You bring up some interesting points, Tricia. I think it's important for
IBCLCs to notice when a baby doesn't open their mouth widely, as a full
drop of the mandible is what's normal for newborns. Some just need the
right stimulus - having touch to their philtrum (that cute dent above
the upper lip), prone positioning makes it more likely the nipple will
brush the philtrum, and also draws the hyoid forward with gravity, which
helps bring the tongue forward and allows the jaw to open normally, so
that's a great (and natural) intervention.
We should definitely refer babies who seem to have difficulty with
normal behaviors if these persist. Issues can be bony, muscular,
neuromuscular, or just from molding, in which case they are temporary,
as you've noted. This is another case where communicating with the
baby's primary health care professional is important.
Catherine Watson Genna BS, IBCLC NYC www.cwgenna.com
On 4/19/2018 11:01 AM, Tricia Shamblin wrote:
> So some concerns I have about this term would be whether or not this would fall into the scope of practice of the typical IBCLC. ENT's diagnose this condition. Apparently they even have a special tool that will measure the angle of the opening of the jaw. And again, I think that's what we are describing - the angle, right? Not a mismatch between size of baby's mouth and mother's nipples - which also can be a problem.
> Most IBCLC's, unless they are an MD, can only describe what they see. They cannot put a label on things or name them. Is this diagnosing and not within our scope of practice? An RN, for example, could say, "I think your baby is not opening their mouth very wide right now. Maybe they are just sleepy right now. If this continues to be an issue and you continue to suffer with nipple pain, we will talk to your Pediatrician and he may refer you to a specialist." I was always taught that naming something is diagnosing, such as "tongue tie" or "small gape." We can describe a restricted tongue movement, for example, but ILCA has cautioned us against using the term Tongue Tie, unless that falls within the scope of our practice.
> While there are babies that are unable or unwilling to open their mouth widely, more often than not, I find that it is usually just a case of mothers and nurses trying to put the baby to breast before it's cueing to feed. Also, many of these babies do much better with baby-led feeding in ventral positioning. Even if the angle is not that wide, many mother do much better in laid-back position in regards to nipple pain and milk transfer.
> I could not find a reference made to it in a Lactation resource. But as I said, found one in a journal from an ENT. Do you also feel that this is something that should be referred for evaluation to an ENT? How do you feel about evaluating this prior to mature milk production? I would suspect that a good number of these babies just have a sore jaw and head from the birthing process and will recover within a few days. Others will have better milk transfer after mature milk production. In my mind, what is a sufficient angle of jaw opening for one baby versus another may vary based on the baby's anatomy, mother's anatomy, baby's positioning and her milk production.
> Tricia Shamblin
>
> ------------------------------
>
> Date: Tue, 17 Apr 2018 10:41:57 -0400
> From: "Catherine Watson Genna BS, IBCLC" <[log in to unmask]>
> Subject: Re: small gape
>
> I use the term, and I suspect I didn't make it up. It's descriptive of a
> baby who can't or doesn't drop the mandible sufficiently.
>
>
>
> ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet welcome
---
This email has been checked for viruses by AVG.
http://www.avg.com
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
