Molly,

A few years ago I had a mom whose baby had a clear anterior type 1 tongue-tie with painful breastfeeding. Our hospital rarely clips also but they called in an ENT and did it prior to discharge. *Pain did not change much and mom communicated as much, but was ignored.* She started researching on the internet and also went looking for me, but I was out of town. By the time I came back, she had already found our closest laser person and traveled the 4 hrs to see him; he took more tissue and also revised the lip. There was some improvement, but still too much pain. I saw them for the first time and noted that tongue mobility still was not great even though the anterior web was gone; the baby had significant tight submucosal tissue that was overlooked.  Ultimately she had to return a third time, and I sent my dear colleague Ann Russell, who lived closer to the laser dentist, to accompany her and make sure he got the rest.  Only then did she finally begin to mend, but it took a long time because so much time had elapsed. 



You mention improved tongue extension (not great, but improved). You did not mention tongue elevation, which is key, or lateralization. Did you feel baby's suck on your finger? If so, how did it feel to you?  Was there any bunching, tight points, etc, that made your finger uncomfortable? This sounds so suspicious of under-treatment. People tend to focus on the visual change in the frenulum after a clip, but may fail to notice whether actual function was significantly improved. There is more to tongue function than extension: there is lateralization, spread, cupping, and all-important elevation.



My particular client felt pain with pumping regardless of the flange size and the suction level. Ultimately, the only pump she did well with was the Limerick PJ Comfort Plus with its soft flange.  Her nipple had been traumatized long enough that it was vasospasm reactive to baby's suck. The third revision finally did the trick, but the trauma took time to resolve. 



*If* the revision was done properly, then I would run, not walk, to send this baby for bodywork. In fact, I recommend this either way. I also believe in lots of tummy time to help stretch the area post-revision.  Continued irritation is either due to yeast/bacteria, or to continued friction and pressure on the nipple. Mastitis is quite suggestive of the latter. I would strongly recommend re-visiting the revision and suck because all that other stuff may be secondary to on-going trauma.



~Lisa Marasco



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