Dear all:

In New York City, we have the good fortune of having many lactation consultants and also several ENTs that are quite familiar with ankyloglossia, including the four types.  Because so many lactation consultants are aware of ankyloglossia in this area, I have also followed up on the opposite problem that many lactation consultants encounter in other areas.  Just as there are many of you who have been the first to spot ankyloglossia, I have found that some babies are completely competent transferring milk without maternal pain when someone else has declared the baby needed to have a tongue tie clipped.  In these cases, all I have needed to do is shift the angle of attachment very slightly and the mom and baby were doing great.  

I would say that the state of the art is still inexact at this moment in time.  We now are in the state where we are demanding more and more of mothers of babies with suspicious frenulums. Go to the ENT it clipped, do the stretching exercises to avoid scarring, do craniosacral, do tongue exercises, get it reclipped, etc.  I'm sure you all can add to the list.  Keep in mind that no ENT yet does home visits so all of this involves making a postpartum mother get out the door for these visits and also do all the exercises and sometimes may be pumping her milk and using other devices.  I do believe that some babies really need all we can give them in terms of assistance.  For these babies, it is well worth the effort on the mother's part for the payoff once her babies feeding is normalized.  

On the other hand, one of the ENTs in our area has been getting reports back that there is a problem in that even when the clipping is done all the way to the point that cutting further would involve cutting into the muscle and even WITH stretching exercises, a few lactation consultants are saying that the solution to clip even more.  This ENT is seeing that beyond a certain point, repeat clippings are not helping the baby improve and are certainly not warranted when further cutting would involve muscle tissue.  I hate to say this, but I think in some instances, the basics of positioning the baby are being lost in the rush to blame everything on the frenulum.  Even if the frenulum is tight, positioning should still be part of the consultation.  

We always have a balance between under and overdiagnosis.  No one is perfect and so of course we are sometimes going to see a problem where there is not and also miss a problem when one is really there.  We are coming from a position where ankylogossia was neglected so we are going to be suspicious if an ENT tells us nothing is there --- yet, we also have to be careful that we are not going too far in the other direction.  And in this regard, I am starting to see that problem cropping up here in Manhattan.

In terms of the prevalence of tongue tie, I have to reinforce what Rachel Myr has so articulately stated.  We all have to stop and consider the fact that we only see a tiny slice of the population.  Our clientele does NOT reflect the population as a whole.  Whenever new conditions are discovered or whenever old forgotten conditions are rediscovered you will always see a surge in prevalence because awareness has increased.  

Best regards,
Susan Burger

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