Alice, do you mean a lingual frenulum?  That would be a tongue tie.

 Tongue tie certainly can interfere with a baby's ability to create a seal.
If you can't seal you can't create suction. Put your finger in your mouth
and seal your lips around it and suck.  Now slightly open the corner of your
lips on one side and try to suck.  See what I mean about no seal, no
suction?

Breaks in seal would sound like a smack or a slurp as the baby attempted to
re-seal.

The report to the doctor should say:  "I observed Baby X attempt to feed
from a cup, by finger feeding, from an SNS, and with a bottle.  The baby is
unable to breastfeed, and is having great difficulty taking in sufficient
food from any other method.  His lingual frenulum is tight and this appears
to be compromising the baby's ability to form a seal around any object that
requires suction for feeding.  Additionally, the tongue is so tethered  it
cannot extend enough to allow the baby to lap milk from a cup.  This infant
is at risk for compromised growth due to impaired tongue function.  I
recommend evaluation by an Ear, Nose, and Throat specialist, or a
pedodontist skilled at evaluating ankyloglossia.  In the meantime, I've
instructed Mrs. X to pump her breasts to protect her milk supply and to use
the (whatever) as this was the alternative feeding method the baby had the
most success with.  I've urged Mrs. X to weigh her baby in your office every
third day to make sure the baby remains stable."  (This last puts the
responsibility for the baby right back on his doorstep, where it rightly
belongs.  He is the Ped.  You are his eyes and ears.  You describe the
problem accurately enough and leave the solution up to him and the mother.)

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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