I'm writing to ask for ideas and support for the following situation:

Mother initially contacted me (as a LLL Peer Counselor) on a Tuesday (11/1)
when baby was 4 days old with c/o sore nipples and sleepy baby.  Gave her
information on both and arranged to visit her the next morning.  Our
hospital has a policy to checkup on breastfeeding babies at 1 week and
formula fed babies at 2 weeks.  All checkups are scheduled for Wednesdays.
The parents were told that all appointments were full for that week so they
could bring baby in the following week (when he would be almost 2 weeks
old).

At my home visit, I noticed that baby appeared very jaundiced and was nearly
impossible to wake up.  Mother was very concerned about weight gain (pees
and poops were fine) and what was to her very unnatural behavior for her
baby.  This is her 3rd child.  She had been very determined and aggressive
about making sure baby ate, but by day 5 she was at her wits end.  I called
the Peds clinic and arranged that she bring the baby in to be seen that
afternoon.  Bili level was 18 and Ped Dr instructed parents to give formula
via finger
feeding.  (Instructions on finger feeding to be given by myself)

I called the mom several days later to find that while baby had "woken up",
feedings were still very painful and time consuming.  Nipples were cracked
and bleeding.  She was "gritting her teeth" at each feeding and was again on
the verge of giving up.  I arranged to visit them the next day along with my
colleague to assess latch and suck.  I was unable to do this earlier since
the baby wouldn't wake up.

When we visited we noticed that the baby had an extremely short frenulum --
just barely under the tip of the tongue -- typical heart shaped tongue.
Aha!  We provided the mother with information on short frenulum and observed
latch and positioning.   We gave information on positions that worked best
for babies with short frenulums, nipple care, and arranged to have breast
shells delivered to her home.  We talked to the Pediatrician who agreed to
see the baby again, when the parents could "make an appointment".  She found
it hard to believe that the baby had a short frenulum since she had examined
the baby herself at his 1-week visit.  I provided the pediatrician with
copies of info on frenotomy and research abstracts [obtained thru a search
of the Lactnet archives :-)  ]

The parents made an appointment and it was documented that the baby had a
short frenulum and the Ped recommended that it be clipped.... The
Pediatrician said she would call the ENT doctor (she couldn't do it herself)
and make arrangements.  The parents waited and didn't hear anything back, so
after the holidays they called the Ped back and found out that the ENT
doctor told the Ped that he didn't "do clipping" on babies less than 6
months old.  The Ped told the father that when she mentioned the effect it
was having on breastfeeding the ENT doc wasn't convinced it was a reason to
clip on a child under 6 months.

That is where it stands today.  The mother's nipples are STILL cracked and
bleeding.... she is determined, but
losing heart.  She called me tonight to tell me how things stand.  She is in
pain and doesn't see an end.  She is frustrated at the blase attitude she is
getting from the doctors.  To her it is as if her pain is irrelevant and
breastfeeding not *that* important.  She says that she feels the message is,
'Either stop whining, or if it's *that* bad, just give formula'.  She says
breastfeeding is not as painful as it was, but it is still painful and VERY
time-consuming....time she has little of with two other children demanding
attention.

The baby is now almost 5 weeks old and happy, alert and gaining weight (due
in large part to the determination and consistent efforts of his mother).
Actually, I think the fact that the baby *is* gaining and "doing well"
despite the tongue tie is leading the doctor to believe there is no problem.
I don't think anyone is truly crediting this mother with the extraordinary
efforts she is making on her son's behalf.  The consensus seems to be that
since he is gaining they should "wait & see" if the frenulum will recede on
its own.  No regard for the mother's nipple trauma and pain.

Is there valid reasoning behind this *6-month* rule?  Any suggestions on
what to say and how to say it to this ENT? (Assuming that I get the
opportunity.)  The parents plan to at the very least try to get an
explanation from the doctor.  He refused to even see the baby!  The mothers
lament was to the effect of, 'On the one hand they tell us over and over how
important it is to breastfeed and on the other hand they (the docs) tell us
it's not important enough'.

This is an overseas military hospital.... there IS no other choice as far as
I know... American wise, that is.  I do plan to check around and see about a
Korean doctor who will do a frenotomy.... but I feel like I'm out of my
depth there.

Suggestions, advice, words of wisdom will be appreciated.

Regards,

Cindi Swisher, RN
Yongsan Army Post (Seoul), South Korea
Where the gas masks that the Army is issuing for babies (and yes they ARE
issuing gas masks!) have pacifier holders and built in nipples for
bottle-feeding!

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