Linda Tandy wrote about finding refs for the ped. The best is the Anna Messner article (which is in the Lactnet archives). I and others have written numerous posts about this issue, also in archives. Briefly, the thing I have seen that best educates docs is a very short LC summary sent to doc immed. after consultation that describes the problem: "Baby has tight lingual frenulum that is attached at tongue tip. The characteristic distortion of the the tongue tip when infant attempts to elevate the tongue is present. Due to limited range of motion of the tongue, the infant appears to be compensating by applying increased positive and negative pressure to the fragile nipple tissue to hold the breast in the mouth and to strip the gland. Mother has blisters along a crease line across the face of both nipples that are inflamed and painful. This tissue damage and pain during bfg has persisted after attempts to re-position the baby. She was advised to seek further consulation from her medical care providers for remedy of the baby's restricted tongue." Then I'd include the first pg (abstract summary) from the Messner article. The rest of the info I'd communicate directly to the patient, who is completely at liberty to seek solutions (which it sounds like she did). The patient should be encouraged to tell the doctor that the bfg. didn't work and hurt her prior to the frenotomy, and worked for her and the baby after it. It was the feedback from pts that has changed the minds of more doctors I know than anything I said. BTW, I had a doctor tell me point blank that it was her perogative to tell her pts about referrals not mine. I agreed, said "yes, m'mam, it won't happen again." I write her LC reports as above. I don't tell her pts "go see so and so" but I still describe the problem and the solution, and when enough pts go back to their MDs and say "The LC told me to ask you what to do next" then there will be some pressure on the MDs to come up with some solutions. Barbara Wilson-Clay BSEd, IBCLC Austin Lactation Associates http://www.lactnews.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html