You can get some really good clues to tongue attachment by just watching 
the baby.  If the tongue tip does not elevate all the way to the palate 
(or at least most of the way) during crying, if the tongue is bunched up 
all the time, if it rolls under when the baby attempts to extend it, all 
indicate a potential problem.

Babies with a symptomatic posterior tongue tie will retract their 
tongues and hump up the posterior tongue during sucking.  This is 
readily felt on a finger.  The tongue might look pretty good, I've been 
fooled by quite a few of these over the years, and did not pick them up 
until the second visit when mom still had pain yet was latching "well".

Another clue is the height of the palate.  The higher and narrower the 
hard palate, the more tongue restriction likely exists.  The only 
exception to this is infants with genetic disorders that cause the 
palate to be malformed, but then the palate looks very strange, not just 
high and/or narrow.

Catherine Watson Genna, IBCLC  NYC

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