We are lucky to have in Austin more than one ENT and some other types of MDs
as well (FPs, older pedis, etc) who will clip a baby's frenulum if sore
nipples can't be resolved with positioning changes.  However, there are
parents who don't want to do any procedures they consider invasive. I have a
2nd time client married to a chiropractor.  She suffered through months of
chewed up nipples with son #1 (now 4) and finally got comfortable.  Either
his tight frenulum stretched, or his mouth grew -- probably both -- and
these changes made nursing tolerable to go on for 3 yrs.  She recently
delivered son #2 and he has the identical frenulum.  When I visited her, I
asked if I could look at the older boy's tongue. Being a typical 4 yr old,
he was delighted to stick his tongue out at me.  It has torn free, and there
is no evidence of a tethered frenulum.  I guess he fell down one day and
prob. clipped it himself.  His speech is great and teeth spacing looks ok.
So she is quite reluctant to clip the infant.  She has complained of pain
for weeks now, gotten cranial manipulation etc. but is toughing it out.  I
have gently mentioned a number of times she could free up the tongue with a
ph. call.

The best that can be offered by the LC in such a situation (or in one where
there is no available person willing to clip) is to use positioning tricks
to bring the lower jaw closer to the breast so the tongue doesn't have so
far to reach.  A tightly flexed football position with baby's butt up
against the back of the seat, and body essentially lying under the breast
looking up.  Baby is brought to breast by pressure on shoulder blades so
that head falls back slightly and isn't flexed forward, (which drives chin
into chest.)  In other words,  you want the baby to lead with the chin, so
it is quite jammed into breast tissue.  You can tell if you've achieved
this, because the nose will be backed off from breast.  Side lying with baby
quite a ways down the torso can work well too.  As baby "roots up" and makes
the crawl up toward the nipple, the head will be thrown back, and again baby
will lead with the chin.  This is a positioning change which can relieve
nipple discomfort to such an extent that the unclipped baby can nurse
without too much nipple damage.  Then on hopes that growth, stretching, and
the bumps and tumbles of the typical kid will free up the tongue.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html