I seek help in knowing which if any short frenulums require surgical
intervention within 12 to 48 hours of life to avoid breast-feeding dysfluency
or failure.

I am a neonatologist practicing now 20 yrs in the same HMO with about 3,000
deliveries per year.  Our hospital almost achieves baby-friendly status.  The
breast-feeding rate for our well-babies has been slightly better (and for NICU
pts significantly better) than average for our locale.  In 19 1/2 years, no NB
had his/her frenulum clipped in the nursery, nor was short/tight frenulum the
single mechanism hypothesized in any BrF failure, as far as I am aware.

About six months ago our perinatal team had the delightful addition of two
lactation consultants who assist with BrF problems among well-babies, NICU
patients, and recently discharged patients.  Quite a few times we MD's have
been approached by one of them with concern that a given baby seemed to
require that frenulum be clipped.  I and my partners are hesitant, and would
appreciate objective guidelines re surgical (or other?) intervention.

(If my question is too naieve for this list, please excuse it)

For completeness, and in fairness to the consultant, I include below some
excerpts from her observations, so as better to convey her point of view:

"...the immediate problem of a hungry baby that she took off the breast after
about 20 seconds of breastfeeding because she had severe pain.  Her
positioning was good, the latch looked all right, and the only problem that I
could identify was the heart-shaped tongue...She did nurse the baby again
before she left the hospital, but in telephone follow-up, she said that her
nipples were bleeding and as soon as she got home she bought formula and fed
it to the baby. Her nipples were too sore to pump and she became engorged.
She said that she would still like to breastfeed..."  "Currently we have 3
mother-baby couplets with babies who have questionable frenulums.  They all
have such damaged nipples that they had to quit breastfeeding to let the
nipples heal.One baby was sent to Head and Neck Surgery by Home Health RN thr
ough Pediatric Phone advice nurse; the mother says 'they didn't clip it
enough', so she is still having problems.  Another baby had trouble latching
on and mother's nipples got sore by the next morning after birth, but she
reported that the baby nursed fine after the frenulum was clipped and the
nipples got better."  "In my limited experience, the mothers'  nipples get so
sore that they quit nursing (either temporarily or permanently) by the next
day if the tongue is heart-shaped.  That is why I feel an urgency to have
someone look at it. I desperately need more knowledge about what to do for
these patients. How do you tell if it will stretch by itself?  Should we refer
all of the possible ones to the Pediatricians or only the ones who don't
swallow and must have some means of transfer of milk?"

This old dog is willing to learn new tricks.  I welcome your suggestions
either on the list, or privately to me.  Thank you.

Margaret Walker MD
Hayward Kaiser
Hayward California
email:  [log in to unmask]