Laura,
Thanks for the info. I don't believe every TT needs revision--it's a matter of function, as you have assessed.  I am looking forward to hearing about the CST effects. Would you be willing to share the name if the provider whose assessment you trust? 
Melinda

Sent from my iPad

> On Feb 12, 2014, at 8:35 PM, Laura Spitzfaden <[log in to unmask]> wrote:
> 
> Thanks for all the feedback.
> 
> Pat, I am not ready to suggest lowering milk supply at this time. Baby has too many other issues that may be relying on oversupply (if Mom even has oversupply). I have found that during the first weeks of breastfeeding it is not a good idea to lower supply and that a full drainage in the morning helps most babies to handle milk flow and also gives information about supply. If mom expresses more than 5-7 ounces, first thing in the morning, I am more inclined to lean toward oversupply and if less, then I am more inclined to consider other reasons for poor latch, clicking and choking. I can also assess Baby's ability to handle a slower flow without compromising supply so early. By 3 months, things tend to regulate and Mom can drop the early morning pumping if the only issue was oversupply.
> 
> Jane and Melinda, I am concerned that Baby's issues may be due to structural issues outside of the frenulae. He has a very asymmetrical gum-line and I think some CST may help with latching issues and then we can see if the frenulae are still an issue and the parents can decide if they want to pursue revision. I want to see if the CST can help baby to open wider and I think the uneven elevation, lateralization and gum-line may indicate torticollis which may be at least a contributing reason for the poor latch.
> 
> I also am not convinced that he is tongue-tied. He elevates well and his frenulum is longer than the typical tt baby. I am fortunate, however that the provider I recommend to parents for revision totally has my back. She catches posterior TT even when I am not sure. If they go for the LT revision, I have every confidence that any posterior TT will be detected and revised.
> 
> Laura Spitzfaden, LLLL, IBCLC, APL
> 
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