There is no research (that I know of) quantifying the degree of tongue-tie 
and then assessing the effect of clipping.

But I can tell you from experience that clipping very small amounts can make 
a huge difference. Often when it looks like "just a mm", it is that the 
frenulum is vert tight (inelastic) and once you snip 1mm the tongue springs 
up, and you can see another 2mm to clip.  I would bet you that this baby's 
frenulum comes out to where the salivary ducts travel from either side of 
the floor of the mouth toward the center.  It seems to be a very common 
place for the really tight ones to connect.  And it is impossible to see 
where they end before clipping.

I recently started clipping submucosal frenulae after watching a video in a 
presentation by Catherine Watson Genna's of Dr Betty Coryllos performing 
one.  I have been amazed.  The first one was a 3 month-old refusing the 
breast because she could not remove milk well.  In 2 weeks she was 
exclusively breastfed.

Catherine is collecting video of ultrasound of babies before and after 
clipping (correct, Catherine?), I believe showing improved mobility of the 
tongue.  Maybe she has one you could share with this Dr?  Really...if you 
can convince them to do it, chances are it will make a difference and they 
will be "sold".  If they are used to using their fingers, it may be helpful 
to get a "grove director" to place under the tongue to isolate the frunulum. 
I can't imagine trying to do those really short/tight ones without one.

Good luck-

Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE

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