Hi Shannon,
Welcome to my world! Although I am not in private practice anymore,
and work in the hospital setting, my experience and that of most LCs,
mirrors yours. It is obvious you are quite well-prepared and I trust
your clients are in very good hands. When we came out of nursing
school, we were just as "green" but we had seasoned nurses to bounce
things off of. Not so with most LCs, most of us didn't have a mentor
at our side, but we sought out mentors by email, phone, conferences,
or lactnet. Now the education and training of IBCLCs is changing and
there will be requirement for a seasoned LC to mentor. And you can see
why that change was needed.
Now to your questions. I don't know the answers about medihoney or
coconut oil, so I'll wait to hear them with you. Regarding tongue-tie,
you are certainly not alone! We bemoan the TT situation on lactnet
regularly. Most pediatricians are not skilled at assessing TT.
Especially the Grades III and IV. Many LCs are not expert at this
either (myself included). The best advice I can give you is to try to
find someone in your area (family might need to travel some) that you
can refer to. It might be a pediatrician, a dentist, a speech
pathologist, ENT physician, a second LC to confirm, a breastfeeding
medicine doctor. It might take you some time to find him/her but keep
looking. Talk to other LCs in your region. Good news for me is that
one of our peds (the chief) began to clip them, first in his office
after a trial period to see if can bf, and now it is such an easy
thing, he does it in the nursery. His example helps the other docs to
be more willing. Sometimes it takes time to "work" on one doctor you
feel might be willing. Another doctor converted when I shared the AAP
article with him.
I might pare down the TT references you are giving to parents. Find
one compelling article or website that is most convincing and from a
well respected source. (Like the AAP for example). Make sure the
reference focuses on the signs and symptoms that are common to
tongue-tie's impact on breastfeeding: nipple pain and damage,
difficult latch, losing latch, lengthy feeds, poor wt gain, etc.
Continue to offer any other interventions that can help in the
meantime, until tongue is clipped, or if parents decide against it (or
just can't get someone to do -- happens and is very frustrating).
Now to the small, near term with probable tongue-tie and poor fit
(colloquially called oroboobular disproportion, I think that is what
you mean): you can see that this is a multifactorial situation, as
they usually are. It would just be a guess as to how long might growth
of the baby take before he can effectively transfer milk. A month? Six
weeks? It depends on the amount of disproportion, how well the baby is
growing under the circumstances, mom's inherent milk making potential,
etc. Perhaps use a WHO growth curve to show parents the usual
trajectory, follow with weekly wt checks for example. Lots of these
cases are judgement calls, and not clear cut. I had a client and I
helped her with baby #2 and #3. She has exceptionally long and
moderately large nipples. Her first baby (didn't know her then) bf for
6 months with supplements the whole time, according to mom. The second
never could transfer milk ("we tried everything" in her words) and
mom pumped x 8 months. The new baby is coming for f/u tomorrow, but
was bigger than others and appeared to be transferring in early days.
Good luck and I hope I have offered something helpful,
Laurie Wheeler RN MN IBCLC
Mississippi USA
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