Someone said that since many of us concentrate on breastfeeding, we may be
more concerned about tight frenulums than a doc who does not concentrate on
breastfeeding.  However, breastfeeding is not the only thing affected by
tight frenulums!  I have had 2 formula-fed infants in the last 2 months with
very tight frenulums that could not suck properly.  One was my patient from
birth, and was clipped at 48 hours of age (mom by then very frustrated with
trying to feed baby, dad with history of frenulum being clipped at a young
age.)  The other transferred care to me at 1 month of age, exclusively
bottle fed, still not up to birth weight!  Baby slid on and off bottle
nipple and gagged a lot.  I counseled the parents who decided on clipping
it.  Baby's feeding technique improved a great deal after.
As someone else said above, it's really less of an ordeal than giving
vaccinations.  I simply hold the tongue up with 2 fingers and clip with a
sharp scissors.  I have the mom or dad hold a light for me, and they can see
what I'm doing as well.  Babies rarely bleed much, if at all, and have
minimal crying.  It's especially gratifying with a breastfed baby, who can
usually go to breast right after and latch better.
It mystifies me why some practioners prefer to ignore evidence in favor of
opinion.
Interestingly, though, my own oldest son is tongue-tied.  Aside from an
early round of sore nipples, we really never had any trouble nursing.  He
did tend to come off and on a lot, but was never grouchy about it, gained
weight well, and weaned at 15 mos.  No speech problems, either.  When he was
5 I saw a picture of tongue tie in a textbook and asked him to stick out
tongue -- sure enough, he can't.  I wonder if there might be a subset of
babies who do fine even with a tight frenulum?

Jennifer Tieman, MD
Family Physician
Mom to 3, and new baby #4 expected 5/31/03

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