I gave a talk at the ILCA conference in Atlanta in 1994 on tongue-tie and showed a clinical vignette from my practice. (Actually, the patient had been in the day before I left for Atlanta!) A lot of people were eager to get a copy of the video right then and there and wrote to me later. I felt that though the video went well with my talk it needed to include more background information in order to stand alone. In response to all these requests I recently completed a 20 minute video on infant tongue-tie and breastfeeding. In my practice I find that a tight frenulum restricting tongue movement has a definite impact on breastfeeding and I have seen babies with failure to thrive, slow weight gain, mothers with very sore nipples, and babies who are unable or unwilling to try latching at all. When a full assessment is done of the baby and the mother and the breastfeeding situation and when ONE IS ABSOLUTELY CERTAIN that there is no significant blood supply or muscle tissue in the frenulum, that is, that it is very thin and translucent with a pen light or otoscope shone through it, it is often desireable to release the frenulum to allow better tongue movement. I have had very good results with improved breastfeeding immediately after or in some cases several days after frenotomy. I have never seen a case of infection, scarring, continued bleeding or continued pain. A caution though, some frenula are thick and meaty and contain abberant blood supply or abberant genioglossal muscle. I would NEVER touch these in the office. I would consult an oral surgeon who would do a much more complex operation with a general anesthetic in the operating room. It is very important to distinuish between frenotomy, which is a simple clipping of a simple, almost bloodless, skin-like structure, and frenectomy, which is a major surgical procedure. And it's also very important to be quite conservative in clipping the frenulum to ensure that there is little or no blood loss. Being aware of tongue-tie as an impediment to breastfeeding and arranging a frenotomy in selected cases with good follow-up to ensure resolution of the problems can make all the difference in the world in promoting breastfeeding success for these mothers and babies. Evelyn Jain, MD, CCFP, IBCLC Director, Lakeview Breastfeeding Clinic fax: (403)246-7076 email: c/o: [log in to unmask]