Hadassah Mann, I like your thoughtful question about tongue-tie in a baby
you're seeing.  I'm not sure how you can be so sure that the parents will
not want to be told about it, but I do think that you have a duty to tell
them what you see, ie the tie and its implications.

I have never seen a tie that seemed so severe that in my professional
opinion needed to be divided. I've only ever seen pictures of them, never
one in person. And because I had hospital privileges I saw a lot of
newborns.  So by the end of the consult all the babies were able to latch
and breastfeed/transfer milk.. So what I did when I came across a tie was
identify it for the mother, who would generally look alarmed.  So then I
would say that a tie didn't usually cause problems, it was like having blue
eyes or brown hair..... What we needed to look out for might be sore
nipples for the mother or low weight gain for the baby - if either of those
things happened, please contact me again immediately and we could
re=evaluate.   I was only contacted once, by the mother of a 9 month old
who had nursed fine, and put on weight beautifully.  But now the
paediatrician wondered if the tie might cause speech impediments as he grew
older.  That was the only one - out of hundreds.

There's a LOT of controversy over ties.  Ties are deemed to be the cause of
a million problems, both during nursing and afterwards.  I fear that 99.99%
of them are misdiagnosed or over-treated.  My observation is that even when
a tongue is somewhat tethered, or heart-shaped when the baby moves it
forward, it does not interfere with breastfeeding. In order to transfer
milk the tongue has only to cover the lower gum and lift 3mm - it is
"fixed" and elevates with the jaw, it does not need to lateralize or reach
the palate while the mouth is wide open.  And, from being able to follow up
these babies for many months, it's clear that the tongue itself grows so
that a tongue that may be somewhat tied in a newborn shows no signs of
being tied once the child is a toddler. I know what I've seen.

Ties are NOT the cause of so many breastfeeding problems, and we have more
tools in our toolbox than frenotomy and bodywork.  But still, I think that
ethically, there is a duty to alert the family when you see one.  Kindly,
and with much reassurance that you're there to help if they should cause a
breastfeeding difficulty, of course.  Problems later - like the tongue not
being able to clean the teeth, or the baby not being able to French-kiss
are not in our mandate, and those things are for someone else to evaluate
when the child is older.

Pamela Morrison IBCLC
Rustington, England (formerly Zimbabwe).

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