Marianne writes:
Baby could stick out her tongue quite well, had free range of motion, no
asymmetrical movements, no humping or thrusting. So... really... how to
assess whether this is tongue-tie?! All looked well! I really wonder... should
we clip all those babies or should we realise that separating them from
their mothers and suboptimal or sometimes even really bad bf techniques
cause damage in the developing relationship, that can only be solved with
patience and closeness and tender care and support for mom who should know she
is doing the right thing by feeding véééry often...? I know that many of
you are wildly enthusiastic about discovering and treating tt, but I still
have doubts as to where the limit should be.
Assessing is function-based, in my opinion. Baby should be able to extend
the tongue with the mouth in gape position, not just stick it out with mouth
slightly open. Range of motion should be free and full with the mouth in
latch-wide-open position. Baby should be able to groove well around the
finger ( during exam) or breast, with no loss of contact/suction, and should be
able to maintain skills while feeding well in a reasonable amount of time.
( The functionality is the key, for me.) Even if we gently sweep under the
tongue, with baby's permission/encouragement and feel that "tendony"
feeling, where one is stopped in the middle while the tissue next to that has
"give", that may not mean rushing to surgical release. I agree that some
babies have been assaulted or restricted by the way pregnancy ended, and/\or
labor, delivery and post-partum occurred. They may need only time with mom
to reorganize. A mom in the situation of discomfort, with a baby who can
get enough to eat without damaging mom, or getting into protracted,
exhausting feedings, may need only positional adjustments, S2S as much as possible,
tincture of time, possibly some CST. Providing mom with reasons or logical
possibilities why she and her baby are struggling is something I consider
paramount. Working out how to cope with what seems to be going on is
something also very important, but I don't think the answer is the same for every
dyad. Some moms are bleeding, getting no sleep, or have a completely
non-latching baby. Some moms are trying to feed the baby 24/7 and the baby loses
milk and/or coughs and gags with even the slowest, most paced alternative
feeds, resulting in poor weight gain and the entire family not sleeping.
Other times mom is uncomfortable, may even tolerate some pain, but skin
condition isn't awful, baby is managing to get enough to eat in a reasonable
time. Some may need to go to breast very frequently, or need some
supplementation with mom's milk due to fatigue/disorganization issue as they try longer
and longer and get less and less. I would not say that assessing and
dealing with tongue restriction issues always means surgical release.
Providing families with our professional assessments and options for dealing with
situations I could say I was pretty enthusiastic about though, yes. :)
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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