>
> Dear Annie,
>
>
>> I work with quite a few tounge ties here, and we find a nipple shield
>> (24MM) works nicely as it stablizes the tonge and keeps it from re-injuring
>> the  nipple and some times they need to continue the use after a clipping.
>>  We do pre/and post weights and they are more than adequate with the nipple
>> shield and monitor overall infant wt. gain once a week. Also making sure the
>> chin is up and some-what over-extended seems to help, many times positioning
>> is easier when using the Breast Friend Pillow. If mom is suppleimenting with
>> formula then she needs to pump. Sometimes when explained to the family that
>> this baby's tounge had 9 months of continuous use in one motion it takes
>> time to change the muscle memory(Imagine how strong your Abs would be if you
>> could do continuous crunches :) )The suggested at home care plan is to BF on
>> demand, pump after feeds and supplement if needed using whatever method the
>> family is happy with. If they choose to use a bottle we suggest a slow flow
>> with wide base and also reinforce positioning with the chin up and somewhat
>> over-extended..
>
> Using the nipple shield the nipple will heal and breastfeeding with be much
>> easier, less pain and as the baby gets bigger and the tonge learns to extend
>> out they should be able to wean of the shield.  I missed the Dec. 13 post
>> and unless mom has raynauds, the nipple shield should ease the blanching.
>
> Good Luck,
>
> Karen Querna, RN, BSN, IBCLC
>
> Spokane WA USA
>
>
>>
>>
>> On Sun, Dec 27, 2009 at 9:00 PM, LACTNET automatic digest system <
>> [log in to unmask]> wrote:
>
> There are 6 messages totaling 320 lines in this issue.
>
>
>> Topics of the day:
>
>
>>  1. sore nipples after frenotomy
>
>
>
>
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>> ----------------------------------------------------------------------
>
>
>> Date:    Sun, 27 Dec 2009 11:35:32 -0500
>
> From:    Anne Brown <[log in to unmask]>
>
> Subject: Re: sore nipples after frenotomy
>
>
>> Many thanks to those who posted replies to my request on Dec 13.  The
>> suggestions were very helpful and mom was receptive to most.  To follow up:
>>  two weeks later, mom still has sore nipples (blisters now) but still
>> reluctant to stop BF and give expressed milk via alternative
>> feedings...despite my encouragement.  Mom on mupirocin for damaged nipples
>> and nifedipine for continued vasospasm.  Mom never tried nipple shield.
>
> Baby still chomps and still cannot lift tongue to top of mouth so she was
>> sent back to ENT who did the original posterior frenotomy.  ENT clipped the
>> tongue again, said that the frenotomy site had scarred over, limiting
>> movement.  Baby is doing CST with some improvement.  Baby's weight is fine,
>> she gets supplemented via bottle with either EBM or formula after some
>> feedings.
>
> I suggested for mom to run her finger under the tongue frequently to
>> prevent the open area from healing upon itself again.  Mom is doing pacifier
>> pull exercises and I will meet w/her tomorrow to teach her how to use a
>> finger feeder.
>
> My questions:
>
> How often should mom do pacifier pull exercises?
>
> Can someone describe the best way to finger feed this baby to help the
>> tongue move better?
>
> If this is not successful, should this baby get a frenectomy?  Does anyone
>> in the CT-NY area do them without anesthesia?
>
> Any other ideas?
>
> Thanks so much, sisters,
>
> Annie Brown, FNP, IBCLC
>
> Greenwich, CT
>
>

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