Hi all,
Thanks for all the response to my question regarding frenotomy on infant < 6
months.  First some clarifications:

1)  The ENT here is the only ENT in the hospital.  I'm not sure if he is
Korean national under contract, but I suspect that is the case since it is
so with many of our doctors.  In any case, he has a Korean name.

2)  I checked with the oral surgery clinic here and they state that they
need a referral from the Pediatric dentist in order to see a child.  The
head of our Peds Dental Clinic has spoken out publicly against breastfeeding
*at will* and night feedings as they "cause tooth decay".  Perhaps he
*would* make a referral....I imagine stranger things have happened.  I've
mentioned this route to the parents.  They say they will think about it
after they talk to the ENT.

The father has called the ENT clinic and asked for the ENT to speak with
him.  That was yesterday and they are waiting for a return call.  They know
that I will talk to the doctor for them or with them if they wish.  At this
point it's up
to them.  The mother states that she is letting her husband handle it now.
She states that she is trying to pull back emotionally so that she can
concentrate on her baby.

I've sent away for the article many of you mentioned in JHL -- actually
there are three articles in that particular issue -- Sept. 1990.  The
publisher doesn't have any of that issue left.  They referred me to the
Society of Human Lactation, which only has one issue left and isn't willing
to
sell it. (who can blame them?)  But they are sending me a copy of the
article.  The medical library here doesn't have JHL (surprise, surprise) but
they are sending away for copies of the other articles I asked for.  Whether
they will be successful or not remains to be seen.

On the off chance that the ENT will respond to the parents before I receive
the copy of the article in the mail, I gave the citation to the mother so
that they could mention it to the doctor.  I suggested that she stress the
difference between frenotomy and frenectomy -- especially if his reasoning
includes anesthesia concerns.

The mother has a 6 week postpartum checkup with the OB and will ask that the
trauma to her breasts be documented.  She stated that with her last baby she
had cracked & bleeding nipples at the 6-week checkup and the OB told her
that she'd "seen worse".  Basically get over it.    So when I mentioned
getting the OB to document it, she was understandably pessimistic.  I
suggested that if this OB said something similar, she might respond, "That's
ok, I'm not asking for sympathy, I'm just asking that you document the
trauma."  I also suggested that it might not be a bad idea to see if the
Pediatrician might document the nipple trauma on the *babies* chart....

As an aside, it *has* occurred to her and me that her last child might have
had the same problem or a milder case since she was being helped by a LLLL
and was told that her positioning and latch were good.  Yeast was ruled out.
She toughed it out then, but she says this is so much worse.

I'll admit that I'm itching to fight this for them, however, until they ask
me to, I have to stay on the sidelines and limit myself to providing
information and support -- which I'm doing.

Thanks again so much for all the suggestions and support.


Best regards,

Cindi Swisher, RN
Yongsan (Seoul), South Korea
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