>Date:    Tue, 17 Jun 2003 09:01:05 -0500
>From:    Barbara Wilson-Clay <[log in to unmask]>
>Subject: tongue-tied baby
>
>Thanks for an interesting case presentation, Lynn.

actually its Lyla :-)  Thank you for responding!

>  The baby's tongue is probably sore from two clippings,


even 2 weeks after the fact?

>  and a restricted, short tongue is weak.
>The clenching of the nipple is a compensation for lack of ability to pattern
>and use the tongue correctly.  When the milk flow rate is augmented (with
>SNS) the baby probably doesn't have to rely so much on the compensations and
>can just swallow away.  For the poorly feeding, weak sucking baby, the
>feeding tube is not a device that actually promotes much milk transfer
>directly from the breast.


this has been the mom's suspicion since the beginning with the SNS - that
the baby is getting the milk with no effort.

>  It is a way to supplement, keeping the
>orientation at the breast and away from bottles, but mom should still be
>doing pumping.


she is - to provide the milk for the SNS

>   Check the size (base diameter of nipples).  If they are
>fleshy, hard to compress and thick, the baby's ability to compress them will
>be compromised by the weak tongue and high palate. Make sure she has the
>right size pump flange to protect the milk supply.


she is large breasted, but her nipples are not huge.

>  Personally I wouldn't bother clipping the superior labial frenum.  The
> lip retraction is probably
>another compensation to try to hold the breast in the mouth with
>insufficient help from the tongue.  You can clip it (will prob. help prevent
>a gap toothed smile:) but it probably won't improve lip flanging much.
>Remember, tongue-tie and tight labial frena are mid-line defects, and they
>could be indications of issues elsewhere in the baby because they are
>connected with other genetic issues.


i know they can be associated with cleft palate or submucousal cleft, and i
think i remember you saying at a conference that hypospadius is also a
midline defect.  any others that come readily to mind that you can throw
out there for my consideration?

>  The mother doesn't necessarily have to
>get this info from you (that's the peds job) but your awareness that this
>infant may have systemic weaknesses can help your perspective.


indeed!

>  There may be many improvements from CST or other gentle forms of
> manipulation, but some
>babies are not immediately "fixable" in terms of their feeding capabilities.
>Maturation will help.


that alone is reassuring!

>In the meantime, keep emphasizing how valuable the
>milk is, keep the milk supply well protected, get the nipples healed up
>(does she need topical antibiotics to clear up a persistent, superficial
>skin infection?)

my colleague and i have encouraged her to do APNO or at least antibiotic
ointment since the beginning, but she has been extremely resistant, and as
her nipples are mostly healed now, with the herbal antimicrobials she has
been using, it doesn't seem necessary at this point.

Barbara, thanks so much for your input!


Lyla Wolfenstein, B.S., IBCLC, RLC
Early Attachments - Breastfeeding Preparation and Support Services
email:  [log in to unmask]
phone:  (360) 281-4719
web:    http://home.attbi.com/~earlyattachments

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