To give you an overall sense of how I would help you, when you come in for any kind of initial breastfeeding appointment, we take several thorough steps:

• we review your medical history;
• we review your baby’s medical history;
• we discuss pregnancy, birth, and early postpartum;
• I examine your baby’s mouth (including how he sucks on my gloved finger), face, and the rest of his body to consider any symptoms of dysfunction;
• I examine your breasts to check their development and any symptoms they may illustrate;
• and I watch you feed your baby (breast, bottle, or both) to get additional information.

From that information, we design our initial care plan to deal with the most urgent issues first and then we address additional issues in further appointments.

Now, we have a saying in the U.S. that opinions are like assholes: everyone has one. And it seems everyone has an opinion on tongue tie these days, with most of those opinions stated emphatically on the web. Many of the viewpoints are extreme and not very nuanced. I take time to try to keep up on the research, and I take annual workshops, to be current on the care I provide clients around tongue tie, while also balancing the contributions of the various factions fighting about it on the internet.

Now, all of us Google things to try to figure out our medical issues. In some cases (especially as women!), doing research ourselves is the only way that we can figure out the underlying issues we may face, so I don’t belittle the idea of it. But sometimes with tongue tie, that means this sequence occurs:

• parents read about symptoms online;
• they decide the baby’s only issue is a tongue tie;
• they go to a random ENT for treatment;
• they do nothing, or they do whatever they’ve read on webpages or in social media, afterwards;
• and then they wonder why things don’t really get better as time passes.

Usually by then, the mom has suffered, and the baby has not breastfed as long or as much as the mom had originally intended. Then sometimes later these families are looking for additional help when the baby is struggling to eat solid foods, or when the child can’t pronounce certain letters, or when the child is exhausted from poor sleep due to apnea. A number of adults who were children in the ’70s to ‘90s are now getting previously undiagnosed ties treated after they’ve dealt with decades of difficulties eating, tooth decay, speech impediments, asthma, etc. We can’t say which of these issues certain kids with unresolved ties will get, but we know that they’re more likely to happen when parents don’t have a good set of care providers when they’re trying to fix things.

Often situations where internet research screams ‘tongue tie!’ are more complicated than that, and that’s where the help of a skilled IBCLC (International Board-Certified Lactation Consultant) comes in. For example, we might have tongue tie + nipple damage + mastitis symptoms + reduced milk supply from poor nursing, all of which needs to be treated. We might have a baby who went to a doctor who did an inadequate frenotomy, a baby who also has weight gain that’s slowed so much that the first job is to get adequate calories into the baby and then go from there. We might have a baby whose previous frenotomy was actually adequate if we work with the baby on oral function. We might have a baby whose gasping and choking at the breast are responding to his mom’s vast oversupply, and who needs to have his torticollis from birth treated before we even consider tongue tie treatment. We might have a baby who has developed an oral aversion, and wants nothing near her mouth now, from the parents being very vigorous with aftercare from a previous frenotomy. We might have a baby who has undiagnosed Pierre Robin sequence, where a frenotomy is completely contraindicated because it would impact the baby’s ability to breathe. Each of these families need customized care designed for their exact situation, and they need a care plan that evolves as the situation evolves.

That’s why private practice IBCLCs like me have studied breastfeeding—and the various things that impact it—for thousands of hours. Many of us are very dedicated to constant learning so that we can help provide families with the best outcomes.