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Yes, Anne, it is important, on what we know now, to use a finger to sweep
under the tongue after frenotomy, to prevent reattachment.  Maybe lifting
the tongue as well, if *lift* has been the worst of the functional items.  I
have started recommending this to the parents of babies I see, after a
medical doctor has clipped the tongue tie.  (It's a medical, rather than a
dental, matter here in Australia.)

 

As the mother is using a bottle with an artificial mouthpiece (teat) for
some feeds, I would also recommend she use at least 2 different types of
bottle mouthpieces so that the one constant shape her baby is getting is her
breast. Since there is no teat that is truly identical to breastfeeding
(advertising is another matter!), I find it works better to use different
types.

 

How old is the baby?  I missed this thread before the holidays as I was "no
mail".  Some other questions:  Is the nipple damage unilateral or bilateral?
Is there an incomplete cleft of the hard palate (easy to miss, but it can
affect suck)?  Does the baby have a short tongue?  Is there a tight labial
frenum restricting the top lip?  Are there other oral lesions?  Does the
baby have torticollis (wry neck) which may be associated with a slightly
tilted jaw?  I am mindful of the wise words of a friend and colleague:  "If
you find one congenital malformation, look for three."  Three is of course
an exaggeration, to get the message across, but sometimes there will be two.

 

I think we are missing something here, since you describe the baby' mouth
action as "chomp".

 

The mother will, I'm sure, be grateful, Anne, for your support and the
efforts you have made on her behalf to find more information.  From time to
time we all get puzzling cases that really challenge us.  These are the
situations that we learn from the most.

 

Virginia

In Brisbane, Queensland, where it is rainy, as well as hot. 

 

Anne Brown wrote:

 

Many thanks to those who posted replies to my request on Dec 13.  The
suggestions were very helpful and mom was receptive to most.  To follow up:
two weeks later, mom still has sore nipples (blisters now) but still
reluctant to stop BF and give expressed milk via alternative
feedings...despite my encouragement.  Mom on mupirocin for damaged nipples
and nifedipine for continued vasospasm.  Mom never tried nipple shield.

Baby still chomps and still cannot lift tongue to top of mouth so she was
sent back to ENT who did the original posterior frenotomy.  ENT clipped the
tongue again, said that the frenotomy site had scarred over, limiting
movement.  Baby is doing CST with some improvement.  Baby's weight is fine,
she gets supplemented via bottle with either EBM or formula after some
feedings.

I suggested for mom to run her finger under the tongue frequently to prevent
the open area from healing upon itself again.  Mom is doing pacifier pull
exercises and I will meet w/her tomorrow to teach her how to use a finger
feeder.

My questions:  

How often should mom do pacifier pull exercises?  

Can someone describe the best way to finger feed this baby to help the
tongue move better?

If this is not successful, should this baby get a frenectomy?  Does anyone
in the CT-NY area do them without anesthesia?

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