I very rarely see a tight labial frenulum without a tight lingual
frenulum (sometimes a subtle, submucosal one). But when the mandible is
also short, the labial frenulum may be the more significant problem. Our
local ENT has found that treating the labial frenulum immediately is
very helpful in babies who can't sustain latch. She also treats
posterior tongue-ties. We are starting a research study to further
examine the interactions.
Since these anatomical issues are highly genetic, getting this mom an
eval from someone who can do a hands-on intraoral and suck exam would be
helpful. Many ENTs don't yet know about posterior tongue-ties.
Catherine Watson Genna BS, IBCLC NYC cwgenna.com
On 7/23/2011 2:28 AM, Allyson Wessells wrote:
> Hi everyone,
>
> I have been a LLL leader for about a year and a half and recently was introduced to the Lacnet community a couple of months ago. It has been a wonderful source of learning, reassurrance, and guidance for me as I continue to learn how to best help mothers wherever they are in their breastfeeding relationships. I am very thankful to all of you that post, review and pass on your expertise and compassion.
>
> With permission to post...
>
> Currently, I have been offering support and information by phone and email to a mother with a 9 week old who has a confirmed upper labial frenulum tie. Some sort of tongue or labial tie was suspected after our first phone conversation during which the mother described difficulty with latching, clicking, pulling on and off, and severe nipple pain/vasospasms despite a lot of futile effort to correct with lactation consultant home visits, pediatrician visits, and OB/GYN visits. I sent the mother some information and pictures of tongue tie and labial tie as well as information to consider possible specialist evaluation.
>
> The mother subsequently had ENT evaluation and pediatric dentist evaluation both of which confirmed the upper labial frenulum to be tight and the possible cause of the mother's intense nipple pain. Tongue was reportedly evaluated to not be problematic. The ENT offerred a surgery under general anesthesia and said the baby would need to be on heavy antibiotics afterwards due to risk of infection. The pediatric dentist, however, is confident she can perform the frenectomy with just a little shot of Novacaine, a laser and little recovery, but not until August 9. The dentist indicated, however, that while the frenulum can be fixed, it won't necessarily improve the baby's latch and stop the pain and vascular injury to the mother. She recommends the procedure, however, to improve suck whether at breast or bottle, but goes on to say she has had limited success with breastfeeding following the procedure.
>
> While this mother is very committed to breastfeeding, the past 9 weeks have been understandably awful and she is unsure about suffering for two more, then proceed with the clip only to then find out it makes no difference with breastfeeding. On the other hand, she doesn't want her milk supply to suffer in case it does. Additionally, she is afraid to exclusively pump for fear of the baby never being able to learn to latch properly.
>
> Further background...this is the mother's second baby and with the first she carried tremendous guilt having stopped nursing at around 6 weeks due to same, severe pain. Now she recognizes same anatomical structure in her older daughter that likely limited nursing duration. Knowing this gave this mother tremendous relief. She was quite determined to nurse her second baby for a longer period of time, dissapointed to experience same, intense pain.
>
> Any thoughts, insight on how to support this mother from here?
>
> Thanks so much,
> Allyson Wessells, PT, LLL leader
> Tucson, AZ
>
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