I also seem to see a lot of little tongues that aren't quite doing their
jobs. But then, no one calls us to say how great breastfeeding is going
-- by definition, we're seeing little muffins in difficulties, and the
tongue is a major factor in breastfeeding.. But I'm always hesitant
to confidently peg the problem as a tongue-tie, particularly the more
subtle ones. (I'm hoping that Catherine Genna Watson's new book will
build my confidence on that topic.) It seems to be so difficult to get
even obvious tongue-ties clipped, I'm so afraid of sending parents on a
hopeless mission. Would Dr. Coryllos be interested in starting a
franchise -- one of her in every major city?
If breastfeeding isn't going well,, I might say (probably also stolen
from someone) "Each mother and baby fits together in their own way --
breasts are shaped lots of different ways and there's lots of variation
in babies' oral anatomy. And some combinations require more fine-tuning
to get a comfortable fit." Then I will point out whatever seems
unusual, like "see, when he cries, his tongue stays curled down in his
mouth. It seems restricted in how far it can move."
Then we try really hard to make the anatomy we have on both sides work.
"Maybe if we experiment with rolling a great big mouthful of breast in
deep, he'll be able to compress and milk the breast without having to
lift that tongue so far, and without pinching you so painfully." Diane
Weissinger's hamburger analogy ("See, a couple years from now you'll be
telling him not to take such a big impolite mouthful,"), and Rebecca
Glover's very asymmetrical approach -- tipping the nipple up and having
a big pouch of areola precede the nipple, which flips in last, with the
finger assisting -- can get a lot of breast in there, and often the
mother will note a big improvement. (Hands-off, baby-led attachment is
probably optimal when a mother and baby are just starting out. But I
admit to being more hands-on, with permission, when mothers have been in
pain for days or weeks -- sometimes we have limited time to convince her
that they can fit together so it doesn't hurt.)
Anyway, I feel that this approach covers me. I've raised the
possibility of the tongue being the issue, without making it sound dire,
final and hopeless. It reinforces to the mother that she and the baby
are a unique combination of two different human beings. If we can make
it work with adjustments to the latch, then she feels she has
successfully worked out a individual challenge with her little partner.
If we can't make the fit work, it seems logical to proceed to talking
about a further evaluation of the tongue, because the topic is out on
the table already.
I do sometimes wonder, even if we can make breastfeeding work ok with
exaggerated asymmetrical latch, how vehemently to to encourage parents
to take further action on the posterior tongue ties, because of the
potential for longer-term issues.
Margaret Sabo Wills, LLLL, IBCLC Maryland
(who's written more in one day than in a year of largely lurking)
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