"Since we (LCs) basically "live and breathe" bf, of course we see
correction as being necessary in a lot of cases."

My experience has been very varied in terms of breastfeeding and
tongue-tie, for example:

1. A pediatrician (American) delivered her THIRD baby and after
breastfeeding each of the others for over 2 years, this one (tongue tied)
was losing weight.  Mom's breasts were tight, she was a slender woman.  She
and her husband, ALSO a pediatric researcher, absolutely refused to have
the tongue clipped.  We worked hard on positioning, but had to add pumping
after every feeding and some supplementation with her milk.  By 4 months,
baby was able to compensate and breastfeed directly.

2. A mom delivered a first baby.  Both parents were African American.
 Mom's breasts very soft and pliable, so even though I was asked to visit
her because the WIC staff person saw a very tongue-tied baby, there was no
weight loss, no pain in mom's nipples.  HOWEVER Dad had a speech impediment
due to HIS tongue tie - he INSISTED his baby would not go through what he
had gone through (Speech therapy, teasing, etc.).  Despite their low income
they traveled to another city and had their baby's tongue clipped.  No
difference in breastfeeding, but Dad felt better.

3. A mom with a first baby - Hispanic - LOTS of pain, LOTS of milk.  Doctor
denied any problem as the baby was gaining weight - but her husband's
brother is paying a lot of money to have HIS tongue-tied child, now age 3,
go to speech therapy.  Both he and his wife helped the parents get to an MD
who would clip the tongue.

It seems to me that Brian Palmer's Website and our experience shows there
are problems BESIDES breastfeeding caused by tongue tie, and it is our
responsibility to inform the parents.  If they choose not to do anything,
that is THEIR choice - but if they are never informed of the reasons for
seeking treatment, then they are not freely "choosing".  (Just like moms
who feed formula but have never learned the risks of feeding their babies
this inferior food.)

It's not just about tongue-tie.  LCs see lots of things besides
breastfeeding problems - Neurological abnormalities, oral abnormalities,
developmental problems, etc.  Some cause breastfeeding difficulties, some
do not (or we know how to overcome them so the breastfeeding is not the
issue) - but we should at least describe to the parents what we have seen
and what our experience has taught us and have in our resource list names
of professionals that we can refer them to for appropriate diagnosis and
care.

We don't diagnose, but we certainly can "observe and refer for further
evaluation, diagnosis and treatment."  As always, it is the parents'
decision what to do with their child - but I know that at least 3 times in
my career a baby's life was saved due to problems I identified as "not
normal".  I didn't know WHAT was wrong - I just knew it needed to be
referred.  (I'll never forget taking one mom and baby to the ER, calling
the father - who said he'd be right there - after he finished his round of
golf!  This baby required heart surgery within 12 hours!)

So even if the tongue-tie isn't causing a breastfeeding problem, It seems
to me we should still inform the parents that there is real debate about
the issue and offer them sources of information.  If they choose to follow
their MD's recommendations, at least we have done our job of education.

Jeanette Panchula, BSW, RN, PHN, IBCLC
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