Yes, absolutely this baby may need special help getting his tongue muscle to
make and manage the new free range-of-motion.  Last week I was touting Cathy
Genna's book as a must-have for us IBCLCs ... and the title "Supporting
Sucking Skills in Breastfeeding Infants" gives you a clue as to the wealth
of information about suck biology that the book contains.

I like it because when I have these tough post-clip cases, I can go back to
Cathy's book, brush up on the pertinent chapters, and sensibily educate the
mom about what it going on and why there seem to be problems even after the
"fix" (frenotomy)  wasn't a magic-wand.  I was just at a conference this
past weekend (with -- coincidentally -- Cathy Genna as a speaker) where we
learned that esp. with these Posterior Tongue Ties, having to go back and
re-clip OR do a lot of post-clip therapy is quite common.  I think as we can
better identify and remedy Type-4-now-called-posterior-tongue-ties ... the
more we will see that post-procedure evaluation is an important part of the
care plan.

The baby may very well need the specialized attention of an oral/ speech
therapist *who understands the oral anatomy and special needs of a BF
infant.*  Often the specialist works once or twice with the family -- and
then sends them home with a battery of exercises that they do on their own
with baby.

It is not rocket science stuff:  mom may simply play "tug of war" with baby
and a (gasp) pacifier.  Mom may use her finger to swipe the frenotomy site
to keep it flexible during healing.  That sort of thing.  Your ability as an
IBCLC to guide this family through this process will be invaluable.
--
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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