I also find the subject of tongue tie fascinating and frustrating.
I am a speech language therapist/IBCLC and started working in 
a hospital here in New Zealand in 2002. It took me several years 
to convince one of the ENT's to snip tongue ties. The other
ENT's are highly sceptical and critical and I recently overheard
one of the practice nurses saying that it is the "latest fashion".

Just a few points of interest from my perspective:
Being an IBCLC I usually explore the feeding history thoroughly when I 
do interviews for children with developmental delay/disability etc.
I so often hear the statement when I ask about breastfeeding that it
was not possible due to tongue tie.

I therefore think that some of that early success through careful 
positioning may lead us astray in thinking that the problem is solved,
but come weeks and months and baby wants to feed all the time, many 
mothers probably wean because of this.

In my very humble opinion it is not so much the positioning of the 
tongue that matters but maintaining that position for the duration
of the feed. So getting the positioning right for 1 minute and keeping
it right for 20 is very different. So I think there is a degree of fatigue
that sets in with the consecutive movements so that they become less
accurate and therefore transfer of milk becomes less effective. 

The huge variation in negative pressure babies can create intra-orally
may also explain why some babies do better than others. A baby that can 
create very high pressure may be able to maintain the nipple in position
while one who is not able to do so need to pinch the tongue either at 
the base or tip (as per the research coming from Geddes in Aus) or may
fail to do so altogether and keep slipping off the breast.

From a speech perspective I notice that children can frequently produce
speech sounds individually and if they cannot they are often very good at
making compensatory movements to achieve a good alternative. The main 
issue in the older child is frequently poor intelligibility, i.e. they loose
accuracy when the sounds are connected into words and sentences and
their speech may be difficult to understand. So once again making many 
movements rapidly and accurately over an extended period may be very
challenging for the tongue with restricted mobility.  
Fatigue can possibly cause further deterioration. I have a colleague with
tt and she feels that her speech becomes quite nasal as she gets tired,
which is interesting because the nasal voice quality is something that is
associated with posterior ties.

As far as assessments are concerned I think the appearance of the tongue has
become less relevant to me over time, it is absolutely the function I am
interested in and very frequent feeding, very short breastfeeds, gassiness
and then of course slipping off, snap back resulting in clicking or smacking
etc. are usually the things I hear about.

I have worked with several bottle fed babies with tt and extended feeding
times are usually characteristic.  

In looking at how babies survived in the past I think we see many babies in
Africa, India etc. who survive with significant unrepaired cleft palates and
they survive because of their mothers/caregivers who are innovative and feed
the baby even if it is with a spoon and it takes hours.

As for the very large tonsils my son who breastfed for many moons(many many)
also had them, but fortunately did not have tt and I always associated it
with a positive immunity, he did not snore and I never thought much of it at
all.

It is great to keep learning with you all on the list.

Loraine Hamm
 
From New Zealand where tongue tie is perhaps also predominant in the
European babies, but certainly also well represented in my little Maori
clients. 

 




    
 



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