Kerry writes:
have a local oral surgeon who clips straightforward stage 1 and 2 tongue-
ties.....but he has never heard of staging....or posterior tongue-tie......I
just referred a baby for a stage 3/4.....and he feels it does not need
clipping.......baby can't latch....doesn't have bad range of motionside to
side.....but has bunching when extends the tongue.....and can't maintain extention
beyond the lower gum ridge.....
~~
Cathy Genna can respond, but just to start off...The article about the
different stages or types, by Dr. Elizabeth Coryllos and Cathy was in the AAP
Section on Breastfeeding newsletter, so many physicians, even pediatricians who
do not belong to the AAP Breastfeeding section, probably have not seen it. You
could refer them to the link to it and let them read though and see what
they say. The link is @:
_http://www.aap.org/breastfeeding/8-27%20Newsletter.pdf_
(http://www.aap.org/breastfeeding/8-27%20Newsletter.pdf)
There are other articles by physicians in Japan, I believe.
Babies who cannot latch and breastfeed are not feeding normally. Since
breastfeeding is not recognized as simply normal feeding, many medical
professionals will say the mom can just pump and bottlefeed and that should be fine. Not
being able to maintain extension with a nice, wide open mouth often goes
with lack of elevation and also compromises the baby's ability to stabilize the
front, and drop the back of the tongue, which then means the baby cannot
generate that nice negative suction pressure that helps draw out milk gently but
powerfully. If the tie is really tight, they cannot latch at all, or they
latch but don't stay, or they latch and no matter how long they feed for they
can't get enough milk. They may compensate with compression, which means pain
for mom and often fatigue for the baby. On a bottle they may have milk loss at
the corners because as you said, the tongue can't stay forward to seal the
corners of the mouth, meaning they may also feed longer, mom needs to pump
more, they may have trouble with bolus control, and may spit up more, have more
GERD, etc. Babies whose ties are really tight, can have trouble with weight
gain even on a bottle, which is sometimes the only way the MD will say go for
the release. Getting a local professional to do it is the challenge then. That
is where sharing the article might help. Dr. Coryllos has actually talked to
other MDs at times and helped them learn this technique. It is more bloody
than the anteriors, and needs more time with pressure on the wound afterwards.
(4 minutes instead of 2). Healing may take a bit longer, and baby may do a
lot better right away, in a few weeks, or months, or it may not change much
at all. Usually at least bottlefeeding skills improve right away. Sometimes
there are other things going on which the release will not fix, like
torticollis, which may not be noticed because it can be quite subtle. As far as the
procedure itself, it is not really different at least with Dr. Coryllos. The
same local anesthetic is used, the same Mickey Mouse ears tongue elevator is
used to visualize the tie and stabilize for the release and someone (I have
assisted this quite a few times) who is not the baby's mom or dad gently but
firmly holds the baby's head still so the doc can do the release. It usually
takes about 2 seconds. Sometimes the deep, tight type 3s or 4s need a second
snip to get through if it is webby rather than a simple anterior string of
tissue.
Hope that is helpful.
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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