I'm late joining this discussion on tongue tie but since I have a stamp on
my forehead that reads, "Can identify posterior tt", thought what I've
experienced might be helpful. I've been through the feelings of over diagnosing and
discussed same with both Cathy Genna and Betty Coryllos which helped to
quiet my fears, as well as, seeing improvement in breastfeeding post frenotomy.
In fact, a pediatrician/IBCLC, whose patients I've seen says with a laugh
that she waits for me to bring up tongue tie as a cause for her patient's
breastfeeding difficulties.
Even though I'm more reassured that posterior tongue ties need treatment, I
still waver occasionally about whether to strongly encourage clipping in some
situations. I never keep quiet about what I see/feel because parents
deserve to be informed, but inside I question my own assessments, especially when I
wonder if improvement in breast attachment may be enough, and effects of tie
are marginal. One recent case of a 3 mos old who began to refuse the breast
with mom's lowered supply turned out well following Dr C's frenotomy though
it took a few weeks, and baby only having had one osteopathic treatment.
This case is one in which weaning was beginning and would have surely occurred
had frenotomy not been done. I had this mom, as I instruct with all, do
tongue strengthening exercises (pacifier tug of war, tongue sweep for
lateralization, pushing tongue down and out) and these may have helped as well. Mom
recently emailed me and said something like how wonderful it felt to have her
baby's hand on her breast while nursing, and well, those types of feedback, make
me swallow my doubts.
I want to add that Dr C now has moms daily elevate the tongue (for
posterior, generally type IV's) by using first two fingers, pad side up, as a prong or
fork, to assess and prevent scarring which is more likely to occur with the
submucosal frenulums; this is done on day 3 (2 days post) of frenotomy so
nothing is disturbed in early healing stage.
I've had parents decline frenotomy with subsequent weaning, and those who
continue to breastfeed despite it but babies tend to have reflux and in my
opinion, are able to continue due to moms' robust supply. In my support group,
which is small, currently 2 out of 6-7, and soon to be 3 babies have had
frenotomy. There are 2 other babes in group, 5 mos and 7 mos, who have tight
frenums who click or have had reflux whose moms chose not to clip. I would like
to know how these babies do as children with orthodontics, etc. The moms
whose babies had frenotomy are also private clients, though I did assess other
babies in group as well. I think it's hard for moms who don't experience pain
or low supply or whose babies don't have highly visible symptoms, to
consider frenotomy when possible long term consequences of not clipping are so far
away.
I have other comments but will wait to post and I'm sorry for being so
verbose. To be continued as I feel this is a vital topic based on the volume of
discussion and my own experience.
Barbara Latterner, BSN, RN, IBCLC
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