I very much appreciated Alison's post, as I do Alison herself, whose work
was very instrumental in my understanding of tongue-tie.  I want to clarify
that just because my report to the doctor sticks to observations rather than
recommendations, it does not mean I haven't talked to the parents
specifically about options.  We have a good situation here in Austin because
several of our local ENTs and a pedodentist or two all are perfectly happy
to clip frenulums.  They didn't used to be, but by working patiently to
communicate with them about the issue, they are now, and any mother in the
city who wants the procedure can get it.  She may need to switch docs, but
usually not, because the pedis will mostly all agree to an ENT eval. and our
ENTs are experienced enough that they spot the kids who need it done.  Many
of the local pediatricians are now quite relaxed about this issue and
support the procedure.

Starting cold to try to influence the medical community on this is tough.
It cannot be denied that there is virtually nothing in the pediatric
literature about this issue.  Until there is, its a huge trust thing for
pedis to be open minded about.  I think Alison and I differ only on tactics.

 Over the years the most influence I have made has been through the reports
I write to the doctors.  I have seen evidence that this information has
educated doctors, who begin to learn what they need to know about bfg.
Ultimately, the doctor must make a recommendation.  If he or she makes a
recommendation to wean to bottles, the parents now know whether the pedi not
going to support bfg.  It's their choice at that point to say I want the
procedure or a new MD.  I send 7-8 babies a year for ENT eval. for
frenotomy, and probably assess that many more again whose parents won't do
the procedure for a variety of reasons. Some of the babies who get clipped
improve immed.  Others take days or weeks to tone up and begin to suck
properly.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html