If all is going very well for a tongue tied infant and mom with breastfeeding, I just encourage mom to be watchful and make sure she's allowing baby to feed often enough and for as long as he needs to (tongue-tied babies who are using compensatory tongue movements are not as efficient, and generally need longer times to feed, and sometimes more feedings per day). If mom understands this, all can be well for breastfeeding. If the palate remains narrow, mom can be advised to consult with an orthodontist when her child is 10 or 11 years old. The palate can be expanded then (maxillary expansion is the name of the technique). If a baby is breastfeeding very well but has a narrow palate, I will encourage mom and dad to remember those two words for the future if still needed. Another possible concern is that alternative tongue and jaw movements may cause facial pain later in life (TMJ syndrome, trigeminal neuralgia, and chronic "sinusitis" are all just beginning to be investigated in terms of the muscle activation used in chewing motions). There are several ways to activate the facial muscles to open the jaw, close the jaw, etc. and perhaps some of these are better than others for long term comfort and health. There are a few recent EMG (electromyogram) studies that examine these questions, but none that factored in whether or not the subjects were breastfed, or whether or not they have a tight lingual frenulum. This is an avenue for future study. Until we know a lot more, we don't know how to counsel parents of children who are breastfeeding effectively in terms of frenotomy for prevention of future problems. I generally encourage parents to look at Dr Brian Palmer's website (http://www.brianpalmerdds.com) and decide for themselves. My own feeling from the outcomes I've seen so far is that if the palate is relatively normal and breastfeeding is going well, leave it alone; but if the palate is very narrow that can cause difficulties with room for the teeth and restrict the nasal airspace and frenotomy may help reduce future problems. I usually refer babies right away for evaluation: if we can't get the latch comfortable for mom using good technique if baby can't keep tongue tip over gum ridge consistently while sucking a (gloved) finger if baby has little ability to elevate his tongue tip (more likely to cause speech problems later) or if baby has a very abnormal palate (which means the tongue has done a very poor job of shaping it). Catherine Watson Genna, IBCLC NYC *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]