Hi Mary,
This baby probably has a submucosal tongue tie (the frenulum is hidden 
under a little fold of the floor of the mouth). You are right that 
tongue tied infants have less tongue mobility when the jaw is open, and 
the tongue often retracts more with a good gape. Babies learn to keep 
their mouths more closed while they breastfeed to try to keep their 
tongue forward more, but this results in more discomfort for mom and 
smaller mouthfuls of milk for baby (hence a higher suck:swallow ratio).

Realize that as IBCLCs we are seeing only babies who are having 
breastfeeding problems, so there are going to be more tongue-tied babies 
among our clients. Maternal characteristics matter too - the more 
elastic mom's breasts and the higher her milk production, the easier it 
is for a tongue-tied infant to breastfeed.

You have the perfect built-in comparison group in your LLL group. This 
same combination allowed me to make a lot of these connections, watching 
those among the LLL moms and babies who never had difficulties and 
comparing them to the dyads I saw in my LC practice.

As for how to speak to parents, I generally talk about how there is a 
continuum of every human trait, and that their baby's snugger tongue 
attachment seems to be contributing to their problems. We'll try all the 
management stuff first, and if this is not enough, I will give them the 
name of a specialist who can assess their baby to see if treatment would 
help. If a baby has horrible tongue function, I may give the specialist 
referral on the first visit. I then put the fact that I recommend 
specialist evaluation and why in my report to the baby's hcp.

Catherine Watson Genna, IBCLC  NYC

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