This topic may have been discussed to death, but it is near and dear to me,
so I must respond. (I have been out of town and just skimmed through all
posts on the subject over past few days!)

I must admit I see a very skewed population, in that I ONLY see moms and
babies who are having difficulty with breastfeeding. But I see a LOT of
tongue-ties of all types.  (I actually see fewer type ones than any other
because they tend to get clipped in the hospital)

Out of frustration at the lack of data on which types are worth clipping and
how to decide which baby might benefit and what age is most helpful, I
started keeping records on all english-speaking frenotomies last august.
Today I think I did numbers 70 and 71, on my way to 100.

I am sending a survey 4 weeks later to ask when and if mom felt improvement
in latch pain and/or removal, as well as chart review.

Interesting things I found after the first 50 were that the more normal the
suck exam pre-clipping, the more likely the clipping would help. No mom was
sorry she had had it done, even if it did not help.  The more posterior the
frenulum, the less likely it would help, but still a significant percentage
(over 50% for a type 4) had improvement of symptoms within 48 hours. (Many
are immediate)    BUT, by the same token, despite expert follow-up with our
LCs, nearly 50% did not have it help at all.

This is a very frustrating issue for me, because I am the person holding the
scissors, and I want to know what to say to parents when they are trying to
decide whether to have it done or not.  One of the tongues I clipped today
was a week old, type 1, and could not latch before at all.  Latched a little
after, but transferred very little milk despite mom able to pump 4 ounces.
Was not an instant magic bullet for them.

Kathy Leeper, MD, IBCLC
Medical Director, MilkWorks
Lincoln, NE

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