To Amy and Pamela:
Thank you for the thoughtful discussion, and being willing to wade into this contentious issue.  "Classic" Lactnet's list-serve format better serves this kind of in-depth exploration, but Lactnet has become a low-volume site, so you might want to tap the larger crowd at its Facebook version as well to get more insights.  (Maybe you already have -- I'm not part of the Facebook group).

In a very busy outpatient breastfeeding center, I work with many mothers, often weeks out, who have already had a tongue-tie clipped, sometimes more than once -- but if they're seeing me, then the procedure was not a quick-fix.  I used to reassure the parents "the frenulum is left-over membrane, without a lot of blood vessels or nerve tissue, so it's this quick in-office procedure."  But the thinking now is that an anterior tongue tie is just the tip of the iceberg, and no tie is released until that diamond-shaped incision pops open. (I've even seen two incisions, above and below the sublingual ridge)  Then there are weeks of aftercare, which parents hate, involving pressing that incision open multiple times a day -- and I'm seeing babies who are so orally defensive that they are refusing the breast.  Tongue-tie release is not always a "might help/can't hurt" proposition.

The tongue is a major player in breastfeeding, and restricted range of motion can certainly be a problem.  I've sent plenty of families to have a tongue-tie evaluated and dealt with (and try to refer to a few nearby practitioners who might do a reasonable job -- parents really head down the rabbit-hole on this issue, since there is no standardization on the evaluation and procedures -- many of the "clipped" tongues still have significant attachments -- and do I send this traumatized family back for another procedure?)

So a tongue-tie can be cause of breast-feeding problems -- but it's not the only thing that can go wrong in the complex process of feeding.  Bodywork/craniosacral/fascial/ physical therapy is another big wormball of a topic -- so many modalities of treatment (keep hearing about new ones!) without a clear path  or much research.  But many of us have had some kind of physical therapy for range of motion/coordination issues.

On a more basic level --  Often no one has shown these mothers how to get a baby solidly latched.  Nancy Mohrbacher had a nice cranky blog-post on this topichttp://www.nancymohrbacher.com/articles/2014/11/16/tongue-and-lip-ties-root-causes-or-red-herrings.html
In working with a mother, I describe what I'm seeing.  LCs talk about tongue-tie all the time, so we don't realize parents hear their beautiful baby has a "defect."  It helps to provide perspective -- there's a lot of variation in humans -- if adults stick their tongues out, some are Gene Simmons/Mylie Cyrus (choose your generation) and others get their tongue out to their lip.  Breasts and nipples also have a lot of variation.  The question is "can we work out the "fit" between these two individuals?"  If the tongue is somewhat restricted (and the often-accompanying high palate), then the team may have to whomp in a really big mouthful to fill the space and keep the tongue in effective contact.

I also deal with a lot of older babies, whose mothers have questions on pumping/return to work/weaning/refusing a bottle, etc. who have been breastfeeding just fine for many months with a pretty restricted tongue.

Thank you to everyone exploring this topic -- keep the research coming.  Just wanted to send some (long) notes from the front lines.

Margaret Sabo Wills, IBCLC (Maryland, USA)
             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome