Jessica

Yes, yes, YES!!!!  You've described exactly what I'm hearing on the 
phone and reading on the lists I belong to.... Tongue tie is 
being  used as a first, last and in-between "cause" of whatever 
difficulty is currently happening - the diagnosis du jour, if you will.

I'm _really_ concerned.  But having expressed my concern in various 
places, including on Lactnet Facebook discussions, sometimes in 
support of others' concerns and sometimes alone, I've received 
accusations that I don't know how to recognize tongue tie, that I'm 
out of date, that I don't appreciate just how serious TT can be... 
and really quite unprofessional responses, even from colleagues that 
I would have thought would have been more - well - professional about 
the debate. But privately, I often receive emails from other IBCLCs 
who also express concern and scepticism about the mushrooming of TT diagnosis.

Actually, for fun, I'm starting to collect stated consequences of 
undiagnosed/untreated/inadequately treated TT, and  and/or some 
strategies that are meant to fix it, besides "revising".  It's the 
variation of consequences that snipping a TT is meant to fix that 
makes me sceptical - these reasons are quoted or summarized below:
    * Thrush is often associated with tongue-tie or sensitivities/allergies.
    * Posterior tongue tie can lead to the need for more burp breaks 
during breastfeeding, since reflux/spitting up is a symptom.
    * Deep breast pain is often associated with a tongue-tie baby 
causing "milk reflux" - the gums or tight oral structures restricting 
the flow of milk and pushing it back up into the breast.
    * Inability to swallow solid foods in a baby over six months.
    * Tummy time as a therapeutic strategy for tongue and/or lip tied infants.
    * Tongue tie can cause babies to sleep with their mouths open, 
especially the deeper ones are suppose to pull the tongue back making 
the mouth pop open.
    * Acid reflux (GERD) can be caused by Tongue & Lip Tie. If you 
have an infant, child or are an adult who suffers from this, consider 
a Tongue/Lip Tie evaluation from an experienced TT Laser Surgeon.
    * Nursing strikes can be related to unresolved tongue/lip ties.
    * Jaundice, latch issues, dairy allergies and reflux. These are 
classic symptoms of tongue and/or lip ties.
    * Video suggesting : TT or LT --> acid reflux, usually treated 
with Zantac --> lowers acid in stomach --> altered gut bacteria --> 
prevents vagal nerve being "educated" --> reduced eye-contact --> 
reduced infant/young child capacity for empathy --> autism. In other 
words, untreated TT or LT can cause autism.
    * 50% of the population suffer from TT or LT.
    * New diagnosis of _lower_ lip tie causing problems (will it be 
cheek ties next??)
    * Babies having 3 or 4 snips yet still the problems go on.  How 
many cuts are needed before someone admits that the problem wasn't 
due to tongue tie??
As I say, I'm concerned.  I'm due to re-sit the IBLCE exam in July, 
and I'm reading the literature on TT and PT very carefully indeed. 
Our formal texts seem to express caution. Some of our pioneers in the 
field are also concerned. The reasons listed above do not gel with 
what I've seen in my 25 years of practice.... and what I've seen is 
that TT can happen, but it's rarely severe enough to cause a 
breastfeeding difficulty that can't be resolved by strategies other 
than surgery for tongues without benefit of 
anaesthetic.  Furthermore, diagnosing and snipping a TT stops anyone 
looking for other causes of latching difficulty, low gain, fussy baby 
etc. etc. and the expectation seems to be that the snip alone will 
fix a problem that may have been months in the making.  I fear that 
TT, PTT, and now ULT is being grossly diagnosed, becoming 
"fashionable" the way Thrush was fashionable in the Nineties before 
we learned to look for bacterial infections as a more likely cause of 
sore nipples.  I'm beginning to wonder whether the term "oral 
mutilation" needs to be invoked for some of these unnecessary procedures.

You're not the only one, Jessica.  Let's keep asking questions!!

Pamela Morrison IBCLC
Rustington, England
-------------------------------------------------------------
Am I the only one seeing this...

I have noticed recently that my outpatient population is picking up 
with parents that have taken their babys to get a tongue or lip tie 
correctioin and now baby is worse with breastfeeding then before.

On almost every mother web forum I look at there are hundreds of post 
about ties and because of this some of these mother's are getting 
ties corrected as their first line of treatment. Then after the 
correction and the baby/mother still having difficulty with 
breastfeeding they come to see us. Some of these babies are nursing 
'worse' then they were prior to the corrections per parents.

I know we have discussed before about us (IBCLC's) not forgetting to 
give first line treatment such as correct latch.

But are any of you guys seeing the same results. Parents that are 
calling for consults and within the first couple of minutes of 
getting history parents say that they took infant to get lip or 
tongue or both clipped or lazered because of x,y or z issue but now 
since treatment the breastfeeding experience is worse and this is the 
first time that they are reaching out to see an LC?

Jessica Callahan IBCLC
NC, USA


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