The article from 2005 or so, by Griffiths et al, reported on a series of
babies they saw in Southampton.  Some were divided immediately on
discovering them, which generally happened when someone started to look into
why baby wasn't able to suckle effectively or why mother was so sore despite
a wide gape with the breast appearing to be deep in baby's mouth.  Some were
followed for a few more days by IBCLC midwives who gave guidance on
positioning and attachment, and if there was no improvement, the tongue ties
were divided after those days had passed.  Their own results were
unequivocally in favor of dividing the tongue ties as soon as they were
determined to be possibly causing a feeding problem.  What they found was
that as soon as the frenulum was clipped, things started improving
dramatically, and until they were clipped, there was very little improvement
even with follow-up by competent, experienced people.  
They do not advocate clipping frenula due to appearance alone, but when
there is even a hint of a BF problem they are swift to do so.  Griffiths
said in an e-mail to me that 'clipping a tongue tie is not an operation, it
is a nursing procedure' and the tongue ties in Southampton are treated by
IBCLC midwives who are trained there by the experienced staff.

We don't have a protocol in my hospital, unfortunately, and we still have a
couple of pediatricians who roll their eyes on being asked to refer to ENT
and one ENT specialist who prefers to wait for two or three MONTHS and see
whether a BF problem develops.  The pediatricians can roll their eyes as
much as they want for my sake, as long as they also make the referral.  One
of them is eager to learn how to do frenotomies herself and we are cheering
her on. Most of them are not that interested, and if one of the BF
specialist midwives request a referral, they don't always insist on
examining the baby before referring unless they are trying to learn all the
different ways tongue tie can appear.  Once the referral is made it usually
gets done within hours, certainly no more than a day later.  

If we've missed it on the ward, they often turn up in the BF clinic for
mother's sore nipples, baby's jaundice, or baby's lack of weight gain.  Same
referral procedure applies and it gets done expediently.  Far better than
sending someone with sore, cracked nipples and a baby who needs FOOD most of
all, on some kind of wild goose chase to find a doctor who believes in TT!

Rachel Myr
Kristiansand, Norway

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