I'd appreciate people sharing references that would help me learn to do 
a more in-depth, systematic digital exam and oral assessment.  Catherine 
Watson Genna's illuminating posts and her recent article on tongue-tie
http://www.aap.org/advocacy/bf/8-27newsletter.pdf

have been very helpful.  But ultimately, like the Wolf and Glass book, 
they've made me more worried about being able to peg these anomalies 
when actually confronted by them in the form of that wiggly little 
baby.  Do people work from a mental checklist to examine all the 
possibilities?  How does one distinguish between what a baby physically 
"can't" do, and what it *won't* do right at that moment for a finger -- 
I've seen babies, particularly in the first couple days, who seem to 
have very constricted tongues  that suddenly relax and expand them  as 
the milk starts to flow more bountifully (which made me glad that I kept 
my mouth shut on a "diagnosis" and just worked on latch.).

Concerning the posterior tongue-tie discussed in the above article -- if 
the frenulum seems more knit into the body of the tongue, can it still 
be dealt with by a simple in-office frenotomy?  Are doctors willing, 
since it's hard to get action taken on very obvious ones?  When it says 
that the posterior tie becomes more evident on a digital exam, what 
exactly does it feel like, as opposed to the normal attachment of the 
tongue to the mouth floor?  What would distinguishes a short tongue, 
from one being held by a frenulum -- would it be that it is bunching?

I know that much of this knowledge comes with having felt and looked at 
hundreds of palates and tongues, but I really want to build on something 
systematic.  I thought this was an interesting article:
http://www.scielo.br/pdf/jped/v80n5s0/en_v80n5s0a07.pdf
in part because it tries to give some strategies for dealing with what's 
discovered.

Anyway, please do share anything that you feel would be helpful.

Margaret Wills, LLLL, IBCLC

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