I'm _still_ following this subject with great interest because I 
remain conflicted between what I've _seen_  (tongue ties that exist 
but which don't cause breastfeeding difficulties) and what I _hear_ 
from many of my colleagues (how consistently tongue tie severe enough 
to interfere with function actually occurs).  In the meantime it's 
impossible to ignore the many anecdotal reports of so many tongues 
and upper lips that have been revised/divided/snipped without any 
resolution whatsoever of the original breastfeeding problem, showing 
that in fact TT was not the cause and raising the tantalizing 
possibility that other interventions would more likely have been more 
effective.

It doesn't seem to be true that the IBLCE still requires no education 
on this topic.  There are good sections on ankyloglossia in the Core 
Curriculum for LC Practice, and Breastfeeding Management for the 
Clinician, Using the Evidence, to name just a couple of the most up 
to date texts.  I will be sitting the IBLCE exam again on Tuesday and 
I confess to more than a little curiosity about how many questions 
will actually be devoted to this topic, to indicate what importance 
IBLCE gives to it.  Personally, I wish they'd issue a statement on 
ankyloglossia.   Never has the adage, "If it ain't broke, don't fix 
it" had more meaning than on the subject of ankyloglossia.  There is 
so much division in professional opinion and it's not helpful to make 
allegations of ignorance or professional incompetence about IBCLCs 
like me who are cautious.

Some of us want much more precise definitions about anterior ties, 
posterior ties, upper and lower labial ties and lately I've just seen 
a question about buccal ties possibly interfering with 
breastfeeding.   The credibility of our profession is being placed at 
risk when we rely on unpublished anecdote rather than published 
serial case histories which can attest to which types and degrees of 
ties will actually require frenulotomy and which are better left 
because they are not the cause of the presenting difficulty.  And 
clearly we, as well as AHRQ and some of the insurers, need more 
research documenting not only immediate results but also long-term 
outcomes, comparing the efficacy of TT division vs conventional IBCLC 
interventions designed to improve positioning/latch/milk transfer, 
before we'll be persuaded to ignore our own existing clinical experience.

Pamela Morrison IBCLC
Rustington, England
-----------------------------------------------
The IATP asked AHRQ to delay its findings until we could provide 
input, but they refused. The statement is extremely disturbing as it 
presumes no validity to clinical evidence and marginalizes the 
experiences of so many mothers.

And, as Judy said it will only serve to do more damage both through 
dismissal by peds and ENTs and especially insurance providers. Sadly, 
the IBLCE still requires no education on this topic either and IME 
the vast number of IBCLCs still do not know how to evaluate oral 
function, assess for TT, make appropriate referrals or support the 
dyad toward functional breastfeeding.

Jennifer Tow, IBCLC, USA & France
Intuitive Parenting Network, LLC


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