Miriam writes: "Baby with
poor tongue range of motion, mother with very sore nipples, baby unable to
maintain a latch.  Please evaluate."

I love this Miriam. You describe what you see and pin point the exact
problems it has created for both mother and baby. I find it more valuable than just a
dx of tight frenulum because, in the most non threatening way, it lets the
practitioner know what the impact of  poor tongue range of motion is. If you
just refer with "ankyloglossia or tight or short frenulum" you are apt to get a
"so what" type of response from the HCP who may not have totally bought into
the effects of tongue tie. By describing its impact on breastfeeding you may be
able to short circuit that response. I also work in a setting, where we get a
good response when we refer our babies for frenulum clipping (probably due to
the fact that we have Anna Messner heading up pedi ENT).  I  like your
description, also, because it  succinctly educates on the impact of tongue tie on
breastfeeding.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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