I feel like I am starting my morning with elevated blood pressure while reviewing my mail. 

There are 2 local ENT groups in town where I practice - I have one that i generally refer to for tongue tie clipping as i've had pretty good success with them clipping newborns for me.  The practice I usually refer to has a doc that has actually clipped a newborn for me in the hospital who was having feeding problems just because I happened to run into him in the doctor's lounge. 
The other group gave me a bad feeling as I saw a couple consult notes where they put off the clipping till infant was older "as they are gaining weight well on the bottle".

I know better to refer to pediatric surgery at the children's hospital, I did my residency rotation in their office and saw several new moms persuaded against clipping at the expense of breastfeeding. 

I'm getting frustrated though. I keep getting referral letters where I specifically requested an appt with one of the two ENTS that I trust to clip newborns, and the office set the baby up with a different ENT physician. Each of these letters could be a carbon copy of the previous.  "baby not breastfeeding well.  They are taking a bottle fine, and gaining weight so I would simply observe and if still a problem we can have it done under general anesthesia after six months of age".  All of these patients have been moms who I have offered observation vs getting clipped and they have all told me they wnated to be clipped b/c of the feeding issues!!!!!!

AAAAAAAAAAAAAAAAHHHHHH!

I never had any training as a resident in doing frenulotomy, and I certainly am not going to just start clipping them in my office without any, but I am getting so frustrated. I felt like I had a "safe" place to refer infants with breastfeeding trouble, yet these moms are getting the message that breastfeeding isn't important as long as baby takes a bottle.  I fight this attitude enough with my own fellow pediatricians.  

Thoughts??  Any other physicians with a similar experience? 

Mary Martin, MD, CLC

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