Tongue tie implies limitation of mobility. I generally document the 
percentage of (what we currently think is) optimal tongue elevation, 
protrusion and lateralization and the results of the digital suck exam 
with and without fluid, and a breastfeeding assessment for each baby I 
see in private practice (including stability of latch, depth of latch, 
any recoil/clicking, overuse of other oral structures, milk transfer). 
All this is communicated to the primary HCP (health care provider).
The frenulum looks like a piano wire if it is attached to the floor of 
the mouth behind the sublingual ridge, and like a sail or hourglass if 
it attaches to the lower gum ridge. You could document location of the 
tongue and floor attachment, and a general impression of elasticity.
For routine newborn exams, you may not need as many details. For 
tracking improvements in mobility in infants you treat, it would be 
valuable to have the data.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 3/18/2014 12:14 AM, Melinda Harris-Moulton wrote:
> As an ARNP and IBCLC, I've just begun seeing newborns in a small
> local hospital for routine examination. Unlike other providers, I assess
> the lingual and labial frenulum: I am not sure how to document my findings
> I am a believer in need for revision in TT and plan on performing this
> service in my practice soon.
> . Today I saw a NB with a tight "piano-wire" lingual frenulum with frenulum
> extending midway between base of tongue and tip of tongue-- maybe 6-7mm
> from tip of tongue. Not assessing feeding in this role, but RN reports baby
> has nursed well twice.
> Question: what is the best way to document this finding? As  a lingual
> "tongue tie" ? Does the word "tie" indicate restrictive movement, or just
> the presence of a prominent frenulum?
> Appreciate your feedback,
> Melinda Harris-Moulton ARNP IBCLC
> Olympia, WA
>
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