Marie,
In response to your post below, I imagine your question about initial latch
post frenotomy is by now a moot point. However, I encourage moms to use the
best latch possible with a possibly upset baby, and not to fret too much if
this particular nursing is not optimal. It is important for baby to nurse
right after the frenotomy to get a general idea if the clip was sufficient as
occasionally when mom reports feeling no difference in suck, a bit deeper clip
may be warranted. In my experience, it depends on the type of tongue tie; if
anterior (type I or II) and if mom has previously experienced painful
nursing/damaged nipples, the clipping can bring a noticeable difference and
immediate relief for mom, and even baby nurses more effectively and calmly. I've
found this to be less so with type III and IV tongue ties which are posterior.
These seem to take more time for baby to use his tongue correctly and can
take a couple of days to 2-3 weeks for complete improvement. It all depends on
the baby and also mom's anatomy and milk supply. I show moms how to do a
couple of exercises to strengthen tongue function, in particular, for posterior
tongue movement (pushing the tongue down and out and pacifier tug of war) if
there's no major improvement within a few days. Tongue exercises should
wait anyway for healing to be under way and to prevent possible infection with
fingers/pacifier in baby's mouth.
I think I'd see, too, how this baby does after having received other forms
of feeding and factor that into judging success of frenotomy since baby may or
may not have some issues breastfeeding again. Supplementing at breast so
baby isn't inclined to use compensatory methods of suck to get milk could be
helpful, too. Prone positioning, such as Australian hold or side sitting (my
favorite as moms find it easy to use) enables deeper latch and natural tongue
extrusion.
Frequent contact with mom (at least daily), reassurance, tincture of time
(in some cases), and a follow up home/office visit I find important. I also
try to have mom in touch with a former client whose baby had frenotomy, ideally
by the same doc, so that sharing occurs. More than you asked, but hope this
is helpful.
Barbara Latterner, BSN, RN, IBCLC
Brewster, NY
*********************************************************
Date: Sun, 4 Jan 2009 21:49:43 -0800
From: Marie Farver <[log in to unmask]>
Subject: post frenotomy latch
Could use your expertise for the following situation:
Mom with chewed up nipples due to piston action chomping of baby with tight
frenum. Getting clipped tomorrow, age 12d. Mom's nipples have healed while
using other feeding modalities. Low milk supply, maybe due to poor latch,
also has hypoplastic-appearing breasts. Mom is pumping regularly, on
galactogogues. Questions: 1. how to approach first latch post-frenotomy; 2.
how long will it take in your experience for a baby to "get it right" with
their new found tongue freedom?
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