Celine and All:  Not all tongue ties need to be clipped.  Celine, in your case, 
yes, I agree with your assessment.  This baby needs a referral/clipping.  But, 
just because you may see a tie on visual exam, doesn't necessarily mean that 
the mom should rush the baby off for a frenulectomy. Assess the feedings 
first.  Are the mom's nipples comfortable during the feeding?  Is the baby 
drinking milk (and ultimately gaining weight well)?  The reason I am pointing 
out the flip side of the coin is that I have worked with many moms/babies 
where there was definitely a tongue tie, BUT nursing was going very well.  Did 
I suggest that baby's frenulum be clipped?  No.  Nipple pain, biting, chewing, 
clicking (or other sounds), poor weight gain, etc. are certainly red flags that 
need further assessment.
We discovered that my now 26 year-old has a pretty tight posterior tie that 
does limit her ability to touch the roof of her mouth with the tip of her tongue 
during a dental exam (she was 13 at the time) when the hygenist asked her to 
flip her tongue back so she could clean the back side of her lower front teeth.  
She nursed well (knew more than me at the time!) and has never had any 
speech issues.  She's just tongue-tied.  I also have a similar posterior tongue 
tie, but I was bottle-fed so it was apparently never an issue.
So, after a good assessment, "if it ain't broke, don't fix it".

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL    USA

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