Dawn,
In my very small practice, I occasionally get tongue-tied babies.  If working
with positioning and latch-on doesn't work I assess the baby using Allison
Hazelbaker's ATLFF (assessment for lingual frenulum function - I think)
scoring sheet.  If the baby scores outside of the acceptable range then a
frenotomy is generally recommended. Some peds will do the surgery readily,
others go ballistic, still others want to refer to an ENT who made react as
the Peds.  A friend of mine, a certified nurse midwife, listened rather
unsympathetically, years ago.  She was not a big fan of frenotomy.  Then she
had a client whose baby's problem was beyond obvious and she very carefully
performed her first frenotomy.   Immediately the baby was able to latch-on -
pain free and  she was a believer.  Since then, if the physician will not
perform the frenotomy, there is an alternate HCP if  the parent thinks after
MUCH discussion that this would be in baby's best interest.  Just one possible
solution.  The cost to parents is quite modest I might add.

Gretchen Andrews, BA, IBCLC, LLLL
private practice, Redlands, CA