When I first joined Lactnet I didn't know how to recognize signs of tongue
tie and I wondered why some posters were always bringing it up.  I regularly
encountered women who appeared to have their babies well positioned and
attached at the breast but were still having a lot of pain and their nipples
looked very traumatized after a few days of BF. And I met a lot of women
whose previous baby had been weaned very early, like in the first couple of
weeks, due to intolerable pain and soreness that nobody could help her with,
and some of them have been treated for tongue tie in later childhood. 

Now I see a case or two of tongue tie virtually every week.  We have about
175 births each month in my hospital.  The few studies we have about tongue
tie point out that the incidence of visually detectable tongue tie is a lot
higher, like three times, among babies attending BF problem clinics than it
is in an unselected normal population of babies, where it is perhaps 3%. 
That should tell us something right there.  Can't remember offhand whether
it was Hazelbaker or Griffith who noted that about half of babies with a
visible tongue tie had no difficulties feeding effectively and without pain
to their mothers.  The other half are the ones who may benefit from frenotomy.  

If it ain't broke, don't fix it - even if you can see the frenulum is
attached near the end of the tongue, as long as mother and baby are happy
and thriving, there is no problem.  After seeing nearly instantaneous
improvement in feeding effectiveness and comfort following frenotomy in
pretty much all the cases of tongue tie accompanied by BF problems which we
have referred, I'm satisfied that our criteria are good enough.  

If feeding is going fine, I don't look any farther. If it is not, then
checking the oral cavity for ANYTHING that could be a factor is a logical
next step in my book, if simply improving positioning and attachment does
not solve the problem.  Once we find a suspected tongue tie, they can't be
evaluated and possibly clipped fast enough for me.  The sooner the better,
because the baby often needs a bit of time to figure out what they can do
with their tongue's new-found mobility and we want them to have the chance
to feed before they go home from clinic.

I would love to know whether tongue-tied babies are overrepresented in the
group of babies that don't spontaneously start suckling shortly after birth.
 I'm not aware of any research into that question.

Rachel Myr
Kristiansand, Norway

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