LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 17 Nov 1998 18:33:33 -0600
Content-Type:
text/plain
Parts/Attachments:
text/plain (32 lines)
It can alienate some doctors for an LC to recommend or not recommend that a
medical procedure be done.  I have learned to couch my assessments (always
written) in terms of what I observe, leaving the doctors and parents to draw
conclusions and decide about the procedure.  In the case of tongue-tie, I
might write:

 Mrs. X complains of sore nipples.  Both nipples are fissured across the
tips, and appear inflamed. Yesterday mother experienced chills and low-grade
fever, associated with engorgement which resolved when she began pumping her
breasts.  The baby has difficulty latching onto the breast, making many
attempts to grasp the nipple before finally attaching.  The infant's
frenulum is attached to the tip of the tongue, and the infant cannot lift
the tongue past the mid-line.  Tongue extension is limited by the short
frenulum, and the infant is unable to cup the tongue around the breast.
This appears to be contributing to poorly coordinated swallowing.  The baby
does not look ill, but sounds congested, esp. after feeding.  She may be
experiencing micro-aspirations of milk during swallowing due to poor bolus
formation, with accumulation of material in the nose.  Since the
range-of-motion of the tongue is limited, the baby cannot create positive
pressure by lifting the tongue to compress the nipple against the hard
palate.  The baby appears to be using compensatory mechanisms (ie creation
of excessive negative pressure, and jaw clamping) to milk the breast.  This
is probably the cause of the mother's sore nipples.  Weight gain is poor,
with the infant still *** oz below birth weight on Day 9.  Pre-postfeed test
weights indicate intake of only 16 ml after 30 min. of effort.

Period.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

ATOM RSS1 RSS2