I've found you need to assess just elevation, extension and 
lateralization. Tongue should be able to lift all the way to the palate 
with the mouth open without pulling up the floor of the mouth, stick 
straight out over the lower lip (without the tongue tip rolling under), 
and follow a finger around to the sides of the mouth (corner of the 
lips) without twisting. If these 3 motions are possible, there is no 
tongue tie. If they are restricted, there is. If there are breastfeeding 
problems, and tongue motion is restricted, our doctor treats.
Catherine Watson Genna, IBCLC NYC

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