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Date: | Tue, 15 Nov 2005 06:52:27 -0500 |
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If the posterior tongue is humping strongly, it's likely that there is a
posterior tongue tie. They can be treated just as easily as the obvious
ones, with a little snip. There is a little more bleeding, and the
mucosa opens up into a surprisingly large diamond shape, and heals
without suturing. It shows how much restriction was really there. One
can get some clues to posterior tongue ties from watching the tongue,
and the most common sucking pattern is retraction humping and biting,
since the gums become exposed and trigger the bite reflex.
Another possibility from what you describe is the uncoordinated
pistoning movement that some kids with neurological issues use. I've
seen some children with genetic disorders (including Prader Willi and
Phelan McDermid syndromes) that used that sort of motion. An
occupational therapist may be able to help, or you could try some of the
standard "suck exercises" used by lactation consultants. You'd want to
see first if the baby accepts oral touch, if so, then you can use some
stroking along the midline of the tongue to encourage
extension/protrusion; and perhaps "walking back on the tongue" to
encourage peristalsis. Central grooving is very important to maintaining
the breast in the mouth and for bolus control no matter how the baby
feeds. A tug of war game with a long cyllindrical pacifier might help
improve central grooving and tongue strength. The Breastfeeding Answer
Book has some good ideas, as do PreFeeding Skills 2nd edition by Morris
and Klein (available from Therapy Skill Builders, www.psychcorp.com) and
the classic Feeding and Swallowing Disorders in Infancy by Wolf and
Glass (ditto on the publisher).
Well, that's my three for today and it's not even 7 am, so I quess I can
get back to work!
Catherine Watson Genna, IBCLC NYC
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