I keep trying to figure out why the resistance to clipping a frenulum when
circs are done so soon post-partum -- generally with no pain relief.

Basically, and in a nutshell, because physicians generally think treatment is
unnecessry and/or it is dangerous.

 I heard
a PT at a conf. once caution against casual frenulum snipping because she had
concerns that cutting anything that anchored a muscle had consequences.

The tongue is a set of muscles, not just one muscle. It is the lead organ in
oro-facial development. Its stability comes from structural stability of the
oropharyngeal area, specifically the hyoid bone.

 Is
this what the docs are worried about?  If so, what is there in the literature
which gives rise to this caution?

Basically what is in the medical literature regarding tongue-tie is
unsupported opinion and mythology. Soem of us are trying to restify that by
doing research in this area.

Tongue-tie is hereditary.

Why is there not similar concern when the proceedure is
done for speech reasons?  How commonly IS this proceedure done for speech
reasons?  I am going to sniff around the speech path. community resources I
have and see if there is literature in their field which might elucidate any
of these issues.

My literature search of all fields uncovered a lot of information about
ankyloglossia, however, not mush in the speech pathology field. There is some
excellent research by speech pathologists done back in the 50s and 60s,
however, speech pathologists are divided re: the impact ankyloglossia has on
speech. Some recommend frenotomy or frenectomy, some do not believe there is
any relationship between tongue-tie and speech problems.

 creative positioning will assist things.  If the baby can be latched
with the chin cocked so it 'shovels' under the breast and really digs in, the
tongue and jaw closure can be located over lactiferous sinuses and off the
nipple.  This helps both pain and intake.  This position looks 'wrong' cause
the nose is so backed off the breast, but with mom holding the weight of
breast off baby's chin, it can work.  Then I suggest mimicing
sticking-out-the-tongue exercises, and coaxing tongue out with light touch to
the tongue-tip to elicit a thrust.  This helps increase range of motion --
esp. is the frenulum is of the thin and stretchy variety.  Sometimes these
things work well enough that clipping is delayed or prevented.  But who knows
if this is the best way to proceed.

Although these approaches are excellent ways to apply a bandaid to the
problem, the infant is still facing oro-facial and pharyngeal development
issues if appropriate treatment of the tongue-tie is not undertaken. I could
spend hours and hours on this but I think hearing what Dr. Palmer hads to say
at the ILCA conference in July this year will go a long way toward addressing
this issue.

Please e-mail me privately if you want to continue this dialogue in detail.

Aliosn K. Hazelbaker, MA, IBCLC, CST