Dear Attie,
I agree. We need to make sure that our babies are being thoroughly 
evaluated and helped with basic breastfeeding management (if there are 
breastfeeding problems) with or without a possible tie. Sometimes even 
with a tie, better latching and positioning can resolve the pain or milk 
transfer issue. In many cases, having some body work done first, before 
you try a revision can help resolve the problem. These are far less 
invasive interventions.

I am very lucky that the pediatric dentist I refer to not only does a 
great assessment but she really wants an IBCLC in place before the 
revision so that there is good breastfeeding management before AND after 
the revision. Sometimes a revision is like magic and all of a sudden 
breastfeeding is so much better. Often it is part of the process and 
change is happens more slowly. The dentist I refer to is very well 
trained and can do the revision as gently and quickly as possible.  I 
trust her to make good decisions about my clients.

That being said, most of my babies, 95% or so off the top of my head, do 
have a positive change with the revision. I honestly haven't had a baby 
that the revision made breastfeeding worse in the long run. Sometimes 
for a week or so, it can be worse, but then it gets better.

We also need more research as well on those babies, who don't get what 
can be classified as a tongue tie revised when younger, and 
breastfeeding problems later. Are there long term repercussions to not 
having a tie resolves for later life? I worry there might be. I have 
noticed that my friends that struggle with sleep apnea now are almost 
all tongue tied! Could we avoid dental caries, orthodontic work, sleep 
apnea, struggles with foods, later in life? I have no answer to this, 
just one of my many questions.

I also have many babies that I would assess as having a possible tie 
when they are 1-6 weeks old, don't get revised, and then come back to me 
at 4-9 months and now the baby is having trouble with solids or starting 
to refuse the breast. When they get the tie assessed by the pediatric 
dentist and resolved, it helps with those issues as well.
I am lucky that I see a good number of my babies on an on-going basis 
due to the support groups I run, and the revised babies do keep nursing. 
But is that the revision or my support group?  : )
We have far too many unknowns in our field due to the lack of research.
So, I think thorough, comprehensive, quality care is the answer.
Thank you!
-- 

Barbara Robertson, MA, IBCLC, RLC
The Breastfeeding Center of Ann Arbor
bfcaa.com

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