About the incidence of tongue tie - it has been reported in at least one article about tongue tie that the incidence in an unselected population is well under ten per cent, but among babies of mothers seeking help for breastfeeding problems it is much much higher.  In the places where you work, are you seeing and assessing every baby born, for signs or symptoms of tongue tie, or are you only seeing the mothers who are having difficulties?  

I have not seen any published articles on treating tongue tie where population incidence rates have been anywhere near twenty per cent, and if you are actually seeing anatomically limited tongue mobility to the point where the baby can not breastfeed without intervention in such a high proportion of your population, it is unprecedented in the literature and should be written up for publication.  

Where I work we have between 150 and 200 births per month, and we refer a couple of babies per week on average for evaluation of tongue tie and treatment as necessary.  Remember that virtually all mothers initiate breastfeeding and we have reasonable coverage to act early if there are red flags for tongue tie, I don't think we miss a lot of them.  Of course they don't turn up at nicely spaced intervals and it's always lots of fun to have to refer the third baby in two days to ENT (see my recent post about the 'n' word there) but it usually works out when we remind them that it may be a week and a half until the next one comes along.  I long to treat them myself but don't see it happening anytime soon, given that the necessary delegation of such authority would have to come from someone who has publicly declared me to be clueless.

Have to laugh a bit here - when my granddaughter was born, one of the very first things I noticed about her was her wide gaping mouth and her complete lack of any hint of tongue tie.  She came out of the water with one short outraged yell before calming herself in her mother's arms but that was long enough for me to see her demonstrating all the oral anatomical requisites for breastfeeding and (this is the ironic part!) I was *so* relieved to tick TT off my mental list of possible problems to watch out for.  Little did I know I would be madly leafing through Cathy G's book and the Wolf and Glass book on sucking and swallowing disorders for much more esoteric stuff in the weeks to come...  and boy have I learned a lot on this one!

Rachel Myr 
who can report that said granddaughter gained 100 g  (approx 3 oz) during her ten day stay in the hospital for the heart surgery, all of it in the last three days of her stay when she was feeding again, and then gained another 280 g (approx 10 oz) the first week back home.  oh to be as resilient as a baby.
Kristiansand, Norway

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