Is neonatal tongue-tie surgery the new tonsillectomy?

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A New Zealand pediatrician is questioning the growing popularity of neonatal surgery for tongue-tie.

Dr. Pamela Douglas believes Deep cuts under babies’ tongues are unlikely to solve breastfeeding problems:

Babies are being cut on the theory that breastfeeding is always perfect and, therefore, it is babies who are “broken.”

When I perform comprehensive breastfeeding assessments on babies with breastfeeding problems or fussiness, including those who’ve had oral surgery in the previous weeks or months, I find a range of underlying problems that have not been properly identified and addressed, though the women have usually seen multiple health professionals.

I regularly see babies who have become even fussier at the breast after they’ve had the deep laser or scissor cuts and the distressing wound-stretching exercises. We call this “oral aversion”.

Occasionally, I find other unexpected side-effects of frenectomies: an under-surface of a tongue partly separated into two, or stitches inserted under the baby’s tongue, or into the upper gum. Parents are told the stitches were because the tie was so bad. But stitches are only put in to control excessive bleeding.

The epidemic of tongue tie is surprising since the natural incidence of tongue-tie has been estimated as 1.7-4.8%

But releasing (snipping) the tongue tie is big business. The surgical fee for frenectomy/frenotomy is $850. I presume that $850 is what the doctor bills; what he or she is actually paid probably varies by insurance company.

How effective is surgery for tongue-tie in reducing breastfeeding problems?

Not very.

A recent review of the literature published in the journal Pediatrics, Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review, found:

Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low. (my emphasis)

In Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance the authors note:

There is wide variation in prevalence rates reported in different series, from 0.02 to 10.7%. The most comprehensive clinical assessment is the Hazelbaker Assessment Tool for lingual frenulum function. The most recently published systematic review of the effect of tongue-tie release on breastfeeding concludes that there were a limited number of studies with quality evidence. There have been 316 infants enrolled in frenotomy RCTs across five studies. No major complications from surgical division were reported. The complications of frenotomy may be minimised with a check list before embarking on the procedure.

Conclusions: Good assessment and selection are important because 50% of breastfeeding babies with ankyloglossia will not encounter any problems. We recommend 2 to 3 weeks as reasonable timing for intervention. Frenotomy appears to improve breastfeeding in infants with tongue-tie, but the placebo effect is difficult to quantify. Complications are rare, but it is important that it is carried out by a trained professional.

That raises the question: is tongue-tie surgery the new tonsillectomy, a surgery that is necessary for certain narrow indications that became extremely popular to treat conditions that didn’t need treatment? In 1959, there were 1.4 million tonsillectomies performed in the United States. By 1987, the number dropped to 260,000. What was the reason for the dramatic change?

Physicians recognized that although tonsillectomy is necessary for enlarged tonsils that obstruct a child’s airway, they aren’t helpful for the reasons they were commonly performed — to prevent minor illnesses that would resolve on their own. As the authors of Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial explain:

Results: During the median follow up period of 22 months, children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group (difference −0.21, 95% confidence interval −0.54 to 0.12), 0.56 throat infections per person year compared with 0.77 (−0.21, −0.36 to −0.06), and 5.47 upper respiratory tract infections per person year compared with 6.00 (−0.53, −0.97 to −0.08). No clinically relevant differences were found for health related quality of life. Adenotonsillectomy was more effective in children with a history of three to six throat infections than in those with none to two. 12 children had complications related to surgery.

Conclusion: Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or adenotonsillar hypertrophy.

Are we making the same mistake with tongue-tie surgery as we made with tonsillectomy? While surgery is appropriate for babies with severe tongue-tie, is it being recommended for painful breastfeeding when it is not the cause and will not effectively treat the pain?

I am not an expert in tongue-tie and I have not reviewed the entire breadth of the literature, so I may be wrong, but I’m extremely dubious about surgery on babies because mothers are having pain breastfeeding. Is it really the baby’s fault? Are the small benefits of breastfeeding really worth subjecting babies to painful surgical treatments? The existing data suggests that surgery for tongue-tie is being overused for a problem that it may not even treat.

I’m also extremely dubious about any surgery recommended by the lactation industry. Instead of acknowledging that pain in breastfeeding is distressingly common and that breastfeeding may not be right for every mother and every infant, babies are being cut on the theory that breastfeeding is always perfect and, therefore, it is babies who are “broken.”

Only further research will answer these questions definitively, but until then mothers should seek second opinions on tongue tie surgery from someone other than lactation consultants and the doctors who perform the surgery. Mothers should ask themselves if the benefits of breastfeeding outweigh the risks of surgery. Should you really cut your baby’s tongue when bottles of pumped breastmilk or formula may solve the problem?

  • jaime harris

    Babies are being cut (by amateurs) on the assumption that heterosexuality is natural. Frenectomy, you say? Most of those are done below the belt.

    • Empress of the Iguana People

      this months old post is about rise of cutting tongue ties in the US.. i had to look up to see if that was even possible. My circumsized husband still has his frenulum. The only things on our kids that’ve been cut are hair and nails
      What is your connection between circumcision and fgm and sexuality? i’m rather ill today, so i’m not seeing it.

      • jaime harris

        The penile frenulum may or may not be cut – no individual result is representative, but cutting cultures don’t know normal male anatomy so no effort is made to avoid it. And no effort is made to regulate “male” circumcision – on the contrary, fanatical devotion is given to preventing any regulations that would require medical training or anesthesia. Anyone can cut their son at home with any method the sky fairy demands. And the practice is designed to be harmful. Thay intent is clearly stated even by the 20th century doctors who turned it into a cash cow. historyofcircumcision dot net has details.

        I made no reference to female circumcision or infibulation (no catchall term works, esp. since infibulation is very rare and the focus on it stops MDs from recognizing the majority of FC). Thankfully you had the decency to make the connection to female circumcision, which directly results from what all such cultures do to boys in the same conditions. As for a connection to sexuality, all cutting cultures condemn homosexuality and masturbation (which foreskin assists) but tolerate rape and pedophilia (which are easier with a blunted penis). But notice – the comparison I made was to cutting tongue ties, and you found FGM to be the more apt comparison. Conscience doesn’t exist (or doesn’t work, else the world wouldn’t be like this), but you demonstrated something better – reason. Kudos.

        The age of the post is irrelevant. The Web enforces a short attention span for the same reason everyone says that any nick to the hood of a girl’s clitoris is on a totally different planet than her brother having his entire organ flayed). Comparing different pieces of information is the foundation of reasoning (and empathy, in this case). Cultures and religions run on irrationality, because a three-word mantra is more efficient to transmit than a scientific paper or the Magna Carta. Connections between different pieces of information are like connections between neurons – and it’s easier to market/proselytize to Homer Simpson than to Steven Hawking.

        • Empress of the Iguana People

          Most religions historically have had a poor opinion of homosexuality and/or biological males in any kind of “feminine” role. That’s hardly surprising.

          A lot of the current kid generation’s American fathers have been circumsized. Docs here used to recommend it for its mild benefits and fairly low risk. They no longer do. My husband is part of that group and we only realized he was after our son was born. (Neither of us has ever seen another man’s genitalia. DH is congenitally blind). He has no problem with his anatomy below the neck, but we are of Irish and English protestant stock and our generation’s more common circumcision rate is an aberration.

          We do not deserve pats on the back for doing what is our cultural norm.

      • jaime harris

        And DO give yourself a pat on the back for not cutting your kids. Most people are simply child owners. You are an actual parent.

  • Essie

    If there is a question or hesitation, Don’t do it. It can be argued that literally every baby has some form of tongue or lip tie. The severity is in the eye of the beholder. The sad truth is that frenectomies are big money makers for pediatric dentists, ENTs, AND Lactation Consultants…yes they are getting kick backs for instilling fear in you that your child will never be able to breastfeed, speak properly, eat solid foods (or my favorite) will be bullied all his life. They get you to do it by listing an overwhelming laundry list of perils your child will face if surgery isn’t immediately performed. The truth is, it is VERY painful for the baby – especially the wound stretching after care. Many babies don’t get better at breastfeeding. Some get worse. If your child does have a true lip or tongue tie, odds are that it will correct itself over time with natural stretching. Or, if it is causing speech problems later, waltz over to your nearest Pediatric Dentist and have it done later in life. There is no need to butcher your poor newborn.

  • RR912

    It helped us. Breastfeeding became easier and my kids grew very well, are very alert and smart. I only know because I lived it. My kids are happy, smart and healthy and I know why choices I’ve made. I know what my parents did and how I turned out. Everyone does what is best for them as long as baby gets fed, cleaned, protected from danger, and is taken to medical professionals when sick that is what matters.

  • adjective

    I’m trying to decide whether or not to get my daughter’s tongue & lip tie clipped. She’s currently 16 months old. (Had zero nursing problems, and in my opinion so far she is forming sounds/words better than her non-tongue-tied brother did at this age.)

    I’ve took her to an ENT doctor, who said leave it for now and see if she has speech problems around age 3. I also talked to a pediatric dentist, who said he recommends all ties always be corrected, the earlier the better.

    It’s hard to know what the “right” choice is. She does grind her teeth and seems a little tense in her core & back muscles, which I’ve seen some people say those are things that can be caused by tongue-tie. But I don’t want to put her through an unnecessary procedure (especially if they would put her under general anesthesia) if it isn’t the cause of those things. And I also don’t want my inaction to cause orthodontic problems, peer teasing, etc. as she gets older.

  • anneshirley

    My first baby was tongue-tied and nursing was excruciating. I had a TON of pressure from my LC to have the surgery done (“it shouldn’t hurt! It’s the tongue-tie!”), so we saw a specialist. She actually wouldn’t do it, saying that the tie wasn’t severe enough to warrant it, and that it would likely not improve our breastfeeding relationship. I ended up pumping for 6 months then switching to formula. Interestingly, my second baby was not tongue-tied, but nursing was still excruciating. This time, with a more patient LC who acknowledged that pain during nursing was common and normal, I was able to deal with it differently and eventually went on to nurse successfully for over two years. So yes, in my experience there IS pressure from lactation professionals to have this surgery.

  • PrudentPlanner

    Isn’t it weird that Woo people say/believe that “midwives use-to keep one fingernail long and sharp to cut the tie on any baby when they were scooping birth fluids from the baby’s mouth”.

    1) The ability to grow long/strong nails is VARIED among humans…. I have incredibly weak nails, I bet 33% of old-timey midwives couldn’t have grown a nail long enough to DIY a tongue tie release.

    2) I disbelieve that it’s so easy to cut an infant in by sweeping under the tongue with a fingernail… perhaps a midwife could have pinched the frenulm to cut it?

    3) EWWWW! The bacteria beneath the fingernails is not good to introduce to a newborn baby’s wound.

    Why would anyone advocate for this practice using such a terrible historical tale?

    • Poogles

      “I disbelieve that it’s so easy to cut an infant in by sweeping under the tongue with a fingernail… ”

      My guess is you’re probably right for most fingernails. However, I have caused some pretty good slices with my own fingernails on myself and others (accidently of course) – my nails are very thin, which seems to mean that they can be very sharp if they catch skin at the right angle (I can also use my nails to slice open thin plastic coverings). Whenever I know I’m going to be caring for or be around little ones, I cut my nails pretty much all the way down to avoid any mishaps.

  • OBPI Mom

    My son’s doctor wouldn’t clip his tongue tie and my son was starving because he wasn’t getting breastmilk out of me (which ended up being my issue… insufficient glandular tissue in hindsight) SO my homebirth midwife clipped his tongue tie. I still cringe when I think about her doing it. She told us it doesn’t really hurt the babies and he cried, nursed, and seemed fine after (similar to when they do the PKU heel prick). Looking back, I can’t believe I let her do that, but I was so steeped in that world that she just seemed so knowledgeable to me. He never had a good suck reflex due to low muscle tone, but that was more due to his birth injury.

  • Margo

    Wandered into I meant , not wondered, although I did wonder what the hell was going on, one minute feeling apologetic to be taking up E.D time, the next minute, being wheeled off for stents. I must say the “happy juice” administered, made for a calm journey.

    • Poogles

      “one minute feeling apologetic to be taking up E.D time, the next minute, being wheeled off for stents.”

      When I had appendicitis (~18 years old), my symptoms were not “classic” appendicitis symptoms. Actually, I had only 1 symptom – a very sharp pain in the area of my appendix that came out of nowhere that then became intermittent (sharp pain that would make me gasp, then it would go away almost completely or just be a dull pain). I had no other symptoms. I was so worried that they were going to end telling me it was just gas pains and I was going to feel terrible for wasting everyone’s time. Turns out the appendix was close to bursting/perforating, so good thing I had gone in.

      • Margo

        Glad you got sorted re appendix.

  • Margo

    And completely left field here, but I am feeling joyful today as today is one year since I wondered in to Emergency Department feeling like I had the flu and ended up having 3 stents put in due to fact I was walking around feeling like crap with heart arteries 70 per cent blocked. So…..today is a good day….hell, every day is a good day. Just feeling so joyful that I wanted to share my experience: I had no chest pain, no pain anywhere in fact, just felt really really unwell, so I consider myself really really lucky.

    • An Actual Attorney

      Good news. Modern medicine for the win!

    • Daleth

      Wow. That’s amazing!

  • Margo

    Midwives do not get extra payment for this procedure, all part of the post natal package I believe.

  • Margo

    Yes, I have noticed an increase in tongue tie snipping here in NZ and have wondered why the increase over the last couple of years. I do know that some midwives in NZ carry out the procedure: needless to say I do not agree with this trend.

  • Pollyanna

    My son was diagnosed as tongue-tied in elementary school by the SLP. He couldn’t say his l’s and th’s because he had trouble getting his tongue to the roof of the mouth. But he successfully nursed for 12 months.

    Maybe a frenotomy early on would have prevented the need for speech therapy. But it had absolutely no impact on his ability to nurse. My personal (anecdotal) experience makes me a little skeptical that the frenotomy helps with nursing even if there is an issue.

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  • Wombat

    I had a frenectomy with my wisdom teeth (that are finally gone, hallelujah) at a relatively older age. I was a little leery because of it’s association with popular woo theory and supposed over-use, but in my anecdotal experience I think it’s made a positive difference. Still have some skepticism, but at absolute worst I think it didn’t do any harm. Nothing to do with breastfeeding for me though, more about making dental work accessible and helping to halt the progression of gum recession! Not things with an easy alternative.

    One thing I will say, though: Even having it done under dissociative anesthesia and local numbing, it hurt so -freakin’- bad. I woke up much more lucid than I expected and the teeth (all 4) were quite mild and massively overshadowed by how much the front of my mouth just hurt. The immediate ouch subsided relatively soon (that evening/night) and the teeth picked up some, but I would still get occasional shooting pain if I moved my mouth just right or bumped it at all for a while afterwards.

    The idea of people doing that to kids without anesthetic, even if they have a legitimate easier go of it (which I personally doubt, but still)… just no.

    • mbeth

      Eh, I had it done at age 5 for speech issues — it’s one of my first clear memories — and there was no significant pain involved in my recovery. Now, I did have some sort of numbing/anesthesia for the snip itself — I remember how weird it was to have some blood coming out of my mouth without feeling any pain — but when it wore off, I wasn’t uncomfortable.

      Now, OBVIOUSLY I am strongly opposed to having it done without anesthesia/numbing/whatever, but I think it may be one of those things that kids recover from more easily than adults. Sort of like, oh, tonsillectomies. 🙂 Which I also had, and which changed my life, which was no longer spent in the ENT’s office with nonstop ear infections and strep throat. (Yes, I had ear tubes. Multiple times. Did nothing except let the gunk drain out of my ears.)

      Now, ALL THAT HAVING BEEN SAID…as an infant, I nursed just fine for a year, despite being born a few weeks early, taken to the baby nursery on a regular basis, hatted, given the occasional bottle of formula, etc. It’s not that I think frenectomies never help with nursing, but I am, based on my own anecdata, skeptical that they are a large-scale magic bullet.

      (My own twins have no tongue ties — I checked early. One loathed nursing — turned out she had a weak suck, which we got corrected — while the other liked it. Both also still have their tonsils, although when one and then the other developed chronic ear infections and snoring, I hunted down the most interventionist ENT I could find and persuaded him that adenoids are for suckers. Two adenoidectomies with “significantly enlarged adenoid” reports later, I have no regrets, aside from having to remember the ear plugs when they have swim class because their ear tubes haven’t fallen out yet. We’ll be going back to the ENT if strep starts being a problem. Lymph nodes, man…)

      • Wombat

        Hmm, thanks for the insight! I don’t have kiddos yet so I don’t have a ton of experience with that side of things.

        I’m just generally skeptical of ‘it doesn’t hurt kids as much’ without a clear mechanism (which I almost mentioned that I could see blood vessels being smaller and less developed being a potential explanation) or lots of evidence of that. Without a mechanism/evidence I think it unfortunately can cover a lot of ‘it does hurt as much but kids are less capable of expressing it and/or ignored’.

        And I was just really surprised at how much it hurt! My peds dentist had offered to snip my top lip one to close my gap like it was no big deal (I ended up keeping the gap) so I figured the teeth would be way, way worse. In actuality it was at minimum tied, and arguably the frenectomy won.

        Oh and I forgot in my original comment, but as far as I know I nursed without major issue, and I was my mom’s first. A first baby with a lip tie should equal total and utter disaster if you listen to some of the more extreme advocates out there…

  • StephanieA

    My son has a tongue tie. I wasn’t big on breastfeeding, but I was so happy when our doctor told us that she thinks ‘it’s a rare baby that the procedure actually helps.’ So we didn’t clip his, and he breastfeeds very well in spite of it.

  • Hilary

    So I commented last week about how I took my almost-2 year old to a new feeding therapist who is pressuring me to have his minor tongue tie revised and claiming that this will fix a bunch of other problems. She called me today and asked what I was planning to do about the tongue tie, and I said that we were either going to have his ENT snip it during another procedure or not do it. She seemed very upset about this, because 1) She wanted us to go to the dentist that she works with instead of our ENT, claiming that it’s better because he uses a laser (am I wrong to be suspicious of profit motives here?), and 2) She doesn’t like that we’re waiting at least a couple of months instead of doing it right now.

    She then reiterated her claim that the tongue tie is causing his sleep apnea. When I told her that we’re pretty sure his sleep apnea is being caused by his laryngomalacia, she said that tongue ties can cause laryngomalacia. Ummm, what? If this conversation hadn’t been on the phone, I probably would have started throwing things at her.

    Anyway, I have a feeling I may need to break up with her at our appointment next week. We’ll see. I’m going to try to make it very clear that I do not want this procedure, and if she can’t accept that and let it go, we will find another therapist.

    • Who?

      Hope it goes well, she sounds like a handful.

    • momofone

      It might be worth asking for sources for her claims. If she produces any, you’ll have a real sense of what she finds credible. (It sounds like a total crock to me, but I am definitely no expert.)

      • Hilary

        She’s already given me one article that turned out to be written by a homebirth advocate/cranial-sacral therapy practitioner. She told me she’d give me an article about the laryngomalacia; I have to admit I’m morbidly curious to see who wrote it.

        • momofone

          It would be interesting to see–on the way out the door. Craziness.

    • mabelcruet

      Hilary-get rid of her. She is talking nonsense and there is absolutely no anatomical or scientific basis for any of the crap she’s telling you.

      There is an association between laryngomalacia and poor feeding in that babies with laryngomalacia often struggle to feed, but one isn’t the cause of the other. Tongue tie in no way whatsoever can affect the cartilage in your airways-there is absolutely no anatomical, structural or physiological connection between them.

      Personally, I’d be asking her how much of a financial kickback does she get from the dentist for every patient she refers.

      • demodocus

        Or if the dentist is her sibling or sweetheart.

    • Dr Kitty

      Remember I said that pushing back a bit would give you an idea of whether you could work together?

      You’ve had your answer.
      I’d disengage, because at this point she has shown that she’s not thinking about your son’s best interest (avoiding pain and distress if you do decide to have the tie cut) and her anatomical knowledge is lacking.

      Apnoea CAN be caused by tongue issues-usually the tongue falling back in the mouth. Thank about that, it isn’t going to be a situation that happens with a tongue tie.

      In a child with laryngomalacia who is under the care of multiple specialists, she appears to be overstepping professional boundaries and, clearly, her diagnostic capabilities by giving you odd advice and disparaging other members of the team. Profit motive or not, this doesn’t sound like someone you should be working with closely.

    • demodocus

      I’m not sure if I’d wait until next week to break up with her (unless it’s 7 am Monday morning and she’s unreachable on weekends)

    • An Actual Attorney

      Just an internet stranger, but I hear the warning bells from here. Does she have a supervisor of some sort? If so, I’d let them know why you are leaving. Possibly also let your insurance know. But she sounds as cuckoo as a clock.

      • Hilary

        I don’t think she has a supervisor, I’ll try to find out though.

    • Charybdis

      Does she have a supervisor or boss of some sort? If so, I would let them know what is going on and see if they can sit in on the next appointment with you. Request a copy of your son’s medical records from her as well.

      I would make it clear as hell that although you *appreciate* her input, the rest of your son’s medical team do NOT agree with her so-called diagnosis. Your son has already had a major lip tie released by the EMT and the EMT does not think the relatively minor tongue tie is causing enough of a problem to be immediately dealt with. It might get dealt with in the future, when your son is already under anesthesia form another procedure, but it is NOT bad/serious enough to treat immediately.

      If she cannot let go of her little pet theory that a relatively minor tongue tie is responsible for all your son’s issues, then you cannot work with her as a member of your son’s medical team. And you need to tell her that in no uncertain terms. Her *concerns* are noted and logged, but unless she can get on board with the treatment plan, you will have to replace her. And don’t feel guilty about it.

    • BeatriceC

      I agree with the others. It’s time to run screaming from this woman.

      And I wouldn’t wait until the next appointment. From what you posted previously, finding another therapist might take time, so you want to focus your energy on finding a new one straight away. It’s the weekend, so I’d either email now or call first thing Monday morning and explain to them that you are no longer in need of their services. How you explain why is up to you. You can go into detail or you can just leave it at the above phrase. Honestly, it sounds like she’s so focused on the Fad Problem of The Month that she’s not going to see reason no matter what you say.

      Good luck. It’s no fun firing a provider. I’ve had to do it a couple times (including about a month ago), and it never gets easy.

      • Hilary

        It’s going to take at least a month to get in with another therapist and probably much longer. We were on this woman’s waiting list for a month and I pulled strings to get an eval so quickly. That’s what makes this all so frustrating.

        • Who?

          Damn.

          My experience is you’re better doing without than wrangling a difficult person. It only gets harder to walk away, and she can do active damage if she’s in your space, if only by crossing with the providers you are already happy with.

          I probably wouldn’t keep the coming appointment: you’re not going to be happy with what she says, and she is going to push you, as she has displayed.

          Sorry to not have something more positive to suggest.

          Good luck with it.

          • Gatita

            I had to fire a speech therapist for overstepping boundaries and I 100% agree that it’s better to go without for a while than to continue with someone who is behaving unprofessionally. Hell, I fired my OB 28 weeks into my pregnancy and it was also totally worth it. If someone is going to be involved with your family in such a personal way they have to respect your boundaries and behave professionally or they’ve got to to.

          • Who?

            It’s like investing-sometimes the smallest loss is the one you take today. The longer you stay involved, the more you lose.

            And yes-respectfulness and professionalism are non-negotiable essentials. This woman appears to be missing beats on both.

        • Daleth

          That sucks. I hope you post a review on Yelp or Angie’s List or wherever so other people don’t waste that much time being bamboozled by her.

      • Essie

        This was exactly my experience with a LC named Grace in SAN Diego!!

    • theadequatemother

      Well that makes no sense. Clipping a tongue tie would probably worsen sleep apnea if anything since the tongue would now have more mobility to fall backwards and obstruct the airway. It sounds like you have a medically complex child and the feeding therapist is overstepping.

      • Hilary

        That’s what his ENT said also, RE the apnea.

    • Essie

      This was exactly my experience with an LC named Grace in SAN Diego!

  • Guest

    I’ve been wondering about our own – in this case lip tie – story. When my first was born, I never really considered it. We struggled to nurse from the get go, she constantly lost her latch, always had a shallow somewhat painful latch, I got clogged ducts monthly if not bi-monthly for quite awhile, she didn’t truly sleep through the night till she was almost 2 (I suspect the 2nd year was entirely behavioral, but I wonder about that first year). But she gained weight great – probably because I was nursing her around the clock for many, many months – so I never really questioned anything. At her first dental check up at 3, our dentist informed me that she had a very severe lip tie that might need correction eventually. And then reminded me that my brother and I needed revisions as children (she’s been our dentist a looong time). I’m pretty sure my now 5 year old just gave herself a revision a few weeks ago when she tripped and tore something in her upper lip- so much blood.

    Kid #2 nursed like a champ from day 1, STTN at 5 months, gained weight perfect. I never had a single clogged duct.

    Kid #3 was born last spring. He looks remarkably like Kid #1. He almost immediately had trouble latching. He would struggle and then fall asleep, but unlike with Kid #1 I just didn’t have the energy reserves to basically nurse him around the clock. The first month he only gained a pound. Although our pediatrician reassured us I was starting to get scared. Month 2 he gained 2 pounds, but he had fallen from the 40th percentile at birth to the 3rd percentile. I decided to take him to the lactation clinic our local hospital runs and we did a feed and weigh. He managed to transfer 3oz, but it took a long time. She suspected he had a lip tie and recommended we go to one of those wackadoo lip tie revision factories that apparently only take cash (!!!!) (I called, there’s a “world famous” guy about an hour from us.)

    So I took him to our dentist who rarely does infant revisions, but she agreed he had a bad upper lip tie. Unlike stories I’ve heard, she (a) only charged $100 (she doesn’t take our insurance anymore sadly) (b) insisted on ordering a local anesthetic for the gum and (c) said she’d prefer to underuse her laser and do more later, if necessary, then cut too much. He cried during the procedure, but almost immediately went back to being a happy guy. We were specifically told NOT to mess with the revision in any way.

    I’ll admit the difference was astounding. We immediately had started giving a supplemental bottle after his nursing disfunction had been diagnosed, and by 6 weeks out he didn’t need it anymore. He gained 4 pounds in 3 weeks, and now is in the 100th percentile for height and 80th for weight.

    I write this because we told our ped about the revision and he was insistent that it was unnecessary and it really was just the baby got bigger. As he put it, “the bigger the vacuum, the better the suction.” I’m really not sure if we got taken for a ride on the latest fad, or if we’re in that small percent of people where these ties are genetic.

    Fwiw, the LC asked me to write up our story so they could begin compiling case studies to better determine when to treat lip ties as she agreed they were being over-diagnosed.

    • Hilary

      My son had a really severe upper lip tie as well, that was identified by the dentist and fixed by an ENT. It definitely did make a difference. Now I’m dealing with pressure from another professional (an SLP) to revise a tongue tie that the same ENT says is minor. My experience of these two situations has been completely different. There are definitely situations where there’s a real issue, and situatioins (the majority, it seems) where it’s not.

  • Stephanie Rotherham

    OT: My mum’s friend has a four year old whom, until he got surgery, has had lifelong problems with his tonsils and throat (can’t remember it exactly, sorry; I’m one of those people that are ambivalent about children and have no plan to produce one myself), to the point of numerous infections and complications, speech problems, and definite food and swallowing aversions, with trouble putting on weight. They wanted him to get big enough to go through the surgery, but to do that he had to gain weight, and to gain weight he had to have surgery. It took ages to get it sorted, especially because they had to have it done at a hospital two hours away by car (she also has an eight year old daughter), instead of in our town’s, but it has vastly improved everything. He’s a bright, chatty, healthy little boy now; we’ve bonded over How To Train Your Dragon. It’s pretty damn awful they had to wait so long to get a such needed surgery.

    • guest

      i find it very strange that you attribute your inability to remember a friend’s child’s exact medical diagnosis to the fact that you do not wish to have children yourself.

      • Melissaxxxx

        Pretty clear that its because they are “ambivalent about children” what exactly are you missing, guest?

  • mabelcruet

    I’m going to claim a CPD point for reading this! One of the things we look for in sudden infant death cases is tearing of the labial frenulum which can be caused by a bottle being roughly shoved into the baby’s mouth, or direct trauma. I never knew that this was snipped deliberately.

    Why are people so ready to cut bits off their baby? A frenum/frenulum is natural, so surely natural=good? I thought the woo-meisters don’t believe in medical interventions?

    And who is doing the surgery? There are whacking great vessels in that area, one wrong snip and you’ve got major haemorrhage. And nerve damage. And salivary duct damage.

    • Gene

      Same here. If I suspect non accidental trauma in a baby, I always document whether the upper and lower frenulum are intact.

      • An Actual Attorney

        “non accidental trauma in a baby” send shivers up my spine.

      • Gatita

        That makes me so sad. 🙁

  • Nicole

    I only have my experience to go on but I suffered for two months. I actually got blamed by the hospital lc who called me a nervous new mom in a letter to our pediatrician and once the tongue tie was diagnosed and clipped it was like night and day. There was no awareness or checking and she was my first so I didn’t know better. Poor kid couldn’t stick her tongue out. It just pinched in. I have no regrets.

    • Nicole

      I realized I wasn’t clear. The hospital LC blamed me for my breastfeeding problems and never diagnosed the tongue tie and then unbeknownst to me at the time wrote the letter to my pedi who also did not diagnose the tongue tie. It wasn’t until I paid a LC $400 out of pocket that the problem got fixed. 🙁 It was my first lesson in the vast quality variation in LCs (for instance the other hospital LC who refused to teach me how to use the pump because she said I didn’t need it and only relented when I pointed out I was going back to work and did in fact want to pump while at work).

  • Hannah

    I’ve posted this before but my daughter had a posterior tongue tie. In my case, the super bossy lactation lady said she was fine and I was imagining the weird, painful things she was doing with her tongue and that the shape her tongue made (deeply heart-shaped and she could not lift her tongue up) when she cried was in my imagination, too.

    Nursing was hell for four months and I pumped like crazy until we went to Dr Wesman, head of Ped ENT at Oakland Children’s Hospital. However, Wesman said that he though deep cuts and laser were unnecessary and cruel. He charged a regular consult fee ($129, if I recall correctly), snipped the tie in moments, and she nursed perfectly and I was pain and Raynaud’s-free from then on.

    Ironically, all the lactation ladies missed it, including the lovely one I hired who was formerly a pediatrician. It was only when my daughter finally gave her a good chance to feel underneath and she saw her really crying that she suggested we see what Dr Wesman said.

    So there’s some anecdata for you. I guess what I am saying is that while my determination was definitely driven by anxiety and an unhealthy obsession with wanting to nurse, the proof was in the pudding. Basically: one size doesn’t fit all on either side of the fence.

    • Inmara

      That’s so strange that people who should know better can miss such a severe case of tie! But even education and experience with breastfeeding doesn’t save from this; midwife in our antenatal class told us a story about herself – she had two children and breastfed them successfully with pain only in first weeks; then with her third the pain didn’t get away at all but she chalked it up as a “variation of normal”. Only when third child started to learn to talk it turned out that she had tongue tie and had to get it clipped then.
      I made sure to ask our pediatrician to evaluate tongue tie in the very first visit, just in case.

  • Zoey

    Back when I was a member of several woo groups, tongue tie or lip tie surgery was very common. Experienced parents shared the names of dentists that would perform these surgeries, which were not covered under the provincial health plan and had to be paid for out of pocket. Some of them even fundraised for trips to other cities to find a doctor that would find and remove a “tie” that no one else could see.

    Generally, it seemed that most parents were happy with the results, although I know one child that developed an oral aversion so strong after her surgery that she needed months of physical therapy before she would put anything in her mouth again, and eventually ended up with a feeding tube (she was otherwise totally healthy). The baby never breastfed again, which was considered a huge tragedy. Much more than any trauma or suffering to the baby as a result of the surgery.

  • ChemMom

    Lactivists are terrible with percentages it seems.

    “You’re having breastfeeding problems? Well only 5% of women don’t make enough milk so it can’t be that. Hey I know! 5% of babies have tongue ties. THAT’S got to be your issue.”

  • Jen

    Oh this post makes me so sad! My little guy is now 18 months old so his tongue tie surgery is long behind us. I wasn’t committed to breastfeeding in the first place, but the pediatrician and lactation consultant on staff when I delivered told my husband and I that our little one was tongue tied and it would need fixed. We were going to decline because we preferred formula to surgery, but they convinced us that it might interfere with speech and other problems later so we gave in to the surgery. It was quick, he didn’t cry, and there were no complications. But now I feel like we were tricked into doing something unnecessary and painful. This was done when he was only 2 days old so I’m now not convinced at all that we should have gone through with it. Darn Kaiser and the BFHI. I’m pregnant now and will for sure decline this until I get a second opinion with this baby. Ridiculous that new vulnerable parents are being tricked into paying for expensive, unnecessary, and painful surgery on their newborns in the name of breastfeeding.

    • guest

      You followed your doctor’s advice, and no harm, no foul. Don’t feel bad now. Severe tongue ties can cause speech problems, so maybe it is helping.

  • Allie P

    Someone tried this tongue tie crap on me when my first was a baby, as a possible explanation of the problem. I googled. My baby was very clearly in the “normal” camp. Someone also tried to diagnose me with whatever the small tubular breast syndrome was. I very obviously do not have that either.

    I started getting very suspicious of all of the random and obviously I’ll fitting diagnoses people were making in order to explain away my nursing problems. That’s when I found skeptical OB.

    • AirPlant

      Well be fair, I am sure that your breastfeeding troubles were very hard on them. 😉

  • Irène Delse

    When the tongue tie is not too pronounced, I wonder if it can get better by itself, or even with such ordinary “exercises” as sticking out one’s tongue? I’m asking this because for some reason, my mother like to play at making faces with us when we were toddlers, and of course sticking out the tongue turned into a contest of who will stick it out farther, curling it towards the nose, etc.

    Obviously, this sort of training came to late to have an impact on breastfeeding, but I’m curious.

  • Gatita

    As an adult who had a tonsillectomy when I was 27 because of a chronic strep infection that didn’t go away with antibiotics, all I can say is OW OW OW HOLY SHIT PAIN PAIN. And yes, good it’s not done routinely.

    • momofone

      Same here, except the age (I was 23). Worse than my c-section by orders of magnitude!

    • FEDUP MD

      It wasn’t even in the same league as my 2 sections, or my hernia repair. Managed 2 sections without narcotics, but was taking them by the handful for the tonsillectomy. My ENT said I would hate him afterwards. Boy was he right.

    • Who?

      My son had his out at 12. He had occasional bouts of bad tonsils from about 4, which gradually got worse and more frequent. He is someone who spikes very high fevers, so would be really sick from the fever and required iv fluids several times to get his temp down.

      He had them out after begging me to let him, while he was lying on the floor of the shower, naked and throwing up with a very high temperature.

      The surgery was terrible, recovery was awful but his health improved dramatically after that.

      • Mishimoo

        I used to get tonsillitis like that and begged to have them removed, but my parents refused. My brother had his taken out after being taken to the doctor for severe bad breath and general illness which wouldn’t go away despite vast quantities of colloidal silver. Turned out they had partially rotted out, and my sister’s began to go that way too. I still have mine and for some reason, stopped getting sick every two weeks as soon as I was kicked out of home.

        • Who?

          Horrible. It’s good you don’t get it anymore-I know people in their thirties who are still struggling with it.

  • Megan

    OT: Little lady born yesterday morning by (awesome thing ever) repeat scheduled CS. We are doing great. Glad I did not try to VBAC since she was 7lbs 2oz at 37 weeks and would’ve been quite large at full term, if I’d made it that far. She has so far been a good nurser and we are supplementing with some formula and hand expressed colostrum until we see if my milk comes in. If it does, great. If not, oh well. So far, has lost 3% of her weight (50th percentile on NEWT) and bilis are great. I am still needing pain meds regularly but anticipate it will only be another day or two before ibuprofen suffices. Big sister was supposed to visit today but is sick so I guess they’ll meet at home. Oh and, OMG, she’s been wearing a hat almost the whole hospital stay!

    • Gatita

      Congratulations! A 37 weeker at 7 pounds? Dang.

    • demodocus

      Hooray on your not-so-little one!

    • Charybdis

      Congratulations!

    • Monkey Professor for a Head

      Congratulations!

    • Dr Kitty

      Congratulations!
      Your little early one is almost a pound bigger than both of my mine (38-39 weeks)!
      Glad the ERCS went well, the first three days are hard and then it gets easier (although afterpains with nursing get worse with each pregnancy).
      Enjoy the relative peace and quiet of hospital, because once you’re home it is going to be bedlam!

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    • Deborah

      Congratulations! A hat? Oh the shame!
      Enjoy your family -)

    • Zoey

      Congratulations! My son was 8 lbs 5 oz at 36 weeks, so I was also glad that I didn’t have to birth him vaginally at term. Ouch!

      • BeatriceC

        So glad I’m not the only one who has giant preemies. My oldest was 8 lbs, 8 oz at 36 weeks and my middle was 5 lbs, 4 oz at 32. Only my youngest was in normal range for gestational age, and he was actually on the small side at 504g and 24 weeks.

    • Mishimoo

      Awesome!! Congratulations on the safe arrival! Hope your eldest is better soon and that feeding keeps going smoothly.

    • Congratulations!

    • Sue

      Wonderful news! Congrats – and enjoy the tiny one.

    • Stephanie Rotherham

      Congratulations!

    • Inmara

      Hooray! So happy for you!

    • Bombshellrisa

      Yay! Congrats! Give her a snuggle for me and enjoy that new baby smell.

  • Dr Kitty

    Warning! Anecdote ahoy!

    I have big, flat nipples, ample supply and two babies who nursed easily.
    For the first six weeks with both of them nursing hurt like a SOB.
    Then it suddenly didn’t.
    Nothing changed, except maybe their jaws were bigger and my nipples had toughened up. Don’t know, but it happened twice, with two different babies six years apart.

    IF I had decided to address the pain and sought advice from a LC at four or five weeks, maybe I’d have been told they had ties. If I had elected to have the ties corrected, maybe I would have attributed the sudden reduction in pain to the tie surgery, when it was actually a self resolving issue.

    That is my theory anyway. Nursing hurts at the start, then it doesn’t, and it is tempting to attribute this change to intervention, when it might have been self resolving regardless of what you did.

    • Sue

      Great point, Kitty. So many things that are self-resolving – whether it’s feeding, unexplained crying etc etc – yet the homeopaths or other remedy-merchants will happily sell you something and claim credit.

    • Who?

      I had a similar experience, not quite so bad the second time-I fed no 1 for 6 months and he is 2.5yrs older, so not so long away from it.

  • Glia

    I had a frenectomy in middle school as part of rather extensive orthodontic work. It FUCKING HURT. It upsets me that babies are undergoing a painful procedure that likely won’t work for most of them, because women have been told that they MUST breastfeed and that if it doesn’t work perfectly it is the end of the world. The all-or-nothing attitude makes it even worse. (FWIW, I breastfed my kid until almost 15 months, and it was never perfect, but it worked for us. I wish I had realized earlier that “worked for us” was more important that “perfect”.)

  • Gene

    It’s quite interesting to see how certain diagnosis fall in and out of fashion. Tongue tie is currently on of the popular ones. POTS (postural orthostatic tachycardia syndrome) is another. And celiac diease. This doesn’t mean that popular diagnoses aren’t real (I likely had POTS as a teen and REAL celiac disease is a bitch), but that people tend to latch onto a diagnosis to either follow the crowd or make themselves speshul. I can’t breastfeed my child because, SIGH, she has tongue tie. Maddie was such a talented volleyball player, but, SIGH, POTS just ruined her life. I’m failing at my diet because no one has gluten free bread!

    Shut up people. You make those who DO have these illnesses look bad!

    • Gatita

      They can also fall in again. I’ve read that routinely removing wisdom teeth fell out of favor but now that people are aging with wisdom teeth some of them are having serious problems with gum disease and have to have them removed even though it’s a much more dangerous procedure in an older person. So now there’s a debate about whether pulling wisdom teeth should become routine again.

      • guest

        I didn’t realize routine wisdom tooth removal had fallen out of favor. I was skeptical as a 17-year-old when told it was necessary to “prevent problems.” I just didn’t want surgery, and I was a dumb 17 year old who didn’t understand why if everyone has wisdom teeth, everyone should get them removed.

        I am also a person with a pretty small mouth for an adult (the sort where new hygienists and dentists invariably comment on it) and I’m quite certain now that wisdom tooth eruption would have caused problems. In retrospect, routine removal made sense. I’ve got fourteen years before it’s an issue for the kids, so I guess we’ll just see what’s in fashion then.

      • BeatriceC

        I had my wisdom teeth out when I was 28 or 29 and they were already causing problems. They had partially pushed through but couldn’t completely break through, and my gums were getting infected constantly. As miserable as that was, I’m glad my parents did go for a preventative removal when I was younger. I’m glad I waited until there was an actual need.

        • namaste863

          I have rarely been more pleased than when I went to the dentist last year and discovered that the reason my wisdom teeth hadn’t come in (I’m 28) was that they were never there to begin with. Broke into my snoopy dance over that one.

          • Sean Jungian

            I felt lucky that I only had 3 🙂 had them out at 18.

          • Valerie

            You guys are lucky- I had an extra one, and they were all removed when I was 18. We had no dental insurance, and they charged extra for the 5th tooth.

      • Dr Kitty

        Oh boy.
        Two of my wisdom teeth came up fine. Two were impacted, started pushing out horizontally through my gums and managed not only to undo the good work of years of orthodontics, but to cause a lot of pain in the process.

        So, with my school leaving exams eight weeks away we decided to get the troublesome ones out, figuring a few days of recovery and all would be good.

        Instead I got Stevens Johnson Syndrome from the antibiotics used as a precaution by my dentist, lost almost 30%of my body weight, almost died, couldn’t speak or eat for two weeks due to the painful ulceration in my mouth and was barely able to sip fluids through a straw. Fun times.

        Still, sat the exams, made it to medical school, so no real long term harm done.

        Honestly, I’m more scared of a repeat of that then the two anaphylactic reactions I’ve had to antibiotics.

        • Sue

          WOW – that’s some staying power, Kitty.

          My husand was once told that he had impacted wisdom teeth, which required an overnight private hospital admission for removal under general anaesthetic. We got another opinion, from a more conservative dentist who confirmed that the teeth had been impacted for years, so were not the cause of pain. However, he suggested root canal work.

          Neither treatment was followed through, the pain went away….

          We all need to be cautious about accepting invasive treatments. WHen there is clear evidence of need, though, they may be the best alterative. These decisions get easier over time. IF the condition is getting worse and not going away, then action may be required.

      • Kelly

        All mine came in perfectly but they are hard to brush and I have had a cavity in one of them and have had it filled twice. I also have crowding and I can’t use my retainers any more because of it. I wish I had gotten mine out when I was in college.

      • Who?

        I had two removed at 18 and one taken out a couple of years ago, after a lot of abject begging from the dentist as it had been filled once and was hard to brush. I am better without it, no question.

        Daughter had all four out under GA, pretty nasty but recovered quite quickly.

        Son’s came through fine, then one had to come out when it got infected, an emergency removal one idle afternoon. He’s got another one brewing and has moved to a fairly remote community with a mild toothache and the sound of my gentle chiding in his ear. Let’s hope the local dentist is adept at tooth removal! Or he can be convinced to go to the dentist next time he’s home.

        • Mishimoo

          Did he happen to move to one starting with A? It’d be funny if he was in the same community as my sister.

          • Who?

            Not the same one, for now anyway.

            Was hoping he’d be around at Easter, but is on call. He may be getting to meet the local dentist in dramatic circumstances!

          • Mishimoo

            I hope there’s a decent one in or close to his community! I don’t think that there’s one in the community where my sister is, as far as I know, they just have nurses.

          • Who?

            Don’t tell me!! I’m hoping it holds until April when he’s on leave, and our guy can do it.

      • StephanieA

        I had mine out when I was 18. I was under conscious sedation, never felt much pain after, and recovery was pretty easy. I’m happy I won’t have to deal with them later in life.

    • fiftyfifty1

      The orthostatic pulse and lightheadedness that are common in eating disorders are frequently misdiagnosed as POTS. Another common misdiagnosis is when (mal)nutritional acrocyanosis is misdiagnosed as raynauds. But with weight gain (and/or cessation of purging) they both resolve.

      • Dr Kitty

        True.
        Also teenage boys in the middle of growth spurts who get head rushes and palpitations.
        Not POTS, just a vascular system that struggles to keep blood flowing to the brain of someone who was four inches shorter last month, and has an excellent compensatory mechanism by increasing the heart rate.

        • BeatriceC

          My middle kid, who seemed to grow an inch or more a month over the span of about 9 months had all sorts of crazy symptoms during that time. His growth has slowed down (he only grew a half an inch for each of the last two months). His doctor ran all sorts of tests, including an MRI for head injury because of the sports he plays, but nothing came out conclusive. What you posted actually makes sense in hindsight, but neither I nor his doctor ever thought about that.

    • Sue

      We seem to be in an era where every symptom needs validation by a medical diagnosis. If you can’t get it from conventional medicine, some woo-meister will happily sell you a diagnosis, complete with “remedy”.

    • AnonymousPatient

      Ehlers Danlos, to go with POTS. It is a real thing, and the theory that hypermobility early in life could lead to fibromyalgia type symptoms in midlife is fascinating and plausible. However it is being diagnosed every which way and blamed for everything from the most minor personal quirks that don’t need medicalizing up to life-threatening weird symptoms almost certainly caused by something else. And it has become a wastebasket for women patients perceived as whiny and needy, too. I made the mistake of mentioning to a doctor that a relative had been diagnosed with it and now I can’t get the damn thing off my chart and every starry-eyed resident demands to hear more about how I must be suffering.

      • Dr Kitty

        There are a subset of fibromyalgia patients who are somatisers and enjoy the sick role. They kind of ruin it for everyone else.

        I know at least one rheumatologist, if they have a cheerful, upbeat patient with chronic joint and muscle pain will investigate exhaustively until they find another diagnosis, because “those types of people don’t get fibromyalgia”.

        • Mishimoo

          That’s why I hate telling people I have it. As soon as I use the ‘F’ word, people either switch off or think I’m a drugseeker. I understand it, I just don’t like it; especially when they try to use it as a reason to disregard my other health issues.

      • Gene

        So, I actually have mild classic EDS. Diagnosed a dermatologist decades ago when I bitched about a scar. We can trace who has it in the family because it is autosomal dominate. And we may have our personality quirks (does EDS make you BS intolerant?), but it’s more of a “huh, neat” than excuse. But it’s lots of fun when some teenage girl (and its ALWAYS a girl) lists EDS as a prior diagnosis and I respond, “oh, me, too. Which type?” As I bend my fingers backwards.

        • Mishimoo

          My mother has decided she has it and is currently attending a support group. It’s mildly amusing to note that she openly admits to “not being flexible”, has rather hardy skin, and has never experienced any dislocations or subluxations but still insists that she definitely has EDS.

          • SporkParade

            Subluxation is a real word? I thought it was made up by chiropractors!

          • Mishimoo

            I can’t blame you, they do like to blame it for everything! I was so annoyed when I found out that is the basis of their treatments and that people buy it. Subluxations are really annoying, but they’re not why I have health issues, they’re caused by my health issues.

          • SporkParade

            So what *does* it mean? I’m too scared to Google it.

          • Mishimoo

            It’s a partial dislocation of a joint, which for me, resolves easily. Either it pops into place properly or I put it back in. Small bit of residual pain for a little while, but not terrible. It appears to contribute to osteoarthritis in the long term due to the extra stress on the joint.

          • demodocus

            Any joint? interesting

          • Mishimoo

            The weirdest one I’ve done is waking up with one of my collarbones out of place. The most painful one was my hip, though I burst into tears because I had failed at sitting, not because of the pain.

          • Jenny Higgs

            Asking google to define the word returns it as a partial dislocation and uses an example sentence where it’s associated with a fracture.

            From what I can tell from a quick google run – it’s where the broken limb bends the wrong way.

            But then I consulted with Wikipedia and wiki felt I should know about radial head subulaxation – a.k.a. Nursemaid’s Elbow.

    • Allie

      I see this in my work as a personal injury lawyer. Certain diagnoses come into fashion and go out again cyclically. Last year everyone and their Aunt Minnie had a concussion. This year, concussions are passe and everyone has PTSD. Not sure what factors contribute to the “trending” of certain illnesses or conditions. With concussions, they’ve been all over the news due to recent advances in the field and concerns around sports figures and young athletes. This year, everyone seems to be traumatized by something. Sorry I sound a bit jaded. It’s just because I am : )

    • BeatriceC

      I have a number of food allergies, and one of them (tomatoes) is incredibly severe. I stopped eating out because of the eyerolls I’d get from restaurant staff when I’d say “no tomatoes please, it’s an allergy”. I had one too many instances of leaving restaurants in an ambulance because the staff at most places just don’t take allergies seriously anymore. I’m convinced that’s because they’ve just become jaded from way too many people claiming “allergy” when they really just don’t like something.

      On the other hand, I know at least one bartender who will never make that mistake again. I was eating in a restaurant where a good friend is also a bartender, but one of his coworkers was working that night. She blew me off and didn’t alert the kitchen that the no tomato request was for an allergy. I had to be intubated by the paramedics on the floor of the bar. Later I found out a couple things. First, the chef, who knows me was PISSED that he wasn’t informed of either the fact that a customer said “allergy”, and the fact that it was specifically me. He had a special procedure specifically for me because of just how little exposure will trigger anaphylaxis in me (I ate there often enough for him to know that). Second, that bartender who blew me off was of the opinion that “allergies aren’t as bad as people claim, if they’re even real”, but was so traumatized by watching the paramedics work on me that she will never, ever make that mistake again.

      • Gene

        Real allergies are scary. Anaphylaxis is no joke. My mother can’t even be exposed to cooking fumes from shellfish. Benihana was, umm, fun.

      • Gatita

        Do you carry an Epi Pen? I hope so.

        • BeatriceC

          I carry two, as that’s how much it takes to keep me breathing long enough for rescue to get to me.

    • Mishimoo

      This is why I stay out of the spoonie tag on Tumblr, it’s just too frustrating. Especially when one of the most common tips for (self-diagnosed) POTS is “Drink soy sauce!”
      Ummm…I’ll just stick with my coffee, thanks.

      • Gene

        Eat Fritos!

        • Mishimoo

          Ahahahaha yes, that was one of the other ones I saw. Along with someone being very angry that I ‘stole’ their thing when I wrote about not being sure if I had the start of a virus or a flare.

  • Green Fish

    Son was born with a tongue tie. His tongue was heart shaped, even when he wasn’t trying to stick it out or move it.

    The pediatrician at the hospital saw that and told us that it looks like a pretty severe tongue tie but he wouldn’t recommend to do anything about it as in his opinion tongue ties were over-diagnosed and over-treated.
    So we didn’t do anything about it.
    And son had trouble drinking, even from bottles, for several weeks until we decided to get a second opinion. The oral surgeon was shocked that nothing had been done, and cut the tongue tie. He used a thing that looked similar to scissors, the procedure took about 5 seconds and 1 drop of blood was seen.
    After that son could finally drink properly, put on weight and things got better.

    That’s my “anectdata”.

    In the end I would like doctors to just carefully look at the baby at hand and not consider a “one size fits all” approach (cutting all the tongues) but also not shying away from a diagnosis just because he/she thinks that the others are over-using it.
    You know, a scientific approach considering the data they see in front of them.

    • demodocus

      Of course! Dr. T’s point was that in some cases (like your son’s) it is important, but apparently a lot more people are getting it done than actually need to.

      • Green Fish

        Yep, and I agree with Dr. T there.
        What I wanted to point out is that there seem to be doctors, like the one I encountered, who apparently so much want to stay woo-free that they start to overlook the few real cases that exist. So babies even suffer when people fight against the woo.
        And all of this makes me a bit sad.

        But I might be emotional today anyway. I’m at 38+0 today and have a bad cold with cough and earache and things are just exhausting.

        • Who?

          Hate those days. Hope you feel better soon.

          • Green Fish

            Thank you.
            Sadly things got worse over night.
            My throat is so swollen that I nearly can’t swallow and the fever is making my circulation wonky.
            I only got very little sleep because I’d either swallow which would wake me up for being painful or I wouldn’t swallow because of my obstructed throat which made me salivate everywhere.
            That in combination with either sweating or shivering of cold was not restful.
            Not sure what to do but this is horrible.

          • An Actual Attorney

            Not a doctor, but it does seem you should go find one. That sounds awful!

          • Green Fish

            Only option yesterday would have been the emergency room in the next hospital. And I couldn’t see myself managing that. So I decided on a phone consultation and then having my husband get the stuff they recommended.
            Things are a bit better now but still far away from “OK”.

          • Who?

            Hope you can get to the doctor soon!

          • An Actual Attorney

            Hope you are on the upswing.

        • demodocus

          I’m also hormonal, 6 months along, and prone to misreading. Feel better soon

    • SarahSD

      I had an anecdotal experience similar to yours. I diagnosed my daughter’s tongue tie, which was so apparent and obviously heart shaped that it caused me to ask a nurse, “is she tongue tied?” before I had heard much about the phenomenon. Fortunately for her, she did ok in gaining weight in the first 10 days or so – probably because I had abundant supply – but I was so bruised from her gums clamping down on me that I dreaded every feed. The doctor had us wait until 10 days or so before having us come in to do the procedure. They clipped with a scissor-like instrument, there was a little blood, one pissed off cry, then she nursed and fell asleep. We didn’t have trouble with healing/fusing and didn’t need any “revisions”. She didn’t fuss any more than usual in the days afterward. Nursing felt better for me immediately and it’s hard for me to believe that my experience was a result of a placebo effect. It’s possible nursing would have gotten less painful eventually, and since it wasn’t preventing her from getting milk, maybe it was selfish of me to have it done. Maybe I should have toughed it out, switched to pumping or formula rather than have my baby undergo this surgery? I really wanted to nurse at the time, and looking back, I enjoyed nursing and am glad we did the frenectomy. But if I had another baby with tongue tie who was not herself suffering because of it, I’m not sure I would make the same choice, because nursing is not as important to me as it was the first time around.
      On one hand, I think my daughter was a “classic” case where frenectomy likely would have been indicated anyway. On the other hand, because she was gaining weight and getting enough milk, and it was only me that was suffering, I’m now questioning the decision. Did I choose do it out of a selfish and misinformed commitment to breastfeeding?

      • AirPlant

        I am an internet stranger, but I think you did the right thing. Your needs are just as important as your baby’s and as long as your baby’s health isn’t on the line, your desire to breastfeed is not something inconsequential. The procedure is quick, there are few complications, it relieved your pain, and facilitated your ability to feed your child as you chose to.
        There are lots of choices that parents make that disrupt their children’s lives, and a needed tongue revision performed by a competent medical professional is not even something that they will carry into the next week. IMO things only get dicey when you are talking about revising a tongue that shows no evidence of a tie.

        • SarahSD

          Thanks, internet stranger. This post is bringing me back to the days leading up to the appointment and the appointment itself, when I tormented myself over whether to go through with it or not. The Dr. telling us that this type of tongue tie could cause speech problems helped me rationalize it. Then when it went so well for both of us, that also helped me feel ok about the decision.

          • AirPlant

            Parenting decisions are hard, and it is so hard not to overthink even when there is nothing to be done about it. It sounds to me like you are doing just fine. You are making good choices and doing right by your kids.

          • BeatriceC

            For what it’s worth, from another internet stranger, I also agree with AirPlant.

          • demodocus

            My formula-fed nephew also had a pretty strong tongue-tie that the doc recommended clipping for possible speech issues. (Or as my sister says, get rid of his (nephew’s) forked tongue.)

  • cookiebaker

    When I had my most recent baby (my 6th), we were having an epic struggle with breastfeeding despite my extensive nursing experience from her siblings. I opted to visit an ENT to have her evaluated for a tongue tie. I wanted to know if she had one, but even if she did, I was extremely hesitant to put her through surgery.

    The ENT evaluated her thoroughly and said she did not have any kind of tongue or lip tie. However, she completely shocked me by offering to do the procedure anyway if I really wanted it done. WHAT?! I said no, of course, I wasn’t putting my baby through unneccesary surgery! Her offer did make me wonder how many mothers must have demanded the procedure from self-diagnosed ties that the ENT just does it to placate parents?

    I never found out why my baby couldn’t nurse. She was unable to transfer milk despite a great latch. My milk supply couldn’t be maintained with a pump, it was steadily tanking, so we’re profoundly grateful for Similac.

    • nomofear

      It’s kind of sad that breastfeeding isn’t a subset of real medicine. Of course, if it was, lactivism might get worse, so who knows what Pandora’s box that would open. Anyway, the reason I say all that is my first daughter would spend an hour plus nursing, then go at it again an hour later. My nips were torn to pieces. Several lac consultants shrugged and said her latch is good and she’s gaining weight (she actually never lost any weight, even as a newborn, and hung in 90th percentile neighborhood), you’re fine….clearly I’m not fine, I’m bleeding and have had mastitis twice! Finally my nips were on the road to healing, and I made an appointment with a different lac consultant to go over pumping, since I was going back to work about a month later. She saw the state my nips were in and was appalled. “They should NOT look like that at eight weeks! You shouldn’t have had mastitis twice! I can’t believe you stuck with it. I would have quit! I’m so sorry no one got this figured out!” (I may have cried in relief!) Turns out, my daughter had NO chew reflex. I mean, none. And when we went to the occupational therapist, they found other mouth weaknesses. A few weeks of doing simple exercises with her a few times a day, and she was fixed. They said that fixing it then probably avoided speech impediments and eating issues later, too. Point is, if breastfeeding was an actual medical field, maybe her issues would have been found at birth. Maybe I wouldn’t have had mastitis at all. Maybe other women running into odd issues wouldn’t hit a wall of mystery. At the same time, I wouldn’t want it being an actual science to become a reason to harass formula feeders that much more.

      • Roadstergal

        More knowledge is always a good thing, IMO. If the true incidence of various maternal and/or baby factors that interfere with breastfeeding were known… well, then, they’d blame it on GMOs and vaccines, but at least some more realistic numbers would be out there.

      • SarahSD

        My baby also brutalized my nips while gaining weight. For us the tongue tie clipping did the trick. She had “classic” heart-shaped tongue, and the ped said it might cause speech problems in addition to the nursing problems I was having, which helped rationalize it for me.

        • nomofear

          Oh sure! It’s definitely a thing that needs to be addressed sometimes. Frankly, I’m grateful that it was not the fashion du jour five years ago, because I’d bet they would have tried to sell us on it, and it wasn’t the issue at all for our daughter – but who knows, we may have tried it out of desperation.

          • SarahSD

            Ha – my daughter is nearly 5 – so it was 5 years ago for us as well. Not sure how faddish it was here in 2011, but I’ve certainly heard more about it since then. I just attributed it to being around more people with babies, in online groups, etc. I wonder incidence of the procedure has increased a lot in my neck of the woods (Southern California) since then. I wouldn’t be surprised if it had already become pretty widespread in crunchy circles here.

      • meglo91

        Hear, hear. I’m constantly amazed at the amount of voodoo, old wives’ tales, and crappy science we tolerate in the women’s health field, which definitely includes breastfeeding.

        • demodocus

          Ugh. Don’t get me started on old wives’ tales. A close friend’s mother is filling my ear with ’em lately. Normally fairly sciencey, this is one area she gets stupid. SHe’s also decided I’m not due until 3 weeks after the doctors say.

          • Dr Kitty

            Given that you know the exact date when embryo entered uterus, how on earth did she manage to add 21 days to your due date?

          • demodocus

            I think she’s counting from the implantation date, not the start of my last period. I can’t convince her otherwise. *She* was positive her daughter would be born 2 weeks after her given due date (39 years ago!) and since C was indeed born exactly when her mother predicted, now the mom is convinced she knows more than all the nurses and docs.

  • Angharad

    Completely OT but I’m biting my tongue after my coworker just said “Humans haven’t needed helmets for any of the last 6000 years, so why would we suddenly need helmets now?”
    This same coworker has made similar statements in the past about car seats and seatbelts. Surprisingly he’s pro-vax.

    • Beth

      well, I’d agree with him that we didn’t need car seats or seat belts for most of the past 6000 years. Just the last 100 years or so.

      helmets would have come in handy though.

      • Angharad

        Haha, I guess he does have a point about the past, although I wouldn’t use it to justify driving around with unsecured toddlers.

      • Zornorph

        Ben-Hur could have used a chariot belt.

    • demodocus

      Um, helmets are new-fangled?
      https://en.wikipedia.org/wiki/Leonidas_I

      • indigosky

        That’s what I was thinking. Helmets have been around as long as there has been recorded history. I’m sure there were helmets before that as well.

    • Roadstergal

      I can’t help it, I burst out laughing at the mental image of a Ken-Ham-style scene with pre-historic men (of course, men) riding dinosaurs with saddles and helmets.

      • MaineJen

        If we were not meant to wear helmets, god would not have made helmets that perfectly mold to our heads!!

        • Roadstergal

          “Our heads were so intelligently designed to fit into helmets!”

    • Daleth

      Your coworker needs a remedial English course. “Not needing” and “not having” are two different things.

    • namaste863

      I hope he’s filled out his organ donor card.

      • Deborah

        Well anything from the head region won’t be of much use.

    • Allie P

      Ah, cute. He thinks humans have only been around for six thousand years. Like, since Adam and Eve.

    • guest

      Uh….the skull is basically an interior helmet. We’ve just lately realized we can supercharge it with an exterior helmet on top.

    • Dinolindor

      I used to work at a small arms and armor museum. Off the top of my head, the oldest helmet *on display* was a gladiator helmet from Ancient Rome. I’m certain we had older ones in storage as well. Then there’s all of the medieval and Renaissance era helmets, and 19th-century reproductions in the collection. And this is just material evidence found at a small museum, not even counting general historical knowledge. Humans have worried about protecting their heads for a long time, man.

  • “Babies are being cut on the theory that breastfeeding is always perfect and, therefore, it is babies who are “broken.”

    Bears repeating. As does the point made below that these are (presumably) the same people who can’t bear to give their perfect babies a vitamin K shot.

    Sort-of-OT-but-sort-of-not: my 6-month-old has hypospadias. He was scheduled to have it repaired next week but we somehow got bumped from the surgeon’s schedule, so I’m hoping we can get back on the schedule soon.

    I have been reading as much as I can to prepare to care for him during his recovery, and I was surprised (though I probably shouldn’t have been) to find that there is a flavor of Internet woo that recommends NOT correcting this! Apparently it constitutes non consensual genital cutting or something??? I have to wonder how much overlap there is between the hypospadias-is-a-variant-of-normal people (a subset of the intactivists) and the people getting tongue and lip ties clipped.

    • MI Dawn

      I’d suspect that too many of the idiots don’t *really* understand what hypospadias is, or have only seen very mild variants where the urethra isn’t too off. When the urethra ends about mid-penis…well, tell me that’s not a problem.

      I also suspect it’s related to the ZOMG circumcision is just wrong, non-consensual genital cutting groups, who don’t even accept medical necessity for a circ (I’m not talking newborn, either – I have a friend who had to have it done at age 18 for health reasons, and the intactivists tore him apart. He should have just lived with all the pain he had, with erections sending him to his knees in agony because circumcision is *always* wrong).

      Good luck to you and your baby boy, and may the recovery be swift.

  • Madtowngirl

    I had this done on my daughter in the hospital because the lactation consultant was adamant that it would help her breastfeed. We’d already been having trouble. I could tell that the pediatrician was reluctant (the LC said I’d probably have to push her), but she agreed to do it without us pushing. In hindsight, I suspect she knew it was unnecessary, but was tired of arguing with people about it.

    It didn’t do a damn thing to help my daughter breastfeed. I wouldn’t say I regret it, persay, because I guess it may have impeded her speech in the future, but I really wish I had known more about it beforehand. I wouldn’t have agreed to do it until she was older.

  • AirPlant

    There is a story that I seem to be constantly hearing variations on. Mom is having troubles, some combination of 18 different pediatricians, dentists and lactation consultants find nothing wrong, until #19 diagnoses said baby with some kind of random ten word long tie classification that nobody else even knew existed. The baby is “fixed” but alas, too late because the actual problem did not improve and the baby’s latch is set in stone and now mom is raising awareness of this grievous oversight so that it never happens to any mother ever again.
    I don’t want to be a bitch, but I feel like somewhere in there is a logical fallacy.

    • Madtowngirl

      I feel like this is exactly what happened to me. My daughter was very clearly getting nothing from me after the initial colostrum (she was preterm, so the blood sugars were proving this), so of course the problem was with her latch! It couldn’t possibly be that I wasn’t producing anything (just because I wasn’t pumping anything didn’t mean baby couldn’t get anything)! I mean, she only had a “little” tongue tie, so it will help.

      It did nothing.

      • AirPlant

        You see it in all kinds of things. At some point a problem or solution becomes trendy and next thing you know everyone and their kid has it.
        There is no shame though in trying to do what is best for your kid, it just sucks that the diagnosis was wrong.

  • Charybdis

    Don’t forget about the one midwife who would do a “sweep” with a sharpened fingernail after the birth of the baby…

    • nomofear

      Omg

    • AA

      ” (On the other hand, we’ve heard of lactation consultants who have, in a
      pinch, used a sterilized fingernail to slice the frenulum).”

      http://www.bestforbabes.org/booby-trap-docs-who-wont-snip-tongue-tie-thousands-of-breastfeeding-moms-babies-suffer/

      Next time I go to the dentist, I’ll ask the hygienist if they sometimes scrape off plaque with a “sterilized fingernail”

      • Charybdis

        That autoclave is rough on the hands and manicures….

      • Angharad

        Is that even possible? I’m no expert but the procedures I usually think of as sterilizing equipment would not work on fingernails (high heat, boiling, harsh chemicals).

        • Charybdis

          Nah, they dip the fingernail into breastmilk before slicing and dicing away.

        • Monkey Professor for a Head

          Plus, if they’re keeping a fingernail long enough to slice a frenulum, how the hell are they maintaining proper hand hygiene.

          • Deborah

            Long and/or decorated fingernails are a performance management issue where I work as you know, infection control is kind of one of those things professionals take seriously.

      • Amy M

        Did you see the suggestion that you politely and diplomatically educate your pediatrician?

      • Daleth

        WTF is a “sterilized fingernail”? Did she put her fingernail in the autoclave?!

        • demodocus

          probably dipped it in rubbing alcohol or something.

      • MaineJen

        “In a pinch.”
        Translation:
        “Oh, I’m just here for a quick postnatal checkup. I see you’re having trouble breastfeeding. Must be a tongue tie! But I seem to have forgotten my…erm…instruments. Ah, well. I’ll just pop into the bathroom and see if you have any nail clippers and rubbing alcohol handy. What? Oh no, we don’t want to bother the doctor about this. I know just what to do. Be back in a jiff!”

      • Gatita

        Are the LC’s asking permission to do this or are they just ramming their finger into the baby’s mouth? Because if anyone tried to do this to my kid I’d kick their fucking ass.

  • Zornorph

    This is an especially interesting question considering the position most lactivists tend to take that circumcision is ‘mutilation’ and that they don’t even want to give their baby a shot on the day he’s born because it might harsh his mellow or something. But they are happy to turn their LO into Gene Simmons of KISS if that’s what it takes to establish the sacred breastfeeding relationship.
    I don’t know the answer to this – other than for breastfeeding, is there any other reason a tongue tie would be a problem? Would it cause a lisp or make it hard to suck on a straw or anything?

    • Sullivan ThePoop

      Plus, as I have said before, I have a friend who is a pediatrician. She says she has been seeing a lot of children with speech problems that came from unqualified practitioners clipping tongue ties in infants.

      • Madtowngirl

        That’s actually an underlying fear of mine now. As I said above, if I hadn’t been so entrenched in the woo, and quite frankly, gullible, I would have waited until my daughter was older and actually displayed speech difficulty. I do take small comfort in the fact that it was done by a pediatrician, so hopefully it was at least done properly.

        • Sullivan ThePoop

          I am sure it was done fine. I didn’t mean to give you any anxiety.

          • Madtowngirl

            Oh, you didn’t give me anxiety, I already had it. 🙂

        • demodocus

          Some of us just kind of suck at talking clearly.

    • Charybdis

      But the circumcision, shots and whatever other things they are violently opposed to do not directly involve them. Getting the baby to latch and successfully breastfeed DOES involve the mother, so of course she wants it to work and will move heaven and earth to Make It So.

      The mother is directly involved, so she does not want HER experience diminished. Kind of like the birth. HER experience and narrative are WAY, WAY more important than the baby’s, who is just a prop in their Life Drama as played out on teh interwebs.

      • Beth

        Isn’t it fascinating? According to these people, we’re designed to give birth, our bodies aren’t “broken” etc. Our breasts are perfectly designed to deliver the customized nutrition our baby needs at any moment in time, provide perfect antibodies for any infection, etc, etc. How dare anyone suggest that either of these processes might not work well or might need medical help.

        But the baby’s tongue? Oh, yeah, that can totally be broken and need a surgical procedure. Happens all the time.

        The same mother nature goddess that made birth, vaginas and breasts so foolproof and perfect was apparently having an off day when she designed baby tongues.

    • Amy M

      I think it can be a legitimate issue that can cause speech problems, but its unlikely that that is as common as the lactivists try to make out.
      Also, if a tongue tie were that severe, would the baby also have issues with bottles? (I don’t know, I’m wondering).
      Also, I’ve seen people online claiming baby had a tongue tip AND lip tie, like its amazing the kid could even open its mouth.

      • demodocus

        My son does have a lip tie (ped confirmed, i asked out of curiosity, and it was a pretty dramatic one). And boy did it bleed when he accidently broke the bottom edge on an apple. Some of the online people also think lip ties interfer with bfing.

        • AirPlant

          I have a fairly pronounced lip tie and a speech impediment and they are connected in a way. Still breastfed like a champ according to my mother so…

          • demodocus

            i believe it, though in my toddlerboy’s case, he shows no signs of speech impediment.

          • AirPlant

            The impediment isn’t so much caused by the tie as the misalignment in my teeth caused by the tie. I find it difficult to voice a lot of frontal consonants so my speech ends up being a bit less crisp than I would like. Nothing major, but nothing that speech therapy has been able to fix either.
            If your kid’s teeth are fine he probably won’t have any issues.

          • demodocus

            that’s probably a bit annoying. I was in speech therapy myself for years. Started before i lost any hearing, and then that really messed me up, lol.

        • Amy M

          Yeah, I wasn’t trying to suggest lip ties aren’t real, but that a number of the women who want to breastfeed so badly and are having trouble, seem to have babies whose mouths are all knotted up. Like maybe they are self-diagnosing, because they can’t come up with or accept that breastfeeding might not be working for some other reason.

      • Sarah

        If it doesn’t loosen, tongue tie can prevent the ‘rolling r’ sound made by vibrating the tip of the tongue, so rr comes out as r in Spanish for instance, this can alter meaning. So if it’s a really severe tie, it’s probably worth cutting for that reason. If you get it cut later in life, you may then need speech therapy to relearn how to make some sounds with the untied tongue, so there are benefits to cutting it early. The risk of complications, while not zero, is very low with frenulotomy.

        • Roadstergal

          I have no tongue or lip ties, and as hard as I have tried over my life so far, I cannot roll an R. 🙁

          • AirPlant

            I read somewhere that if you don’t do it regularly before 5 or so you physically lose the ability for the rest of your life.
            Human bodies are so weird!

          • Roadstergal

            Faaaak.

          • Poogles

            Hmm, I never had any reason to roll r’s until I started taking Spanish in 7th grade, but I’ve always been able to do so with no problem after that *shrugs*

          • Sean Jungian

            Yeah I can do it when the stars align but usually I just sound like a cat coughing up a hairball.

          • BeatriceC

            I can’t roll my R’s to save my life, which sucks when you live in an area that’s predominantly Hispanic and you’re trying to speak Spanish. However, I can make that throaty, hacking sound that’s common in French like a native. One of my old bosses spoke French as one of her 4 native languages (born to parents of two different nationalities, in a country that spoke a third language, with a nanny that spoke a fourth), regularly commented on my excellent French accent when I used her to practice my spoken French. Not that I can speak the language anymore. I pretty much forgot everything as soon as I stopped using it.

          • FormerPhysicist

            Me too! German was a much better second language for me than Spanish. I have no trouble with those sounds.

    • Angharad

      It probably would depend on how severe the tie is. The first time I took my daughter to the pediatric dentist she asked if I had had trouble breastfeeding because my daughter apparently has a fairly pronounced tongue tie. Leaving aside how intrusive the question is, she was right. I asked if we needed to do anything about it and she said it was unlikely to cause issues with anything other than breastfeeding, which I had already stopped by that point.

    • Roadstergal

      A good friend of mine has a major tongue tie – she can barely stick the tip of her tongue past her lip. She speaks several languages fluently and can do an impressive variety of UK and US regional accents (English is not her native language), sings beautifully in a semi-professional choir (she sang a capella at my wedding), and seems unencumbered by the tongue thing.

      It’s true that she forms some sounds differently than the ‘standard,’ but the outcome is the same.

      Anecdote! Also, she was bottle-fed (mom had planned to from the get-go).