I have had the good fortune to be a La Leche League Leader and an IBCLC all over the US and in Puerto Rico - so I want to chime in on this topic - this, like many in this discussion, is a PERSONAL OBSERVATION and not a scientific study:

When I began, as a Leader (1975) and an IBCLC (1985) in various Eastern and Midwestern states – I saw very few tongue ties – but I wonder if it was due to the fact that it was years ago.  Did moms just give up and never even try to find a La Leche League Leader or IBCLC when they had the symptoms … so I never got to see them?

HOWEVER, when I was in Puerto Rico (1990's), I had to refer at least one mom a week to the ENT who would do the surgery – and I was only seeing about 10-15 a week! (I only saw the moms that were having problems, so I didn’t see all the patients being discharged).  I also saw more inverted nipples there than I had ever seen in the previous 20 years!

My theory is that tongue tie and inverted nipples are genetic – and it depends on what is in the genetic pool that you are seeing.   This also is reflected in the pliability of the breast tissue - as I've seen some very tongue-tied babies transfer milk very well with no damage in mom's nipple/breast when her breast is malleable and good positioning is achieved.  

I think this means that the national/worldwide population’s ratio of tongue ties would not be helpful for individual IBCLCs to know when taking care of their patients – because these ratios may not be reflected in their community.  

My recommendation to IBCLCs is to take lots of pictures, document and gather data and use it to create a good system of referral and educate those who serve YOUR area…so they can catch and refer/correct issues before moms give up!  These also can be used to teach what is NOT a tongue-tie, and how to collaborate with others in your community to resolve them (CST, OT, PT, MD with experience in treatment for xxx or YYY, etc.).  

Jeanette Panchula, BA-SW, RN, PHN, IBCLC

California, USA

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