Helen and Lactnetters,
     Good for you Helen.  To add a comment on tongue tie. one of the babies with tongue tie that I saw this year was not at first identifiable, as she could poke her tongue and certianly had it over the gumline.
   The baby was about 4 months, with faltering weight gain, very experienced Mum.  History of mastitis.  Everything, when I took the history, was suggestive of poor tongue function leading to a critically low supply.  So I looked very closely again.  Yep, the baby could point her tongue, but she had limited elevation, i.e. she couldn't lift it adequately.  This meant she had a wide gap between tongue and palate with the nipple/areola "teat" not being compressed.
    I always keep a list of medical people in different parts of the city, whom I know are knowledgeable and proficient about dividing tight frenula. The one the parents chose agreed wih me and did the frenotomy in his office.  There was a small improvement immediately, but further improvement was slow as the baby had to unlearn the faulty techniques she ws using to try to compensate, and learn how to use the increased tongue function.  (As Helen said, follow-ups are a sensible course.)  During the period of waiting for the medical appointment, more than a week, the supply problem became critical and required the temporary use of a home-made feeding tube device to boost what the baby could get and prevent dehydration.  Very motivated Mum, a pleasure to work with.
     Probably if I hadn't had a special interest in tongue tie, I wouldn't have picked this one up.  I'm glad I did, as the frenotomy helped the mother and baby to continue and improve breastfeeding.  Now, months later, they are still going strong.
     The message from this is:  don't just go on appearance.  Check the tongue function, too, and not just protrusion.
      Happy New Year, everyone.
                     Virginia
                     Private practice
                     In sunny Brisbane, Queensland, Australia

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