Quiroz-Lewis ultimately found herself at the health department seeking formula.

That day, the district breastfeeding coordinator happened to be there. She and Quiroz-Lewis engaged in a welcome exchange; the woman wondered why she was switching to formula.

“I showed her my scabbed breasts,” Quiroz-Lewis recalls. “At that moment, my baby started to root.”

The breastfeeding specialist took the cue and asked if Quiroz-Lewis would try to feed her baby.

For the first time in six weeks, Quiroz-Lewis says she felt no pain while breastfeeding as the woman put her baby “so lovingly” to her breast. For over an hour, the woman sat attentively with Quiroz-Lewis and guided her to a support group about to take place.

“[I] walked into a room filled with breastfeeding women, babies running… women laughing loudly, grandmas holding toddlers while their daughters tried to nurse,” Quiroz-Lewis recalls. “I was home.”

Six months later, the breastfeeding coordinator offered Quiroz-Lewis a peer counselor position.

“My love for the health of moms and babies has become my passion ever since that fateful day,” she says.

Today, Quiroz-Lewis is a bilingual health and wellness coach, Certified Lactation Counselor (CLC) and executive director at LABALink (Latin American Betterment Association.)

In celebration of Hispanic/Latino Heritage Month, we showcase Quiroz-Lewis’s accomplishments and contributions to the field of maternal child health as she works tirelessly to improve health outcomes for Latino families.

Quiroz-Lewis has nearly two decades of public health experience.

“During these years my passion has continued to be improving access to culturally and linguistically appropriate services for Limited English Proficiency (LEP) Community and health equity for People of Color (POC),” Quiroz-Lewis says.

She spent 10 years with the WIC Breastfeeding Program and five years with the Mississippi State Department of Health Office of Health Disparities Elimination and Office of Preventive Health as State Diabetes Coordinator. The Office of Health Disparities Elimination was instrumental in developing a strategic plan and policy that would ultimately address poor maternal child health outcomes. It brought the first medical interpreter trainings to the state where Quiroz-Lewis was a trainer, and it provided the first Spanish language chronic disease trainings in the state. The office hosted a health fair and collaborated with other community partners to bring nutritional workshops to residents.

“It was a huge success but lack of funding has [prevented] us from doing the work that is necessary to scale programs that are direly needed,” Quiroz-Lewis says.

Quiroz-Lewis is responsible for restructuring the main role and mission of LABA to improve quality of care, access to care and increase community and business partnerships in the Latin American community.

She is also a Community Transformer Trainer for Reaching Our Sisters Everywhere (ROSE) with a goal of forming a breastfeeding coalition for Latinas.

Her work doesn’t end there. Quiroz-Lewis is a master level trainer for Stanford’s Chronic Disease and Diabetes Programs and a CDC Lifestyle Diabetes Prevention Coach. She has been asked to speak before the City of Ridgeland’s Chamber on Diversity, Inclusion and Language Access and has participated in the B.B. King’s Museum’s Racial Equity Panel Programs.

She is part of the Mississippi Breastfeeding Coalition and the International Cesarean Awareness Network (ICAN.)

Currently, Quiroz-Lewis conducts interviews with women in the Latino community about their hospital birth and breastfeeding experiences and access to resources in their language to help engage providers and advocate for proper maternal health services by sharing personal stories.

“In the Delta, Latino moms are invisible,” Quiroz-Lewis states. “They lack a voice because they are undocumented and either do not speak the language or do not speak well. There is no one to advocate for them, nor do they have the resources to advocate for themselves.”

As a self proclaimed writer and storyteller, Quiroz Lewis documents the accounts of her life; stories from Ecuador, her family’s migration to the States, growing up Latina in New York, marrying and moving to rural Mississippi.

“Writing can be a way to influence people, advocate for yourself and the rights of others as well as show vulnerability and be able to connect with people on so many levels,” she says.

Latino authors like Sandra Cisneros, Julia Alvarez and Esmeralda Santiago have deeply influenced Quiroz-Lewis.

“Their contribution to the literal world and to humanity as a whole, by giving a voice to our community and our people, highlighting our struggles and successes, sharing our culture and the light we bring to this country, brings me great pride,” she says.

Quiroz-Lopez honors their legacy working to improve conditions for Latino families in a state with chilling maternal infant mortality rates, some of the lowest breastfeeding rates and highest obesity rates.

“There are so many things that we can improve on– basic things which are not part of the CDC’s recommendations–which can prevent so many of these tragedies,” Quiroz-Lopez begins. “Things that involve cultural practices, basic nutrition, the care of our women and babies by our tribe, the cuarentena, days of rest which follows birth which gives emotional and physical support to a mom who has just delivered a tiny human.”

She goes on, “In this country where healthcare is a right and technology is at the tips of our fingers, we have forgotten the human part of health care, which along with our cultural practices can be used to improve health outcomes on maternal child health.”

As allies, Quiroz-Lewis offers this for our consideration: “It is impossible to understand the complexities of people’s cultures and languages and cultural norms. What can work in these cases as our country moves into a more diverse population, is kindness. Show kindness to your clients. Listen, look at the expressions on their faces, do not leave without making sure that mom is doing ok, come back and follow up. Show love.”

Breastfeeding, peace and justice

Source: United States Breastfeeding Committee

This Thursday is The International Day of Peace (“Peace Day”) which has been observed globally for over three decades. Established by unanimous United Nations resolution, Peace Day offers “a globally shared date for all humanity to commit to Peace above all differences and to contribute to building a Culture of Peace.”

As a prelude to Peace Day, we are sharing a beautiful piece (with permission) by World Alliance for Breastfeeding Action (WABA) Young Leaders Frenny Jowi and Bryndís Skarphéðinsdóttir which was originally published for WABA as an International Youth Day Statement in August this year.


Young people are key agents of change in conflict prevention and sustaining peace. On International Youth Day 2017 WABA celebrates young people and their contributions to conflict prevention and transformation, sharing with our work across generations, for inclusion, social justice and sustainable peace.

Youth, Peace and breastfeeding!

Breastfeeding and peace. You may wonder what the link is between the two.

In the words of Anwar Fazal, Right Livelihood Award Laureate and Chairperson Emeritus of WABA, “Breastfeeding is about peace and justice. It is the natural and peaceful way of nurturing our children. In a world often wracked by injustice, violence and war, breastfeeding can be a sentinel of peace- inner peace, peace with other people and peace with the environment’’

There are more young people in the world than at any time in recorded human history. Half of the world‘s population is younger than 25 years old. The majority of the younger generation live in developing countries, many of which are countries affected by conflict.

It is very important that young people play a key role in sustaining peace and promoting a sustainable future. It is our future that we are shaping.

Conflicts often tend to arise in poorer countries, that experience wide inequalities, lack of security and cannot meet basic human needs. The protection, promotion and support (PPS) for breastfeeding, when taken seriously and with urgency by communities and governments, demands that we reevaluate our priorities and place people and the planet at the centre of how we organize our world.

Women are at the centre of global development issues. Poverty affects women disproportionately. The feminization of poverty is a social justice issue and we cannot ignore it. Child care and breastfeeding are still largely seen as ‘women’ work’. Unpaid care work confines women and stops them from achieving their full potential. For peace and harmonious co-existence, we must recognise and integrate women’s roles in the work place, politics and all aspects of public life. Women’s breastfeeding rights are directly linked to the common good of our communities. The rights of girls and women are at the core of peacebuilding.

Breastfeeding advances sustainable development by improving nutrition and health, preventing child mortality and by decreasing the risk of both communicable and non-communicable diseases, for both mother and child. When addressed in societal terms the protection, promotion and support of breastfeeding becomes an important enabler to tackle poverty, promote economic growth and reduce inequalities.

Conflicts and refugee producing situations create stressful environments that have a negative impact on the mother’s ability to breastfeed. Mothers in crisis situations often feel forced to turn to bottle-feeding. Breastmilk substitutes lack the immunological benefits of breastmilk. An unhygienic environment and unsafe water mean that a bottle-fed child is up to 25 times more likely to die as a result of diarrhoea or other diseases than a breastfed child.

According to The World Health Organization, more than 820,000 lives, mostly babies under 6 months of age in low to middle-income countries, could be saved annually with increased exclusive breastfeeding. Breastfeeding is one of the top interventions for reducing under-five mortality, as it provides the nutrients needed to survive and thrive.

There are enormous economic benefits to any country from reduced illnesses, costs of health care cost and increased productivity. But not enough funds or attention have been given to the importance of breastfeeding.

This International Youth Day, there are three things that give us hope that by working together, young people can play an active role in building the future we want.

Firstly, World Breastfeeding Week 2017 saw the launch of The Global Breastfeeding Collective. Led by UNICEF and WHO, this partnership brings together some 20 international agencies, including WABA, with the goal of increasing investment in breastfeeding worldwide. Secondly, WABA has aligned World Breastfeeding Week with the Sustainable Development Goals providing a framework for a long-term campaign to achieve our collective ambitions across issues. Thirdly, as WABA Young Leaders, young people have space and support to inform, engage and galvanize others to contribute meaningfully to this process.

Young people have a voice and will hold governments accountable. Together we can build resilient and peaceful societies.