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Date: | Tue, 3 Jul 2007 10:23:16 EDT |
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I had a case recently where a mother had extreme sore/cracked nipples. This
was her second baby and she did not have these problems with her first.
I saw her at 5 days postpartum. Both nipples had cracks on the tips and one
nipple the crack was larger and deeper. Observing a breastfeeding, the
positioning and latch appeared correct and deep but the mother was in extreme
pain. Baby was transferring milk and had started to gain weight.
I examined the baby's mouth after the nursing and found a bubble palate and
a short frenulum. The frenulum did not attach to the tip of the tongue nor
was it a posterior tongue tie. I would describe it more in the middle.
The mom had already picked up a Rx for the APNO and would start that right
away. I reviewed more of an asymmetrical latch, trying a nipple shield,
pumping for a couple of days while nipples healed, and clipping the frenulum. I
gave her an article from ABM on frenulums to read over on making her decision
and than discuss this with her pediatrician.
Mom called me back the next day and told me that her mother said she was
tongue tied and so was she. Both had tongues clipped while they were babies.
The mom meet with her pediatrician who initially blasted her with any idea of
clipping a tongue even though she told him both she and her mother were
clipped. The next day he called her back and had made a referral to an oral
surgeon at Children's hospital.
At that visit the oral surgeon made the decision that the frenulum should be
released so numbed the area and than used laser to free the frenulum.
The mom went on to nurse and had much less pain. She told me there is a
small white spot where the laser had freed the frenulum.
I know of only one other case where laser was used but that was for a very
fibrous frenulum and was done in the OR.
Have others seen this approach? Any comments?
I am happy that everyone in this case came out winners.
Ann Perry, RN IBCLC
Boston, MA
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