>I assume you've already checked out infant-related issues, such as =
 >tongue tie, including a tongue that will protrude okay but not elevate =
 >(and thus not 'milk' the breast effectively).

This brings to  mind a question i have had for some time.  i seem to see a
lot of babies who fit this description - either a short tongue or a
seemingly restricted tongue mobility - BUT, no visible frenulum to clip.  I
am aware of z-plasty and other procedures, but i wonder - how often do you
all actually refer for such procedures?  i cannot imagine many parents
being receptive to the more invasive surgical procedures on their newborns
- and do they work in all cases of restricted tongue mobility?  if not, or
if parents don't want it, what alternatives exist?  just extreme
positioning and perhaps cst?  i appreciate any input into what seem to me
to be very challenging cases (when its causing a problem of course).


Lyla Wolfenstein, B.S., IBCLC, RLC
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