Hi Katrina,
Congratulations on passing the boards.

The webbing or tight mucous membrane holding the tongue to the floor of 
the mouth is the differential between a posterior tt and a short tongue. 
If you lift or press back on the tongue, a submucosal (posterior) 
frenulum will become more apparent. I have an article with lots of 
photos on my website (below) under 'quick help' for moms to use to 
determine whether their baby might have a tt or not. You are welcome to 
look at it also.

Also check carefully for torticollis or any other neck or jaw 
restriction that could cause traction on the hyoid which would pull on 
the floor of the mouth and restrict the tongue. If those things exist, 
sometimes treating them eliminates or reduces the tongue restriction 
sufficiently for the baby to breastfeeding without frenotomy.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 1/6/2012 2:36 PM, Jijmumma wrote:
> Hello wise women,
>
>
>
> I'm posting as a very new and nervous IBCLC!
>
>
>
> I am also a LLLL and a mum came today to our meeting with very painful
> nipples and a baby predominantly on formula. I have mum's permission to
> share her story. I had spoken to her before on the phone and we discussed tt
> due to the persistent pain and damage she was getting, blanching and chafing
> and the fact lots of people have seen her and said the latch looks fine. I
> explained that pain meant something was wrong so she came along to see us.
> The first thing I noticed that although baby's tongue was very mobile and
> moved upwards quite well there was no visible frenulum (more like a
> web/membrane) and that the tongue seemed very short. During the feed(which
> was painful even though baby's position was good and his mouth looked well
> attached) I felt that he hardly transferred any milk(very little swallowing,
> lots of NNS and fretful wriggling-even though mum had milk dripping).
>
>
>
> I was at a loss really because I couldn't do any sort of manual exam (I was
> there as LLLL not IBCLC and haven't bought my insurance yet so haven't
> practiced in that capacity yet) but to be honest I really lack confidence in
> the area of identifying unusual tongues through examination (I wondered if
> this might be a sneaky posterior tongue tie due to short tongue and baby's
> inability to maintain good suction without damaging mum). I really couldn't
> see the baby bringing his tongue down over the gum line at all-but it's so
> difficult to see!!  I hated to refer her to a busy clinic but felt I
> couldn't do much more for her other than help her feel ok about feeding the
> baby and maintaining supply. How do people gain this kind of experience? I
> think I'm more scared of missing a tongue tie than I am of wrongly
> diagnosing one that's not there, so I didn't rule it out and suggested she
> went to get a second opinion. Any other ideas? Was I completely off the mark
> to be suspicious about posterior tt?  I really want to learn from these
> difficult helping situations, so am grateful for any information or
> suggestions you may have.
>
>
>
> Katrina Soper LLL Leader and IBCLC in Wales UK.
>
>
>
>
>
>
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