Dear Cathy and Lactnetters,

I'm finding this discussion on tongue tie research and the subsequent
questions that have arisen helpful and interesting though find myself still
questioning my ability to diagnose with conviction in certain cases.  An
obvious tongue tie with heart-shaped tongue or frenulum attached to tongue
tip is usually confirmed by HCP's amd gets clipped.  What I struggle with are
those that functionally appear to be tongue tie but HCP tells mom this is not
a tongue tie and won't suggest clipping and mom chooses not to listen to me
and seek specialist opinion.  Then I question myself and work on
strengthening tongue and tongue extrusion thinking it's nerve involvement or
neuological but still question whether tongue tie should be ruled out.

Babies I've seen like this present with occasional tongue extrusion WNL but
never with gape; mom has nipple damage or soreness (one mom says she often
feels tongue hitting face of nipple like sandpaper, though not always- has
occasional perfect latch and suckling-a pain free breastfeed where tongue
abrasion not experienced), clicking and/or snap-back sound heard with
suckling, and clamping/biting occuring with most feeds.

My questions:  can a tongue tied baby have occasions where she can breastfeed
correctly?  is the inability to extrude tongue with gape related to tongue
tie? (these babies can bring tongue out with partially open mouth and lick
their lips but not be able to extrude tongue over alveiolar ridge when
latching (even with improved positioning, suck training, Charm hold suck
training, etc).

What am I missing or misunderstanding?  I have and use Hazelbaker's
assessment tool, have Clay's Atlas to show parents and handouts as well, have
paid attention to neuro problems, like high tone, irritability, and use tips
Cathy's suggested re her New Beginning's article and personal contact.  Don't
have a nearby colleague to refer to nor a working relationship with ENT or
oral surgeon other than knowing who to refer to and having had ENT's
willingly clip those frenulums that show obvious ties (which I know might be
helpful).  Your replies are appreciated and sorry for length of post.

Barbara Latterner, BSN, RN, IBCLC
Brewster, NY

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