Firstly, if your baby is latching onto the breast well, there is no pain or any pain has resolved and your baby is gaining normally after your milk has transitioned, you do not need to worry about tongue tie. Not all babies need to have their mouths assessed by a specialist. The babies that I want as a Certified IBCLC Lactation consultant to assess for tongue tie are the babies that are:
not able to latch on to the breast or not able to sustain a latch on the breast
babies that are causing their mothers persistent pain or injury of the nipple
babies who are not gaining when they should or who are not gaining enough
When I do assess of these babies I want to do it in a calm, gradual way. I want to observe the baby in many different moments. For example:
when the baby is sleeping, where does the tongue rest when sleeping
when the baby is crying, what is the shape of the tongue when crying
what does the suck feel like when the baby sucks on my gloved finger
Can the baby stick their tongue out of their mouth
what is the shape of the babies tongue when it is moved
what does it feel like or look like under the babies tongue
All of these assessments take time and patience. I am not usually able to observe all of these situations in 2 minutes of assessment, it may take as long as 30 minutes.
There is a lot of discussion within the lactation consultant and pediatric communities about tongue tie and its over diagnosis. This is a valid discussion, as we do not want babies whose tongue is normally functioning to be released. I always have this discussion in mind if I feel it is warranted to even assess a baby for tongue. I am learning all the time on how to assess more accurately, more through and more research based. In the last 4.5 years I have been a working Certified IBCLC lactation consultant, I have sent 4 babies in for further assessment for tongue tie by an experience specialist. Many times before sending babies to these specialist I recommend osteopath treatment to first help improve the babies tongue mobility. I only forego osteopath treatment if it is an S.O.S. case where a baby is unable to latch on to the breast due to poor tongue mobility and that baby has many markers for an anterior tongue tie.
What I have realized over my years as an IBCLC and previous years as a Canadian Midwife, is that I must not take this responsibility lightly. That I must not fall in to the current pattern of over-diagnosing tongue tie and cause babies unnecessary pain. I am also grateful that I work in private practice, which enables me to take the time needed to assess slowly and thoroughly. I am also grateful that I am able to see many of my clients over many weeks to help see the larger perspective and spread out the support for women and their babies.