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A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breast-feeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

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Tongue-tie can cause many serious breastfeeding problems and even lead to breastfeeding cessation. As the mothers’ stories listed in “When Tongue-Ties Were Missed: Mothers’ Stories” attest, healthcare providers often do not correctly identify when a baby has a tongue-tie. Assessing tongue-tie is essential. What should clinicians look for? Which professionals should be the ones identifying and identifying tongue-tie? Assessing tongue-tie is the focus of this article.

Attrition of exclusive breastfeeding is highest during the first 3 months postpartum. Timely management of breastfeeding in the outpatient setting through innovative models of healthcare delivery may increase its duration and exclusivity. Our goal was to examine the structure and function of physician-led clinics in the United States that specialize in providing outpatient clinical support for breastfeeding-related issues ("breastfeeding medicine clinics"). We posted a survey on Listservs of the American Academy of Pediatrics, American Academy of Family Physicians, and Academy of Breastfeeding Medicine. The survey collected information on (1) clinic and physician demographics, (2) visit characteristics, (3) referral and reimbursement, (4) clinical activities, (5) continuing education resources, (6) teaching/education activities, and (7) advocacy activities, of physician-led outpatient breastfeeding medicine clinics. Lead physicians from 13 clinics responded to the survey. Their clinics provided clinical care for time-intensive breastfeeding problems. The clinics we described that were in existence longer than 2 years appeared to be economically sustainable. Most physicians who had provided specialized breastfeeding support for more than 5 years reported that their income was commensurate with others in their specialty. Most physicians who provided specialized breastfeeding medicine care additionally provided primary care services within the same clinical setting. Further research into fiscal and organizational aspects of establishing specialized physician-led breastfeeding clinics is needed. The potential of such clinics in contributing to collaborative practice-based research, as well as medical student and house staff education, needs to be explored.