There's a decision rule in this article:

Anjana Srinivasan, Carole Dobrich, Howard Mitnick, Perle Feldman. 
Breastfeeding Medicine. Winter 2006, 1(4): 216-224. 
doi:10.1089/bfm.2006.1.216.

The only change I'd make is for the requirement of a visible frenulum. 
Frenula can be submucosal and invisible unless the tongue is elevated...

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 3/8/2011 5:43 PM, Naznin Hebert wrote:
> Hello all,
> I am working in a breastfeeding clinic in a teaching Family Medicine Center
> where there are several Physicians, who are available, if I need them, for
> medical reasons. One of the main reasons I would need them for would be a
> tongue-tie.
> The problem I have is each one of them has their own personal reason of
> performing a frenotomy or not. For some if the bb is gaining weight than it
> is not necessary to do one. For others if we correct the latch than there
> should be no nipple pain. For some if bb is under 2 weeks old they are
> reluctant to do it, etc. In my opinion we are not preventing problems. We
> are just waiting for complications to happen and then treating them and by
> then sometimes it could be too late. Since it is a teaching Centre, I am
> also afraid that the residents may not learn the true reasons and benefits
> of a frenotomy. So I plan to use a freotomy algorithm, so that everybody
> follows the same rules. Does anybody else use one or knows where I could
> find one? I would greatly appreciate that.
> Thank you in advance,
> Naznin Hebert RN, IBCLC, RLC
> Montreal, QC
> Canada
>
>
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