Well, I figured this day was inevitable.  I received a call from my Nurse Manager last night stating that many doctors (mainly from one large practice) have complained to the Head of Peds about my observation of tongue ties in babies from their practice.  I worked this past weekend and did encounter a couple of babies who were tongue-tied, one severe and one more moderate.  Of course, the important thing to note is that both babies were having trouble breastfeeding.  One baby not latching at all and the other latching with mom in excruciating pain.  Of course we tried many other strategies for latch and positioning, etc.

I discussed with the parents what the baby needs to do with his/her tongue for effective breastfeeding and explained that the tight frenulum that I was observing may be contributing but that sometimes they look one way but can actually accommodate quite well, etc.  I left a note for Peds recommending a referral to ENT and suggested that the parents talk to them when they rounded the next morning. This particular service, and Head of Peds, doesn't believe that tongue-ties and frenotomy can affect breastfeeding and that they are fully backed by the AAP.

I believe what they want me to do is leave a note for Peds and not talk with parents about what may be negatively impacting their current breastfeeding.  Many of these Peds fully disregard my note and never discuss with parents unless parents have also been educated about the subject.  I believe that I am ethically bound to speak honestly with parents.  I don't offer to do the procedure, of course, and I recommend that ENT be called to "assess".  I offered to meet with Head of Peds and suggested that he speak with the ENT practice that comes to the floor.

I will gather up my IBCLC Code of Ethics and Clinical Competencies,etc.  I will also bring any research that I have.  Just checking in if anyone else has had a similar "calling to the carpet" and if there are some crucial pieces of research that I don't want to miss.

Thank you
Amy Slotten, RN, IBCLC
Ann Arbor, MI

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