I thought I'd relate the story of a mother I am currently working
with.  The baby is 10 weeks old now.  Soon after birth baby was noted to
have a tongue tie.  She was unable to extend the tip of the tongue over her
bottom gum line.  The hospital staff elected to 'just observe' as 'we don't
snip those any more'.  Baby never latched well, became jaundiced ++,
required phototherapy and eventually on Day 5 she was started on a nipple
shield. Baby started to feed better and gained weight.  They went home.

The mother was keen to get rid of the shield, but it took her 4 weeks to do
it.  Feeding without the nipple shield was an 'on again, off again' affair
with the baby becoming very distressed.  About this time she noticed the
tongue tie had torn - she said it looked pus-y under the tongue and the tip
of the tongue was bright red.  No HCP was concerned.

When I saw her for the first time yesterday the frenulum was attached back
from the tip of the tongue and the baby could extend her tongue over her
bottom gum (and no sign of infection by now).  Every feed was a battle with
the baby to take a total of about 4 minutes of feeding.  She feeds about 10
to 12 times in 24 hours.  She is thriving with normal output.

My observation is that they have two problems - an abundant milk supply
with a very forceful MER, and a baby who has never latched onto the breast
well.

I would be interested in your comments about the torn frenulum.  This poor
little mite has had most unpleasant oral experiences ever since
birth.  We're working on avoiding the initial MER for a start, which has
resulted in two happy feeds in the last 24 hours (the mother is
delighted).  We've discussed good latch and the mother tries, but hasn't
persisted because the baby gets distressed very quickly.

Baby rejects a finger at the junction of the hard/soft palate.  I thought I
might start offering a little breastmilk from a curved tip syringe when the
baby first accepts the finger - the idea being to start getting the baby
used to having something in the back of her mouth. as we work on improving
the latch.

Comments?  Suggestions?

Denise

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Denise Fisher BN, RN, RM, IBCLC
BreastEd Online Lactation Studies
++++++ earn 120 L CERPs +++++++++
mailto:[log in to unmask]
http://www.BreastEd.com.au

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