An interesting discussion happened yesterday that might impact our discussion of tongue-ties and releasing and subsequent effects. A nurse practitioner at my hospital noted that her stepchild (a 13 year old) was unable to extend her tongue past the gumline. She explored until she could find an ENT that would divide it. This required a couple of stitches to stop bleeding. She said that the child could not extend the tongue right after the surgery. The explanation was that the muscles that ordinarily work to extend the tongue were undeveloped because unused. The child was taught to grab her tongue and pull it out while making the effort to use those muscles. After a few weeks (note weeks) of work, the child could then finally stick her tongue out, curl it, etc. This child was NOT breastfed. TO extrapolate - how often does this happen with our babies? WE clip the tongue, then try to feed. If not immediately improved, mom gives up and thinks the surgery was ineffective. What about teaching all these moms suck exercises to rebuild the affected muscles and explaining this state of affairs to mom? If mom is using a bottle, it should be something that encourages the baby to wrap the tongue and use those muscles correctly, not a bottle that can be effectively emptied by biting. If you measure the distance from the gum line to the point on the back of the tongue where the baby can wrap around, it is much longer than many of the bottle teats I have seen! Just thinking here.
I have found that using this approach has really helped mom to see that it's not hopeless when the cure is not immediate!
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Rosemary Gauld
Sent: Wednesday, March 15, 2006 12:26 AM
Subject: Re: Difficult Latch
Thank you so much for your prompt replies with all the great suggestions / information.
At yesterday's visit, the mother was able to achieve a comfortable latch by trying the lying down position again and for the first time, her nipple was beautifully rounded at the end of the feed instead of the usual pinched / ridged shape. Observationally, she has a much more capable approach to her baby and is less timid in her handling of him.
We have been using the asymetrical latch technique (as shown in the video "Follow Me Mum" and demonstrated by Kitty Franz. This baby is not great at maintaining a wide open mouth and the mother, with her large pendulous breasts is not easily able to catch the exact moment of opportunity to latch - very much a "hit-and-miss" affair. Lying down obviates the need of supporting the baby's head and adds support to her breast but when we tried this a few weeks back, the mother could not manage it without ending up in tears.
I agree that it is this baby's tongue that seems to be the root of the problem. I think the frenotomy was deep enough in that there is definitely much more freedom of movement but it is what happens during a feed that indicates all is not well. On digital assessment, this baby initially pulls his tongue back (bunching), then cups well and sucks well for a while before drawing it back again. (Lateralization is scored at 2 on the Hazelbaker ATLFF). Visually at the breast, this is exactly what he does. Difficult latch, then does well with superb milk transfer (I can hear the milk pouring into the baby for a sustained 3 - 4 minutes without a break) and then he wriggles and starts munching (the mother's description).with only an occasional swallow. Palate is of normal range - not high or bubble shaped.
This is a very stressed mother and I have tried to keep interventions down to a bare minimum. She had tried nipple shields before my initial consult with her, and had not found them to be of use or comfortable, although she probably had not used them correctly. This baby can latch and do well, and I thought it would be better to work with that than re-introduce something she already had an aversion to. Test weighing would have been more than she could suffer through and I have judged that the baby's output has been sufficient not to warrent doing it. I will have to consider supplementation at the breast if the weigh on Friday does not elicit at least a 150 - 180g gain. This mother's breasts leak milk all over the place and her supply appears adequate at present.
I have been concerned about a yeast infection all along and together with the infection spreading from the nipple, considered that the APNO (still being applied) would be the easiest treatment. Perhaps I should add Gentian Violet? This mother automatically does breast compression.
CST therapy is not big here in SA but I will certainly research any update in this field.
The rolled up small towell under the breast did not seem to make a difference.
I will keep in touch
Gratefully
Rose Gauld
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