I must admit I am thoroughly confused by the wait and see approach to tongue
tie.  If it is hurting mom and/or baby is having difficulty latching and
there is no other complication (like ones I see at times who have extremely
tight muscles that could be causing a 'looks like a possible t-t' effect),
then why is anyone waiting?  A clipping is generally an easy procedure -
baby hates being messed with and cries but it is so quick and beneficial I
don't understand why one wouldn't do it.  I have parents who do not bat an
eyelash to circing their newborn son but freak out over a clipping, and Docs
who don't believe in t-t's so won't clip - even when mom is in extreme pain
and baby is having difficulty feeding!  The long term issues, like snoring,
apnea, digestive issues, speech therapy can all be virtually eliminated by
this simple procedure.



Tongue ties can cause a myriad of problems.  Look to Dr Brian Palmer for
more info on that.  It is not normal for babies to snore, it is not normal
for them to not be able to elevate their tongue, it is not normal for them
to have restricted tongue motions.  Tongue ties can cause loss of milk
supply as baby gets older and can not drive the supply because his tongue is
not working right - he may be gaining weight fine in the beginning, but
living on 'let-down' is NOT right.  How many babies have I worked with whose
LC or HCP noticed a t-t and did the wait and see approach only to have mom
come to me 2 months later with a crashing supply looking for help with
increasing the milk supply?  I see a t-t and strongly encourage her to get
it clipped and she then gets mad wanting to know why she wasn't told about
these risks!



My personal and professional opinion is that the wait and see is too risky
without very careful observation of the dyad.  I only do the wait and see if
there is significant tight muscle involvement and I am not 100% convinced
that the t-t is a problem or even a true t-t.  Things I note for this:
Normal palate but tongue looks tied with restricted or t-t-like movement.
If I see a true t-t the palate is almost always high to some degree.



The only ties I cannot find anyone to clip here are the posterior (with 1mm
or less that needs clipping) and submucosal.  No one will touch them here
and it makes me mad.  I know there are videos (I've seen them) on how to do
this, what it looks like etc.I can't find them right now.  If anyone knows
the links.I'd love to have them.



Just my thoughts after seeing too many babies with t-t and cleaning up the
wait and see mess that often happens in my area.



Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net




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