Pam,
Why is this baby so congested? Microaspiration is one common cause of 
nasal congestion that worsens through and after a feeding. It can happen 
either as the baby swallows if they are not good at bolus handling (many 
tongue tied infants aren't) or as reflux comes up the esophagus 
(ascending aspiration).

Improving tongue grooving can help bolus handling. Since the frenotomy 
was done a little late, it might take this baby awhile to improve. You 
can play tug of war with a long cyllindrical nipple pacifier, to 
encourage the baby to groove the tongue to hold onto it.
Catherine Watson Genna, IBCLC  NYC

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