I would agree with what's been said. And Cathy is right - if you think
it will be useful to do the exam, being respectful of the baby is
really important. Otherwise all you get is biting, or gagging, or
wailing!

Very often the tongue tie/funky palatal arch go together. Since I work
now with lots of newborns (v my long career in the community as a
LLLL) sometimes now I have felt a palate that is high due to
mechanical birth stressors (boy that sounds scientific but it mostly
means "squished head"!). Often that looks better by the next day!

Also, if a baby is not draining the breast well, sometimes you need to
assess strength of suck. That is a real challenge because a hungry
baby will do their darndest to suck as hard as possible, and a more
sated baby won't suck very hard because they have no need to do so.

Dawn Kersula MA, RN, IBCLC
in southern Vermont
and looking forward to Kathy Kendall Tackett and Nancy Wight at our
VLCA conference this week!

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