Tania has put together a very good letter, but I hate to say it, I
don't think I would have time to write that out. In the past, I have
used form letters where I could pull up the template on my computer
and fill in the details of the client and the pertinent info. Now that
I have a great rapport with the docs and usually see them every
morning, and we fill each other in on clients, I can just do a quick
phone call.
However, a busy LC could certainly use the info from Tania's example,
and put in a short letter with bullets, as below:

--MOTHER describes his latch as pinching (I often give pain scale,
e.g. 8 on a 0-10 scale).
--MOTHER'S nipples are showing signs of Stage II nipple damage
--unable to raise his tongue normally, nor is he able to lateralise his tongue.
--BABY is showing symptoms consistent with a Type 3 or Type 4
tongue-tie (add a reference if you can, AAP article?).

--I recommend that MOTHER have BABY'S tongue evaluated by
an ENT or other physician familiar with ankyloglossia and breastfeeding.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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