I also had a client a couple of weeks ago who presented with sore nipples
and a baby who was having difficulty latching, then nursing only in short,
frequent sessions. One look into the baby's mouth confirmed what a visiting
nurse suspected: tongue-tie. It was moderate-- attached midway on top and
bottom, though pretty elastic. Baby was able to extend tongue beyond
gumline.

We optimized positioning, which helped baby get a better feeding and
resulted in much less pain for mom. Mom and I talked about the "wait and
see" approach; we needed to see how much onger term improvement resulted
from our changes before making the judgment to pursue clipping. After a
couple of weeks, she decided that baby was indeed tiring from constantly
working against the frenulum, and her pediatrician readily referred her to
an oral surgeon. (That's a pleasant surprise around here!) The clipping was
done with a local anesthetic for which baby wasn't allowed to breastfeed for
about 45 min afterwards, but once he did, mom noticed the difference
immediately. She is so happy, says the remaining pain is gone and baby is
really tanking up now and spending longer at the breast. She wants to know
how she can make sure any future babies get taken care of right away!

This was one of those cases that could have been pushed to wait while baby
grows and frenulum stretches. However, based on criteria of how hard baby
was having to work as opposed to the moderate appearance of the frenulum,
timely action was taken that gave immediate positive results. I wish all my
cases could be handled by the interacting HCPs in such a calm, reasonable
manner.

Lisa Marasco, BA, IBCLC

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