In a message dated 12/15/2004 12:07:14 AM Eastern Standard Time, [log in to unmask] writes: tongue tie (even a far posterior one (type 4) can prevent tongue elevation beyond the very tongue tip... With these conditions, even a perfect latch will not lead to perfect sucking. Sometimes the sneakiest tongue ties (type 3 and 4 that no one ever notices) can cause worse tongue retraction and chewing of mom than the more obvious classical "heart shaped tongue" type 1. ... It's hard to get the pediatrician to go along and let the mom have a referral to a specialist, because some of them don't even "believe in" difficulties from obvious tongue tie! Sigh. Catherine Watson Genna, IBCLC NYC Occasionally it seems the result of "Karma" that I've read a Lactnet post on a condition that pops up in a mom the very next day: I just saw a mom-pp day 7- she'd developed deep nipple/areolar junction cracks by day 2 in hosp- all who saw baby during the first week observed great nipple shape, a great latch, great positioning, great transfer of milk, and extensive damage. By day 7, she had had to use form d/t nipple damage so severe that even pumping was causing more damage-(avulsion-type along the deep cracks)-she was on Dicloxacillin d/t beginning mastitis (no surprise there), and trying to hand express without success-now becoming engorged. On observation, baby had no observavble tongue-tie; closer exam showed tip mobility and elevation perfect but mid-tongue stayed flat and wide w/little ability to cup- I had just read the AAP link on tongue-tie recently posted-(Thanks Catherine- the pics are fabulous!) and I was sure this was a posterior tie. Since I couldn't see an obvious frenulum under the tongue, I didn't think we'd find a pedi who'd agree to clipping- Mom had tried n.shield during the week, but reported infant didn't like it, and mashed it flat, but agrred to try it again. Firts I inverted nipple shield deeply before putting on and popping it out so her cracks were well into the shield cylinder. I then got babe really well positoned obliqely across mom's chest with head tilted WAY back and jaw extended forward (what I've termed "Pez Dispenser" position)- she got on deeply bottom-jaw first, suckled without problems, and happily nursed- mom had NO pain for first time ever. Towards end of nursing babe tends to revert to mashing, but mom can tell immediately and detaches her. She still needed to express residual milk, and even with larger flange, it was extremely painful. So we tried pumping with nipple shield on- great result- expressed easily, no pain! I don't know if anyone's treid this, but it worked really well. Thanks Lactnet- Lucia Jenkins RN,IBCLC Wakefield, Ma "Never let the day see the setting sun without seeing some breastmilk run." *********************************************** 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(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html