I don't see many tongue-ties.  This one was a direct referral from a ped's
office (a rarity in itself and actually from the nurse practitioner, who'd
like to sit for the exam someday).  Mom had quit nursing her first baby at
a week because of raging sore nipples, and it was happening again with this
one.  The nurse practitioner had been the only one to spot the tongue-tie,
though it was hard to miss.

Mom said her sister had been tongue-tied at birth, but ped had snipped it
(w/o permission; would that happen today?) before the mom even saw it.

We worked on positioning, and by golly eliminated the pain.  But milk
transfer was slow.  I wrote a letter to the ped recommending frenotomy, and
recommending frequent weight checks if frenotomy not performed.

Mom was delighted to be pain-free, didn't seem concerned by the
inefficiency (*I* was) but rented a pump to help with engorgement and
understood to give pumped milk to the baby as needed.  She continued to be
pain-free, returned the pump soon thereafter, and seemed totally content
with the lengthy feedings they were having.  But she *did* want the frenum
clipped, figuring that at the very least now was the easiest time to deal
with it.

I sent the pediatrician's office all the JHL articles from the 1990 6(3)
issue and Alison Hazelbaker's evaluation tool.  He made a referral to an
oral surgeon, and I sent *him* all the JHL articles and the evaluation
tool.  The oral surgeon wrote me a nice letter about how in his experience
ankyloglossia is very rarely a feeding problem, more often a speech
problem, and that he looked forward to reading my materials in the next few
days.

In the meantime, baby had another weight check at the ped's:  gaining just fine.

Today I heard from the mom:  She had the tongue clipped yesterday.  Baby
fussed some at yesterday's nursings, as if sore, but has had fun exploring
the outside of her mouth with her tongue... and, just as I had hoped, she
fills up in 15 minutes at breast instead of 1/2 hour to an hour.  Mom is
thrilled.  "Now I have more time for my other child."  You can be sure I
quoted her in my report to the surgeon and ped!

Diane Wiessinger, MS, IBCLC, LLLL  Ithaca, NY