Hi Pamela
I think there is not one of us that has not been challenged and challenged
again by the issue of tongue tie. To me the recent Australian study 
 Todd DA, Hogan MJ.  Tongue-tie in the newborn: early diagnosis and
 division prevents poor breastfeeding outcomes.
  Breastfeeding Review 2015; 23: 11-16.
reflects our dilemma, yes 11% of the population have tongue tie, 
yes about 50% of these do not have breastfeeding difficulties, 
but if there are signs of the tongue tie causing difficulties no, we should
not wait, because it will affect whether mothers will persevere or give
up, so it looks as if when it looks broke, we should try to fix it. 

I agree with you that at times the tongue tie will be released and 
problems continue. One condition that I think we need to be very
careful to exclude, when we look at poor feeding in the newborn, is
clefting. An ENT recently criticised LCs in our setting because a 
cleft was missed and the child was referred for tongue tie release.
I cannot imagine that this would happen frequently, but i guess it should
not.

Another condition that may present as early difficulty with feeding may 
be hypotonus, but unless there is a specific diagnosis e.g. a chromosomal
disorder, then the cause for poor feeding may only emerge much later 
and if there was a tongue tie and that was released, once again we need
to look at whether there was harm and may this actually benefit the 
child over time e.g. as regard eating of solid foods. 

I agree that our learning journey continues and that "accurate definitions"
are elusive, but in the end it is about function, how is feeding progressing
and is tongue function as assessed by the LC impacting on the baby's ability
to establish breastfeeding.

From my perspective we should get some credit as a profession based
on the fact that we are coming with some evidence that tongue tie
impacts on breastfeeding. I know of few other professions that care to bother
to examine the impact of tongue tie in their field.
The ultrasound studies done at UWA demonstrated
that tongue tie release can change dynamics of tongue movement. Whether
the changes are sufficient or timely to ensure that a mother continues to 
breastfeed will still vary case by case. Feeding is complex behaviour influenced
by a multitude of factors and in the end we can only do our very best,
with the resources available to us, to help every individual mother. 

Statements made by HCPs e.g. Paediatricians are not made IMHO on the basis of 
expertise. Lack of quality evidence does not mean there will never be evidence. 
 LCs work on the ground with mothers, anecdote resulted in interest
and research in many fields of health care. Yes I agree that we cannot rely on it, but I do think that
HCPs should listen to anecdote. I still believe in the LLL mantra "a thousand mothers cann't be 
wrong". Do we really believe that thousands of mothers do better after tongue tie release 
purely from placebo effect, I don't think so.

We have seen a lot of research results over the past 10 - 15 years in comparison
to the years before that, and the research in general has been driven by the
need to expand knowledge and expertise in this regard. Yes we want to see more and of
better design and quality etc etc. but I do want to say that for me, coming from a 
different discipline, i.e. SLT, I would not have had the knowledge and expertise that
I have today, if it has not been for the work done by LCs over the past 10+ years
in this regard.

The knowledge I have gained has also led me to look critically at other areas of my 
practice e.g. as regards difficulties with eating of solids in babies and toddlers and
speech difficulties and although I am very aware that we still have a long way 
to go, I am now more convinced than ever that LCs have made an enormous
contribution to knowledge in this area and that they should continue to pursue 
their learning in this regard with confidence. 

Also of interest if you cannot access above study:
http://evolutionaryparenting.com/the-role-of-early-diagnosis-of-tongue-ties-on-breastfeeding-success/

Kindest Regards from New Zealand
Loraine Hamm
SLT/IBCLC

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