"Baby has a small tie that can't be treated"
I meet so many parents who have been told this, it seems to be popular at the moment. Parents I meet because of feeding problems; problems that are of course not being caused by that "mild tongue tie". Except they are...
Babies who might have reflux, colic or wind because they are either unable to make or maintain a deep enough latch at the breast/bottle, spending their entire feed sucking in air.
The resulting symptoms can be wide and varied, complicating diagnosis further. Some feed constantly, other sporadically; some reflux, vomit, spluttering or gulp, bobbing on and off when the milk ejection reflex (let down) is triggered or the bottle is tipped. Some gain weight whilst others don't and if baby can't organise co-ordinate their sucking and breathing fast enough, this is often misdiagnosed as "fast let down", or that baby needs a slower teat.
Some are told as their baby can protrude their tongue, it isn't restricted enough to cause problems; without considering that "pulling tongues" is really quite different to opening your mouth wide and brining your tongue forward to feed; or that you also need lift and sideways function as well as extension. Others are told the tie isn't impacting after barely a cursory look in baby's mouth, or a quick sweep under the tongue.
The other BIG problem with simply having a quick peek in a baby's mouth, is you can often confirm whether a frenulum is restrictive, but it's much harder to confirm insignificance the same way. In order to do so you have to piece together the signs and symptoms, watch the baby at the breast/bottle, assess their suck and what the tongue is actually doing during the feed. If there are significant indicators, a specialist who is competent lifting the tongue is needed to complete the picture.
Because problems caused by tongue tie, aren't caused by how the tie looks, but about how it allows the tongue to function (or not), and looks can be deceptive. A tie can be like a super thin wire, or slightly wider and diaphanous but still visually "tiny"; yet if it is tightly holding the tongue it doesn't matter if it's super thin or a more chunky number. Furthermore a tie can look insignificant from the front, but when assessed properly, one can find the frenulum runs back down the tongue, getting thicker and causing significant restriction further back.
"It is not always possible to predict which tongue ties will inhibit breastfeeding, as characteristics of the mother’s breasts also have an effect on such factors as milk transfer. The length of the frenum (or the apparent severity of the tongue tie) has no bearing on whether the baby will be able to breastfeed efficiently.
Mr Mervyn Griffiths found that: “…the thickness, shape and percentage length of the tongue tie were not predictors of success or failure. …This suggested that the function of the tongue (i.e. the symptoms themselves) produced by a combination of tongue, mouth and tongue tie is more important than simply the appearance of the tie.” (tonguetie.net)
Whilst cosmetically this may be the case, a tie anywhere down the tongue can significantly impede function, without causing any dramatic visual changes or pulling to a heart shape.
Regardless of where the tie is, a baby will still compensate with an alternative tongue action, which may (or may not) lead to problems. They may still fail to make a seal at the breast or bottle, pulling, slipping or gradually working their way back to a shallow latch.
Lastly one could also argue the "smaller" the tie, the more restrictive it is. Long, stretchy frenulums may not be restrictive whereas short, tight, small ties are likely to result in less movement. Does that sounds less significant to you?