The ENT that I refer to and occasionally lecture with, Dr. Pat Connolly,
says that it isn't so much the tongue extentsion that is key in tongue-tie,
but inability to lift the tongue.  The tongue must compress the teat against
the hard palate, thinning it to roughly half it's resting diameter (Smith,
et al, ADJC, 1988).  At maximal compression maximal expression of milk will
occur.  If the tongue is tethered to the floor of the mouth and can't
robustly strip the gland, the baby will fatigue early from the effort, have
limited intake, and prob. will resort to compensatory measures to try to get
more milk (i.e. excessive application of suction and excessive use of the
jaws to try to increase effect of compression.)  It is these compensations
that are so abusive to the nipple.  The forward extension of the tongue does
effect bfg efficacy and comfort, too, of course.  There is no padding of the
gum ridge when the tongue can stay forward, and suction is also negatively
impacted because the tongue may have a hard time helping the lips for the
seal around the breast.


Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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