In my area I am lucky enough to have several pediatricians who easily clip  
in office.  However, some mothers do not get this issue diagnosed until  weeks 
into the sore nipples and slow weight gain.  That seems to be one  piece of 
the difference in results also.  For those moms who get the  diagnose in day or 
so, and get immediate clipping in a ped's office minus the  analgesia and 
cauterization there does seem to be almost immediate relief and  better feeding.  
However, for those who have babies in the weeks or months  range who have been 
suffering with their sore nipples and finally get help, it  may not be as 
quick a fix.  If they see an oral surgeon in the area the  procedure itself is 
followed by cauterization, and this seems to lengthen  the healing process.  
Because of the age, there is a much longer period of  time of 'misuse' of the 
tongue that needs to be corrected.  These dyads  take longer to heal, longer to 
get breastfeeding going well.  It also  depends on compounding factors such as 
a high palate or narrow palate due to the  lack of the tongue's ability to 
reach the palate and shape it  properly.  I never tell a mom to expect 
'immediate' improvement  because you just never know.
 
On my list of things I wish were done:  as long as they are checking  the 
babies out, why not routinely check for short frenulum also.  They  check for so 
many things, and this is so easy to check for.  A quick range  of motion, a 
quick check under the tongue, and if there is a problem mom  can make choices 
for treatment immediately.  Seems to me it would make a  lot of sense to deal 
with this earlier rather than later. 
 
Take care,
Pam MazzellaDiBosco, IBCLC
FL, USA
 
 

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