On Fri, 18 May 2007 Jaye Simpson, IBCLC wrote:

I had 3 babies who were t-t this week.  Wow.  One I need to vent with....

Hello Jaye, 

There are many issues in your very long post and I'm not going to comment on them.  One of those mothers was fortunate to have your hours of input into supporting her after that traumatic experience with a brutal clip.  I can relate to your seeing 3 tongue-tied babies in one week, as I tend to see tongue-tie in clusters like that, and then not see any for weeks or months before the next cluster.  Two in the last cluster were, mercifully, very mild indeed and had good Function.  (Most I see haven't.)  The other, however, was more complex.

Some thoughts:

- It helps to have a short list of local medical people who are experienced in identifying and clipping those tongue-ties that negatively affect breastfeeding, and who are gentle with babies and their parents.  Brisbane is a very spread-out city and so my list includes medical people in different localities.  Feedback from parents helps me know if anyone has a poor attitude, espec where there is a group practice.

- Unless the tongue-tie is a very simple one, it is wise ask the mother to stay in touch to monitor growth, espec if she still has nipple pain.  As this indicates the latch still isn't optimal, it can be a pointer to those mother-babies dyads where milk transfer is less than optimal and who are at risk.  Things can go downhill very gradually indeed, till they show up.  Urine and bowel output may seen okay to the mother for a while, on questioning, but additional questions about breast softness and whether a letdown is felt, will help pick up a milk transfer problem *before* it reaches a stage where the baby stops gaining or starts losing weight.

- For these clients, it makes sense to advise expressing once or twice a day to provide additional stimulus, just in case.  It also means there is breastmilk on hand if the baby needs topping up.  Your clinical judgment will determine whether to increase the expressing or taper it off.

Regards
Virginia

Virginia Thorley, OAM, PhD, IBCLC
Lactation Consultant (original cohort of 1985).
Cultural historian of the History of Medicine.
Brisbane, Queensland, Australia.
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