Please see below especially the part I've highlighted with asterisks**
I tried to find the AAP article, but I couldn't but I have it at work.
There are lists
of signs and symptoms like nipple pain, injury, mastitis, low intake,
low wt gain etc.
Be objective and list those specific s/s. I also try to state mother's
goals, as often
we are working with a mom who keenly wants to bf or bf long-term. It
is important for
doctor to know those goals.
Laurie Wheeler

NeoReviews (2010) 11, 513-519
© 2010 American Academy of Pediatrics
doi:10.1542/neo.11-9-e513.

    Tongue Tie and Frenotomy in the Breastfeeding Newborn
Isabella Knox, MD, EdM*

Department of Pediatrics, Division of Neonatology, University of
Washington, Seattle, Wash.

Tongue tie or ankyloglossia has been the subject of much controversy.
As defined in this review, tongue tie occurs when a common minor
embryologic tissue remnant—persistence of midline sublingual tissue
that usually undergoes apoptosis during embryonic development—causes
restriction of normal tongue movement. Effective breastfeeding
requires newborns to fine-tune their tongue movements to adapt to
their mothers' particular nipple and breast anatomy and physiology. In
the presence of tongue tie, **two categories of signs/symptoms arise:
those related to nipple trauma and those related to ineffective breast
emptying and low infant intake**. Untreated tongue tie can lead to
untimely weaning and its attendant health risks. Frenotomy is a safe
and effective procedure to release tongue tie and improve tongue
function and breastfeeding outcomes.

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