Marianne writes:

Baby  could stick out her tongue quite well, had free range of motion, no  
asymmetrical movements, no humping or thrusting. So... really... how to 
assess  whether this is tongue-tie?! All looked well! I really wonder... should 
we  clip all those babies or should we realise that  separating them from  
their mothers and suboptimal or sometimes even really  bad bf techniques  
cause damage in the developing relationship, that can only  be solved  with 
patience and closeness and tender care and support for mom who should  know she 
is doing the right thing by feeding véééry often...? I know that many  of 
you are wildly enthusiastic about discovering and  treating tt, but I  still 
have doubts as to where the limit should be.


Assessing is function-based, in my opinion. Baby should be able to extend  
the tongue with the mouth in gape position, not just stick it out with mouth 
 slightly open. Range of motion should be free and full with the mouth in  
latch-wide-open position. Baby should be able to groove well around the 
finger (  during exam) or breast, with no loss of contact/suction, and should be 
able to  maintain skills while feeding well in a reasonable amount of time. 
( The  functionality is the key, for me.) Even if we gently sweep under the 
tongue,  with baby's permission/encouragement and feel that "tendony" 
feeling, where one  is stopped in the middle while the tissue next to that has 
"give", that may not  mean rushing to surgical release. I agree that some 
babies have been assaulted  or restricted by the way pregnancy ended, and/\or 
labor, delivery and  post-partum occurred. They may need only time with mom  
to reorganize.  A mom in the situation of discomfort, with a baby  who can 
get enough to eat without damaging mom, or getting into protracted,  
exhausting feedings, may need only positional adjustments, S2S as much as  possible, 
tincture of time, possibly some CST. Providing mom with reasons  or logical 
possibilities why she and her baby are struggling is something I  consider 
paramount. Working out how to cope with what seems to be going on  is 
something also very important, but I don't think the answer is the  same for every 
dyad. Some moms are bleeding, getting no sleep, or have a  completely 
non-latching baby.  Some moms are trying to feed the baby  24/7 and the baby loses 
milk and/or coughs and gags with even the slowest,  most paced alternative 
feeds, resulting in poor weight gain and the entire  family not sleeping. 
Other times mom is uncomfortable, may even tolerate  some pain, but skin 
condition isn't awful, baby is managing to get enough to eat  in a reasonable 
time. Some may need to go to breast very  frequently, or need some 
supplementation with mom's milk due to  fatigue/disorganization issue as they try longer 
and longer and  get less and less.  I would not say that assessing and  
dealing with tongue restriction issues always means surgical  release.  
Providing families with our professional assessments and  options for dealing with 
situations I could say I was pretty enthusiastic about  though, yes.  :)
 
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA

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