I had a mom with an infant who had a noticible, but not extreme
tight lingual frenulum at birth.  She had had the same thing with
her earlier babies and asked about getting it clipped.
Unfortunately her MD was not one of the few we have who believe
clipping can make a difference.  Her pediatrician was adamantly
opposed as he believed it had to be extreme to need attention and
even then had his doubt.  She came to see me at 10 days concerned
about the nursing (surprise, surprise!). Baby kept slipping off the
breast ins\ spite of good positioning, breast support and initial
latch.  Weight was 12% below birth weight!  This mom happens to be a
Peds RN who works in her pediatrician's office, but he still
wouldn't consider having the frenulum clipped when she had asked.  I
immediately called and talked to him to report the weight
(fortunately, the baby seemed to be in fairly good shape in spite of
the loss-moist mucous membranes, good skin turgor, etc-diaper count
about 2/3 what it should have been).  I discussed what I had
observed and that I thought the frenulum was most if not all of the
problem.  He questioned the need, but I held my ground, so he
reluctantly agreed to refer her to the ENT in his practice (talk
about overkill!).  Mom made a quick call to the ENT office and
learned that he would only do it in the hospital under general
anesthesia!  At that point the dad said "I could probably do it
myself-I watched the others being done."  Mom asked if there was
anyone I could suggest who would do it more reasonably.  I told her
of 2 OBs in groups other than the one she went to.  I mentioned that
I didn't know what her insurance setup was and whether it would
cover for something "out of the loop", especially without a MD
referral> She replied that she didn't care.  I called the OB who is
most willing to do them and asked if it would be OK with him if I
referred her.  His first response when I told him the story was "Why
wasn't id done right after delivery?" When I told him who the OB
was, his response was "I'm going to have to educate him".  He said
to send the family right over and he would do it.
I called the mom a week later (she was to call me if she had
problems) to see how it went.  I was especially interested to learn
the Ped's reaction to her going somewhere else.  First of all, the
OB did it without charging!  The Ped was impressed with the weight
gain in just 2 days and again a week after.  Mom reports that he
only agreed to it because he respects my knowledge regarding
breastfeeding.  After seeing her results, he said he would have to
change his opinion and would look for someont to refer moms to who
would do it reasonably.
That came at just the right time-one of those days when I had some
doubts whether I was really making a difference.  Needless to say,
it made my day!
Winnie Mading RNC, IBCLC - now to change hats completely and go get
some stones ready to cut and polish as a demonstration at our rock
club show this weekend!

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