The Lactnet archives provide a wealth of clinical studies on the affect of
ankyloglossia (tongue-tie) on breastfeeding.  There are numerous references
and discussions that have taken place over the years.

  In my opinion, getting the frenulum clipped is not especially an
emergency.  Many times there is a brief delay of a day or so, or even a few
days, while issues of locating a person who can do the clip, dealing with
issues of insurance and payment, etc. are worked out.  In the meantime, a
calm reassurance that this is all remediable will best serve the mother and
baby.

 Interim management includes choosing feeding positions that thrust the chin
in closer to the breast (i.e. extended head positions) and breast support
and compression during feeds.  If the nipples are too traumatized, treat
with gentle cleansing and topicals to heal and rest mother for a day or two
on a good pump.  Feed the milk to the baby however baby can best manage,
being careful to use pacing techniques that help facilitate safe swallowing.
It's certainly over-kill to go to the hospt. and have anesthesia if a simple
frenotomy is all that is needed.  Just keep checking around for a
practitioner who doesn't do it that way.  Patients can refuse procedures and
request referrals to other providers. This often motivates practitioners to
explore ways of providing services that are preferable to consumers.

 It is obviously better to have the procedure done sooner than later, but I
frequently see poorly feeding infants with tongue-ties who  are a month old
before the problem gets picked up.  With appropriate interventions, these
situations are manageable and solve-able.  When mailing or faxing your
report to the doctor, you might want to briefly and politely describe what
you observed with regard to the baby's feeding behavior and mom's nipple
condition, and mention perhaps one or two of the most recent articles, such
as the one below (which if you haven't read is available on line at
www.pediatrics.org

Ballard J,  Auer C, Khoury J, et al:  Ankyloglossia:  Assessment, Incidence
and Effect of Frenuloplasty on the Breastfeeding Dyad, Pediatrics 2002,
110(5): e 63.


Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html