It's subtle, but there are visual signs:
Lack of tongue elevation when the baby cries.
A pulled down area on the surface of the tongue where the frenulum 
inserts underneathe during certain tongue movements.

Of course, feeling it is the best way to dx.

There will be pics in an upcoming book. (I don't know if I'm even 
allowed to say this much on Lactnet).

Catherine Watson Genna, IBCLC  NYC

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