Make your own free website on
Denise Punger MD FAAFP IBCLC
Letter to a Pediatrician I
What we do
Making an Appointment
Insurance Plans
Curriculum Vitae
Breastfeeding Task Force
Join the Task Force
My Pregnancy and Birth Stories
Concern about VBACs
Breastfeeding Photos
Favorite Links
Contact Me/ Guest Book
Family Photo Album
Pregnancy Photography
"Breastfeeding Inspiration
and other quotes from my kids"
Parenting Articles
Breastfeeding Success Stories
Mother to Mother
Health Products
Occupational Medicine

Dr. _______,

It has come to my attention that there has been some confusion about 
Baby A.L,
a consult that I saw a few weeks ago for tongue-tie. I'd like to clear
this up.

A.L. was brought to my attention by mom's child birth educator. She
informed me
that mom asked your nurse for a consult to see me at the medicenter. It was
explained to me that your office nurse stated that your office never refers
to the medicenter.(Is this really, true?) The child birth educator asked me
what the proper procedure was to get a breastfeeding referral, for suspected

I had an opportunity to meet with Dr. Robbins [CMO, Vice President of Medical Affairs] to see how I should go about
getting breastfeeding referrals.  Dr. Robbins suggested I call you directly.
With moms permission I did call to speak with you about the anticipated
tongue-tie clipping. Your office manager sped things up and gave us a
referral number. For the babies sake, I wish now I had talked to you

Mom brought the baby in. I observed how the baby was latching prior to doing
anything else and noticed this baby had a disorganized suck and tongue-tie.
No wonder mom has so much pain with breastfeeding.

Regardless of the frenotomy, it was apparent to me that this baby needed
therapy with a speech pathologist who is trained in infant feeding problems.
As you know I recommended a Cynthia Andric to mom. This therapist has
experience working with me s/p tongue-tie. It is my impression that your
office staff thinks the frenotomy I did caused the poor suck.

It is, also,my understanding that the office staff has a problem with me
performing a
frenotomy. If the staff has any questions about my credentials to do a
frenotomy, Dr.
Robbins or Chris Freidman in Risk Management or the A.A.P, itself, can be
I went through the proper channels at Martin Memorial to have privileges to
do a frenotomy. Current information about frenotomy shows that delaying the
procedure leads to a down hill spiral of breastfeeding and sucking problems.

It is unfortunate this mom did not get the referral much sooner.

It is my impression that your staff actually expressed their dissatisfaction

with my judgement, evaluation, and procedural skills to the mom and the
therapist I recommended. Specifically they said, "This office will never
refer to Dr.
Punger again." Are you aware that your staff is making those calls for you?

Additionally, your staff has made a big-deal about who to refer the therapy
to. The staff made a referral to a speech therapist who I have been told
admitted that her knowledge in infants s/p frenotomy is limited and mom
should go to the experienced therapist I suggested.

Your staff needs an inservice and update on frenotomy and tongue-tie. May I
suggest a video by Evelyn Jain MD. The Lactation Consultants at MMHS have a
copy of the video. Dr. Jain and Brian Palmer DDS, both specialist in
ankyloglossia, also have websites explaining tongue-tie, which are easy to
find in a search and I often recommend to patients.

I am only informing you of staff problems. But if you have any problems with
my skills or credentials feel free to contact me directly, if you would like
to discuss this case with me or any other breastfeeding concerns let me
know. I'd be happy to help. The patients need us to openly communicate.

Denise Punger MD FAAFP IBCLC
International Board Certified Lactation Consultant
home- number

Visit our
Don't forget to update your bookmarks!
Denise Punger MD FAAFP IBCLC
4640 S. 25th Street
Ft. Pierce, Florida, 34981
Copyright 2005