Marie,

In response to your post below, I imagine your question about initial latch
post frenotomy is by now a moot point.  However, I encourage moms to use  the
best latch possible with a possibly upset baby, and not to fret  too much if
this particular nursing is not optimal.  It is important for  baby to nurse
right after the frenotomy to get a general idea if the clip was  sufficient as
occasionally when mom reports feeling no difference in suck, a bit  deeper clip
may be warranted.  In my experience, it depends on the type of  tongue tie; if
anterior (type I or II) and if mom has previously experienced  painful
nursing/damaged nipples, the clipping can bring a noticeable difference  and
immediate relief for mom, and even baby nurses more effectively and  calmly.  I've
found this to be less so with type III and IV tongue ties  which are posterior.
These seem to take more time for baby to use his  tongue correctly and can
take a couple of days to 2-3 weeks for complete  improvement.  It all depends on
the baby and also mom's anatomy and milk  supply.  I show moms how to do a
couple of exercises to strengthen tongue  function, in particular, for posterior
tongue movement (pushing the tongue down  and out and pacifier tug of war) if
there's no major improvement within a few  days.  Tongue exercises should
wait anyway for healing to be under way and  to prevent possible infection with
fingers/pacifier in baby's mouth.

I think I'd see, too, how this baby does after having received other forms
of feeding and factor that into judging success of frenotomy since baby may or
may not have some issues breastfeeding again.  Supplementing at breast so
baby isn't inclined to use compensatory methods of suck to get milk could  be
helpful, too.  Prone positioning, such as Australian hold or side  sitting (my
favorite as moms find it easy to use) enables deeper latch and  natural tongue
extrusion.

Frequent contact with mom (at least daily), reassurance, tincture of time
(in some cases), and a follow up home/office visit I find important.  I  also
try to have mom in touch with a former client whose baby had frenotomy,  ideally
by the same doc, so that sharing occurs.  More than you asked, but  hope this
is helpful.

Barbara Latterner, BSN, RN, IBCLC
Brewster, NY
*********************************************************

Date:    Sun, 4 Jan 2009 21:49:43 -0800
From:     Marie Farver <[log in to unmask]>
Subject: post frenotomy  latch

Could use your expertise for the following situation:
Mom with  chewed up nipples due to piston action chomping of baby with tight
frenum.  Getting clipped tomorrow, age 12d. Mom's nipples have healed while
using  other feeding modalities. Low milk supply, maybe due to poor latch,
also has  hypoplastic-appearing breasts. Mom is pumping regularly, on
galactogogues.  Questions: 1. how to approach first latch post-frenotomy; 2.
how long will it  take in your experience for a baby to "get it right" with
their new found  tongue freedom?

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