The pediatric ENT that I send tongue-tied babies to thinks that the ability
to lift the tongue is prob. even more crucial in terms of ability to
breastfeed than is tongue extension.  He suggests evaluating lift by
watching the baby with the mouth wide open (as it would be when positioned
at breast).  See if the baby's tongue can elevate up off the floor of the
mouth to past the mid-point. You can position your own fingers on either
side of a frenulum and gently lift the tongue, or watch the baby during
crying and when trying to latch.

 Frenotomy is a simple snip of a frenum that can release the tongue.  When
the tongue is fused to the floor of the mouth, this will involve a more
complicated surgical procedure for repair.  The case Lisa described is a
good time to use a test weight, I think.  I'd see what kind of ability the
baby has to transfer milk, and observe for signs of fatigue while feeding.
Observe mom's nipple shape as baby comes off, and querry as to level (if
any) of discomfort.  A good trick involves tilting the baby's chin in to
shorten the "reach" it takes to get the nipple to lie along the length of
the tongue. Support the breast to save the baby from having to work that
much harder Breast compression would be useful.

 If the baby isn't transfering much milk, is ending the feed early from
fatigue, or the mother is in pain, you may have to institute post-feed
expression, supplementation with her milk, and see what resources there are
to eval the function of the tongue.  She may or may not want to go forward
with frenuloplasty.  If not, do the best you can to protect baby's growth
and the milk supply.


Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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