Catherine Watson Genna's "Supporting Sucking Skills" she has a section on  supporting breastfeeding when a tongue-tie isn't being released.  A great book.

Each mother-baby team is figuring out how they fit together,  a lot of mothers have had some tenderness for the first couple weeks that does resolve with growth and practice, and there are lots of babies out there with some level of tongue-tie who are nursing fine.  So we have to cautious about implying that getting the tongue-tie clipped is going to solve everything instantly, because it's not always the instant cure.

Sometimes if the tongue is restricted, if the mother helps the baby whomp in a big exaggerated "sandwich" of breast tissue (in the Rebecca Glover style) it fills the oral space and keeps the tongue pinned forward in good contact, and there is less air to evacuate to create suction.  Getting gravity on the team's side, with the mother a bit reclined, letting the baby organize and start the search (which encourages a good gape) and keeping the chin anchored, so the baby isn't grabbing the nipple out of the air.  It's "drag and drop" -- the lower jaw is dragging on the areola, and the nipple drops in last, as the baby reaches up.  

In CWG's aforementioned book, there's a chapter on helping exaggerate the latch when need be, written by Rebecca Glover and Diane Wiessinger, with "baby-led and mother sped" ideas.  

I have seen mother-baby teams who have been through two clipping procedures, still playing with pain, and no one has actually worked with them on fine-tuning a deep, dug-on latch, which should be the first line of attack.

Margaret Wills, IBCLC, Maryland




> Date:    Tue, 22 Sep 2015 19:12:55 +1200
> From:    Jacquie Nutt <[log in to unmask]>
> Subject: Getting round unclipped tongue tie
> 
> A current client's two week baby has a tongue tie, but she won't hear of a
> frenotomy.   How can I help her to overcome the difficulties in feeding a
> tongue-tied baby ..... ie using different positions and exercises?
> 
> First week grazed nipple tips - we got through that with getting the baby
> to suck her finger and latch him only when he was sucking rather than
> gumming.
> 
> This week the grazed nipples are healed but there are small cracks on the
> side.   He has started clicking while feeding.  Weight gain was initially
> great; will keep a close eye on that, and of course if it drops, that will
> be a possible lever to help her and her partner reconsider.
> 
> She is being amazing stoic through all of this and claims that her nipples
> are just "sensitive".  I think my toes curl more than hers do..... She is
> so sure that by the famous 6 week mark, baby and she will have "learned how
> to breastfeed".
> 
> Thanks for any suggestions.
> 
> Jacquie Nutt
> Currently based in New Zealand
> 
>    

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