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Subject:
From:
"Catherine Watson Genna, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 16 Jul 2007 09:33:40 -0400
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I agree with Laurie Wheeler's suggestion to have a neurological consult 
for this baby. Babies with neurological conditions can have very 
uncoordinated tongue movements. Mostly the tongue lifts and drops, with 
a pumping/pistoning movement. Sometimes the baby does not respond to 
normal stimuli at all. If it's a neuro issue, gentle massage and 
stroking around and inside the baby's mouth can help draw the brain's 
attention to the tongue, and help the baby improve her tongue movements. 
There are several published strategies to do this, most have in common 
stroking the cheeks from tmj to corner of mouth, stroking the lips to 
encourage rooting, rubbing the outside of the gums from front to back 
repeatedly (3 times in each quadrant so the baby can anticipate the 
movement and start to follow with the tongue), and then stroking the 
inside of the cheeks and then the tongue. Midline stroking from tongue 
tip back to mid tongue is most likely to stimulate sucking movements, 
and then there's the old "walking back on the tongue" exercise, which is 
meant to simulate the direction of muscle activation during sucking.

I'd also feel under the baby's tongue. Sometimes this constellation 
(very little tongue mobility with a tongue that does not look tied) 
occurs with  a submucosal tongue tie, other movements seem normal (baby 
roots) but the tongue can barely move, except for asymmetrical lifting 
movements at the corners, one corner at a time. If there is a submucusal 
tie, you will feel a tight string in midline below the center of the 
tongue, instead of the resilient genioglossus muscle at the base of the 
tongue.
It can be snipped in the office, but bleeds a little more, because the 
fold of the floor of the mouth that must be snipped a little to get to 
the frenulum is vascular. I'm going to talk about our research with 
these sneakier tongue ties (submucosal and posterior) at ILCA. (Can I 
say this?, we don't get paid to present at ILCA.)

If it's a neuro issue, encourage mom to feed the baby her milk however 
the baby can take it, and continue offering the breast at least a few 
times a day. Tincture of time is amazing, one baby with a neuro issue in 
my practice first latched at 5+ mos, and was breastfeeding exclusively a 
week or two later.
Catherine Watson Genna, IBCLC  NYC

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