On Wed, 31 Dec 2003 Lyla Wolfenstein wrote:

....  i seem to see a
lot of babies who fit this description - either a short tongue or a
seemingly restricted tongue mobility - BUT, no visible frenulum to clip.  I
am aware of z-plasty and other procedures, but i wonder - how often do you
all actually refer for such procedures?  i cannot imagine many parents
being receptive to the more invasive surgical procedures on their newborns
- and do they work in all cases of restricted tongue mobility?  if not, or
if parents don't want it, what alternatives exist?  just extreme
positioning and perhaps cst?  i appreciate any input into what seem to me
to be very challenging cases (when its causing a problem of course).

Lyla,
    I can't think of any easy answer.  There not much that can be done about a congenitally short tongue, except maximise the latch and positioning.  The tongues that are "seemingly restricted" without a visible frenulum are a tricky one. Even more so the tongues that appear both short and adhered. Like most IBCLCs, I'm not medically qualified and so if the mother and I can't find a workable way to improve attachment, I would discuss with her a referral from her GP to a paediatric surgeon experienced in this.  It is then his/her assessment as to whether anything can be done, for this baby, in this situation.  This becomes a medical matter and outside my expertise, and I know when to refer on - or at least discuss this with the parents. It helps to have a list of surgeons who are aware of the effects of restricted tongues on breastfeeding and don't dismiss BF as unimportant!
   If there is a family history, the parents may also be bringing a lot of emotional baggage or family folklaw, too.
   If the parents are not interested in a second opinion from an appropriately qualified medical person, I recommend to them that they consider an assessment by a speech pathologist when the baby starts to say the first words, if there seems to be any restriction or difficulty with specific sounds.  I'd consider a speech assessment particularly important if the mother decided on weaning.  We can't fix everything, but we can give the parents the best advice we can and recommend appropriate referrals.  Even where there is no problem at all with breastfeeding, and keeping in mind the idea that "if it ain't broke, don't fix it", I'd still discuss having a speech assessment at a later stage.  We have had this situation in my extended family in another state - a little boy who breastfed beautifully despite tongue tie, causing no pain and growing fast, but who later had massive speech problems. (It's a long story.)
   Happy New Year,
     Virginia
     in *hot*, dry, sunny Brisbane

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html