I'm late joining this discussion on tongue tie but since I have a stamp on my forehead that reads, "Can identify posterior tt", thought what I've experienced might be helpful. I've been through the feelings of over diagnosing and discussed same with both Cathy Genna and Betty Coryllos which helped to quiet my fears, as well as, seeing improvement in breastfeeding post frenotomy. In fact, a pediatrician/IBCLC, whose patients I've seen says with a laugh that she waits for me to bring up tongue tie as a cause for her patient's breastfeeding difficulties. Even though I'm more reassured that posterior tongue ties need treatment, I still waver occasionally about whether to strongly encourage clipping in some situations. I never keep quiet about what I see/feel because parents deserve to be informed, but inside I question my own assessments, especially when I wonder if improvement in breast attachment may be enough, and effects of tie are marginal. One recent case of a 3 mos old who began to refuse the breast with mom's lowered supply turned out well following Dr C's frenotomy though it took a few weeks, and baby only having had one osteopathic treatment. This case is one in which weaning was beginning and would have surely occurred had frenotomy not been done. I had this mom, as I instruct with all, do tongue strengthening exercises (pacifier tug of war, tongue sweep for lateralization, pushing tongue down and out) and these may have helped as well. Mom recently emailed me and said something like how wonderful it felt to have her baby's hand on her breast while nursing, and well, those types of feedback, make me swallow my doubts. I want to add that Dr C now has moms daily elevate the tongue (for posterior, generally type IV's) by using first two fingers, pad side up, as a prong or fork, to assess and prevent scarring which is more likely to occur with the submucosal frenulums; this is done on day 3 (2 days post) of frenotomy so nothing is disturbed in early healing stage. I've had parents decline frenotomy with subsequent weaning, and those who continue to breastfeed despite it but babies tend to have reflux and in my opinion, are able to continue due to moms' robust supply. In my support group, which is small, currently 2 out of 6-7, and soon to be 3 babies have had frenotomy. There are 2 other babes in group, 5 mos and 7 mos, who have tight frenums who click or have had reflux whose moms chose not to clip. I would like to know how these babies do as children with orthodontics, etc. The moms whose babies had frenotomy are also private clients, though I did assess other babies in group as well. I think it's hard for moms who don't experience pain or low supply or whose babies don't have highly visible symptoms, to consider frenotomy when possible long term consequences of not clipping are so far away. I have other comments but will wait to post and I'm sorry for being so verbose. To be continued as I feel this is a vital topic based on the volume of discussion and my own experience. Barbara Latterner, BSN, RN, IBCLC **************Get a jump start on your taxes. Find a tax professional in your neighborhood today. (http://yellowpages.aol.com/search?query=Tax+Return+Preparation+%26+Filing&ncid=emlcntusyelp00000004) *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome