Greetings.
PTP.  4 month old EBF.  9 lbs 10oz at birth, now 17 lbs 8 oz. Mom wanted checked for TT Lip Tie. 
Concerns are : reflux (was on Zantac, now off) , recently went from feeding 15-20 min every three hours to feeding 15 min every 1.5 hrs. Had sore nipples initially, not painful now. Has noticed milk leaking from sides of mouth. No sputtering/ choking at breast. Will not take bottle (several nipples tried and she just chews on them)
Typically only uses cross cradle hold. Has tried side lying but "a lot of milk leaked out of her mouth onto the sheet beneath her"
Exam: lip frenulum class 3 in appearance but very elastic. Lip flares slightly at breast. Tight naso labial creases. Tongue: class 4 tie in appearance but also long and elastic. I can easily slip my fingers beneath tongue on each side of frenulum with causing frenulum tautness or discomfort. Good lift, extension and lateralization. No cupping or humping.  Hyperactive gag, requires gradual insertion of finger for exam. Palate normal. The oddest thing is that, instead of extending her tongue and curling it around my finger, she extends her tongue (about 1cm beyond lip) and "rocks it" back and forth from one side of finger to the the other side. 
At breast: only nursed in cross cradle or side lying, baby refused laid- back position. Upper lip flared with tight n-l crease. No clicking. No leaking. Not a real deep latch, but not slipping off to nipple tip either.  No dimpling. Without any deep rhythmic sucking she took 55ml in less than ten minutes, which she happily spit up when I later put a finger in her mouth.
??? Who best to refer her to? She saw a local slp who "seemed rushed" and told her to use a Dr Browns bottle and support under her chin during feeds.  Any ideas for stretching lip? Encouraging suck? I did suggest body work but she wasn't sure she'd pursue that.
Thanks for any suggestions
Melinda Harris-Moulton IBCLC FNP
Olympia Wa








Sent from my iPad
             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome