I wish there was more research in this area...

my guess is that it is really dependant on who you have doing frenotomies 
for you.

Where I live there are a few Pedis and FPs who clip them, but often only 
clip them about "half-way".  By this I mean that a frenulum usually has to 
be pretty obvious to be clipped...coming near to the tip of the tongue.  So 
it gets clipped a couple of mms, about to the opening of the saliary ducts 
in the floor of the mouth.  This is enough for some babies to be "cured" of 
the pain or poor removal, but not enough for others.  I often "reclip" these 
babies.

I also suspect it matters how long the baby has been trying to compensate 
for the tongue restrictino before clipping.  It seems to me the younger they 
are at clipping the better chance you have for an "instant fix".  But if 
they have been chewing or whatever for 3 months before you fix it, they are 
less likely to instantly change their ways. (but I HAVE seen that happen as 
well)

And then I think it matters if there is a submucosal frenulum as well (which 
I used to call "built-in" to the underside of the tongue)  I have recently 
started clipping these, which can occur by themselves, or as an extension of 
a frenulum that visibly separates from the tongue.  So sometimes you clip a 
visible frenulum only to find a fibrous strand continuing on into the floor 
of the tongue.  Sometimes these kids will be better than before clipping, 
but not perfect.

There is much to learn...

Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE

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