Jenny writes:

I don't  think we can assume that a surgeon looking at a posterior tongue tie 
will have  that understanding.  Not every tongue tie needs to be fixed.  It 
may  be helpful to develop language to describe the importance of the impact of 
 tongue tie on feeding and not just to describe the anatomic  
components.



This is a crucial piece. The presence of a tongue-tie is not the reason for  
referral. (I have seen ties like rubber bands that stretch, cause no one  
trouble, pain or effort.) There has to be an impact on the nursing dyad.  The  
times I have accompanied moms to see doctors I knew would not clip,  but they 
wanted to go to whoever their family or pediatrician recommended, I was  very 
careful to describe the impact on function. All the moms had significant  pain, 
many had significant nipple wounds, and babies had feeding issues of  latching 
and/or efficient milk removal. These physicians were still unimpressed,  
because the babies could bottlefeed, although often not efficiently either. Some  
physicians did understand the issues of function, but still would not do the  
release because they were afraid the bleeding would be too much, or because  
they lacked the experience with this kind of tie. I respect this. Mostly  
thought it was devaluation of breastfeeding as normal. Some moms got dejected  and 
just quit trying at all, others went on to go to someone who could evaluate  
them and treat them.
 
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA




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