Hello, fellow lactnetters!
        I introduced myself about a month ago but, I must admit, I find this
whole Information Superhighway thing quite intimidating so I have faithfully
been reading the issues but have not yet written!  This line is a great way
to get into it, though!  Very interesting.

        I would like to share my expertise about a medical hinderance to
breastfeeding that often goes unnoticed, mainly due to the unfortunate(to
say the least!) stress on formula feeding over the past several decades.
This is tongue-tie.  Frenotomies used to be routinely performed because of
the obvious negative impact a tight frenulum can have on breastfeeding.
Namely, it will lead to damaged nipples for mom and poor weight gain,
unnecessarily long feeds and inability to stay latched for the poor babe.
Tongue-ties only rarely affect bottle feeding.

Here are some tips I hope you will find helpful in diagnosing a tight frenulum:

Inspection:     Heart-shaped tongue
                Prominent frenulum

Palpation:      Unable to protrude tongue over lower gum
                Unable to cup tongue
                Snapping back

Feeding Assessment:
                Unable to draw nipple back and maintain suction
                Mother in severe pain
                Clicking, coming off, infrequent swallowing
                Breast refusal
                Slow weight gain

        Release should be performed as early as possible when a problem is
identified as the baby's best interests and the mom's confidence are at stake!

        I have done a lot of research in this area at the Lakeview
Breastfeeding Clinic in Calgary and have made a video demonstrating the
assessment of a tongue-tie leading to its release.  If you have any
questions or comments I would love to hear from you!  I hope you found the
above information helpful!

With best wishes,
Evelyn Jain, MD, CCFP