Alison L. Montag asks: "If I can look at pictures in "Supporting
Sucking Skills" and see a picture that matches what I'm seeing, how
come the experts don't see
it?"

Or, to put it another way, as the professor of otolaryngology who
heads the ENT dept at my hospital said to me at a meeting, in front of
all my supervisors and all my breastfeeding clinic colleagues AND the
heads of ob/gyn and pediatrics, after hearing my explanation (based on
Cathy Genna's lectures and writings) of what doesn't work when the
tongue's mobility is restricted, "I don't understand it," and when I
asked him as calmly and politely as I could which part of the
explanation he didn't understand, he said "I don't understand how YOU
can know all this stuff when people who actually DO have a clue, don't
know it."

This was so NOT a lightbulb moment for him that I can't begin to
describe it - but it was one of the clearest  and ugliest power plays
it has been my misfortune to experience first hand in my career and I
don't mind confessing that I cried for days afterwards - but he never
saw me shed a tear, I managed to keep calm until he left the room.  It
didn't make things any better that everyone else present at the
meeting chose to stay silent, which actually might have been the most
strategic response, because this man is so afraid of any threat to his
power monopoly that to point out his inappropriate behavior might have
meant the end of division of tongue ties in our entire region.

By coincidence, I just looked today at an edition of Penelope Leach's
book 'Baby and Child, from Birth to Age Five', translated into
Norwegian in 1994, and she wrote about tongue tie in her section on
normal newborn anatomy (my translation back to English, may not be
identical to English original):
"The tongue of a baby is fastened along a greater part of its length
than the tongue of an adult. Sometimes it may appear that the tongue
is almost constrained and immovable. Previously it was thought that
such children had 'tongue tie' [in fact the Norwegian translation says
it was thought such children had 'a frenulum' :-)] If some of the skin
folds tying the tongue were not cut away, it was thought that the baby
would not be able to suckle properly or learn to speak. We now know
that true tongue tie, which will not correct itself through the normal
growth process, is an exceedingly rare phenomenon. Most of the growth
of the tongue in the first year of life takes place from the tip of
the tongue, so that it is fully mobile around the baby's first
birthday. In the meantime it has no significance for suckling, eating,
or speech that it is well (sic) fastened."
In the same section, sucking blisters on the upper lip are described
as a normal finding from the baby 'sucking strongly' and no reason for
concern.  See how much Cathy's work gathering expertise, getting it
published and disseminating it, has done for us?  We do know better
now, because we are capable of assimilating new knowledge.

I don't know that health professionals gave much credence to the great
things Penelope Leach did write, either, so I wouldn't blame her for
the persistence of the view she reports as fact here.  It is
consistent with what I was taught in the late 1980's.  We used to
think that if you could see a frenulum you should divide it. That is
obviously not the case - but neither is it the case that you should
NEVER cut a frenulum, which is the view of the aforementioned
professor of otolaryngology.  We are endowed with intelligence and the
opportunity to learn from the experiences of others, and most western
health care professionals pride themselves on practicing
scientifically, whether or not they do so. I have come to the painful
conclusion that knowledge is not power. Power is power, and power
holders determine which knowledge is respected and which is ignored,
or ridiculed, or even persecuted. Sorry if I sound jaded - it is
probably because I am - but not jaded enough to stop caring or to give
up!

The best way to get an ally is to help a breastfeeding
otolaryngologist whose baby is tongue tied - speaking from experience
here, and not tongue in cheek.  If the tongue can be placed in the
cheek the frenulum is probably fine :-P Remember, too, that if you
work in a special clinic for breastfeeding problems, you will see a
higher proportion of babies with TT than if you are just making rounds
on the postnatal ward, because they are overrepresented among babies
with feeding difficulties. I know, DOH, but it bears pointing out now
and then.

Rachel Myr
Kristiansand, Norway

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