In speaking with Drs. Kotlow, O'Callahan and others, releasing a short frenulum will probably help but will definitely not hurt.  When it is a simple office procedure, I would consider that an invasive procedure.  I agree that not all breastfeeding problems are related to tongue tie but if I have any suspicion (damaged nipples, popping on and off the breast, actually seeing or feeling a tight frenulum), I will not hesitate to refer them to a doctor who can make the diagnosis and do the release. I do not see harm in referring.  I do see harm in not referring.  

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