Jennifer Tieman, MD asked: "I wonder if there might be a subset of babies
who do fine even with a tight frenulum?"

I have found that if the mom has very pliable tissue - the milk supply and
transfer can be excellent - It has been the combination of a tight frenulum
with a small or very tight-tissue breast that I have observed as causing a
real problem...

However, I also met one mom who was fine breastfeeding ONE baby with a
tight frenulum, but when she had TWINS both with tight frenulums, she
sought help - and was my first case to refer to an MD in Puerto Rico for
clipping - he had just done her toddler, and was open to the idea of
clipping infants - though he had never done it.

I imagine with one baby she was able to change positions and "rest" nipples
more often, but with twins, this was not possible.

Jeanette Panchula, BSW, RN, PHN, IBCLC
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