In response to the question of whether to discuss one's assessment of an obvious ankyloglossia, but hesitating to state this to the parents due to the perception that the parents don't want to hear that professional observation, and hesitating also due to the current controversies on tongue-ties and their management:  

Thus far in my long career, I have indeed seen a number of cases of ankyloglossia.  However, during my first five years in the field (1995 - 2000), I don't recall seeing even one instance of tongue-tie.  I was in a very small town of 8,000 residents in my home state of West Virginia then, which is primarily a rural state.   I was also a beginning clinician in our field at that time, and had previously worked as an RN in a birth-to-age-21 population with genetic and other chronic health problems.   

My small-town existence changed when I relocated to northern Virginia in 2000 and endured the long commute into D.C. and the greater metropolitan area for the next 12 years.  Working in that large urban area, I saw several instances of tongue-tie, but by far the most dramatic and severe case of ankyloglossia I've seen was in 2015 in a tertiary care facility in the southern part of the U.S. where I was then living.  The infant was a term baby, and the mother had requested the consult for significant nipple pain during feeds.  

During the initial part of the consult, the mother had an immediate strong pain response to the baby's oral grasp, and I demonstrated to the mother how to safely release the baby's latch in order not to damage the nipple-areolar tissue, then provided manual guidance to the infant for a wider and deeper latch.  Before the baby re-attached to the breast, he cried when he was released from the breast, and his pronounced ankyloglossia caught my eye then.  The baby's tongue didn't elevate at all while he briefly cried in protest of the brief un-latching, and upon closer inspection, the frenulum was wide, very short, thick, and uniquely jagged - - I have not seen such an unusual frenulum before or since then.  The wonderful, elderly pediatrician who managed the well newborns on that mother-baby unit was in his late 70s then, and was happy to perform the frenotomy.   

Prior to the baby's frenotomy, while providing patient teaching to the parents about ankyloglossia, I made a point to casually mention that it's not unusual for another family member to also have a tongue-tie.  I had noticed the mother's very pronounced speech impediment, and would have very much liked to look at her frenulum if she had offered it for inspection.  The mother did say that she had received speech therapy all the way through school, and that the speech therapist had recommended the release of her frenulum to help improve her speech, but that her parents didn't want her to have the release done.  I mentioned that some folks have the release done in adulthood, then resumed patient teaching about the baby's feedings.  

In regard to the perception that the parents in the OP didn't want to hear about their baby's tongue-tie, that brought to mind another consult from nearly a decade ago in which a young newborn was referred for ongoing weight loss.  This was an outpatient office consult, and test weights did not exceed 0.1 ounce.  There was notable facial asymmetry in the baby, and jaw excursions during the feed were essentially nonexistent.  Finger-feeding the infant for suck training was also poor in regard to jaw excursions and transfer.  I should note here that this was the most dramatic instance of facial asymmetry in a newborn that I have seen to date, and referred the infant to a craniosacral therapist, along with patient teaching for the need to supplement the baby in order to support normal weight gain in the baby.  The mother declined to use a supplementer at the breast, so that was not attempted in order to assess with another test weight whether the baby could transfer the supplement adequately at the breast.   I was carefully diplomatic in pointing out the baby's asymmetric facial features to the mother, and the mother appeared angry and offended during that discussion.    

So often our work is deeply appreciated by the families we serve, but not always.  It's important to thoroughly document one's assessment and the plan of care, which serves as a historical record.

I do understand and sympathize with the writer's hesitancy to discuss a currently controversial topic in regard to ankyloglossia.  In regard to other health concerns as a former patient, as a family member of those receiving health care, and in my long career as a registered nurse and as an IBCLC, I've seen the very best of medical management and also some of the very worst (I have reached an age where I feel comfortable stating this here).  Documenting our clinical observations and the plan of care is part of the work we do.  I have never regretted the amount of time spent in documenting my consults.  

With kind regards,

Debbie

Debra Swank, RN BSN IBCLC
Program Director
MoreThanReflexes Education
Elkins WV USA
tel 304.619.1433
http://www.MoreThanReflexes.org


   

   





  

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