Nikki, if all the ot and speech paths were attending Beckman's
training, I would be thrilled!  Unfortunately, so far, every time a
mom has seen a ot/slp, the focus has been on bottle nipple and lip
seal. And there is no improvement in breastfeeding, but, hey, they can
bottle feed great now.  I have a mom with a baby who has posterior
tongue tie, very restricted, cannot elevate tongue with a gape at all,
and also has the most disorganized suck behavior I have seen in a
while. He has no lateralization capabilities either, he just folds his
tongue over...and likes to that while eating too. Barely manages a
bolus and dribbles entire feeding.  I have my fingers crossed that
this slp will be able to help.  The mother saw her just for an
assessment, and the first thing asked was "do you have a bottle with
you".  So, not such a good sign maybe.

Just this minute, while composing this post, I did just go to
Deborah's website again, and admit I had not checked it out since I
commented to her that I wish she had a list of those trained by her.
Ah, and what do I find?! A list!  I am so happy to see it and will
pass it on to the mothers I see who need the services. The other
thing, therapists often require a referral from a pediatrician, who
sometimes says "there is no problem" even if it affects breastfeeding
because it does not affect bottlefeeding. I try to explain to mothers
that breastfeeding is the normal oral skill behavior, and an inability
to breastfeed is important. But, you all know that not everyone is on
the same page with that thought.

 think the posterior tongue tie is a 'piece of the puzzle' but not the
whole picture. As in any tonge tie. The reason some babies get clipped
and immediate improvement is noticed and some still struggle shows
there is more to consider. My thought, just from common sense, is that
they are using their tongues in utero. And, not using them correctly
since they have the restriction.  Who just posted about the
compensatory behavior starting before we even see them?  Thank you for
that and I now add it to my reasoning for the 'why' of not an easy fix
just to clip for all babies. (However, the majority, it is like a
miracle fix, and immediately there is improvement.) Stands to reason
that even if we correct the restriction, we still need to teach the
proper tongue use.  I do see great results from CST rather the
practitioner knows the entire picture of why it works or not, it does
work for many babies. Since CST was developed by a DO, I think there
is a complete understanding of how it all works together. I tend to
suggest a mom see a CST who is either a DO or a chiropractor so there
is 'the whole baby' understanding.  I do agree that posterior tongue
tie can be compensated for in some babies, just like an anterior
tongue tie can be compensated for in some babies.  I have been doing
this a long time, and I can remember when finding someone to clip was
not so easy as it is for me now.  And, there are still those parents
who don't want to clip, so we have to try to work with what we have.

There is more than the tongue, there is the palate.  When the tongue
as shaped the palate in a way that maked it difficult to get a
comfortable latch, it requires another approach to latching and extra
care given to not having the nipple catch in the little dip in the
palate it likes to find.  I have also found that focusing more on
placement of the nipple, as in as far back as possible, and not so
much on the gape helps because the babies simply cannot open wide and
have tongue elevation. Finding just how wide is wide enough, and still
give good tongue mobility is very individual because it is about the
breast and the baby.  Compensation may mean a smaller gape.  It helps
a lot when the mom has nice soft pliable breasts.  What is very
difficult is a baby with tongue and palate issues coupled with a
mother with very firm breasts.

I too wish I could learn more, but LCs can't know everything. We can
try though. haha. It's a pity we can't find a specialty degree for LCs
that encompasses all the therapies we would need to know, but just the
pieces that related to breastfeeding and lactation. Thinking like the
docs and therapists who learn it all...then specialize.  We could skip
the learning it all, and just learn the 'specialized' part.  I mean,i
don't need to know how to teach a child to make the proper sounds, or
teach a disabled child proper motor skills for chewing and swallowing,
but I should be able to diagnose tongue tie and teach proper oral
skills specific to breastfeeding.   Of course, I am older now, so by
the time this 'specialty' exists I will be too old to make use of it.
Oh well. Haha.

Pam MazzellaDiBosco, IBCLC, RLC
Florida

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