It has been a while since I have posted but I need help with a client with a 7+ wk old who had a frenotomy for a type 4 ankyloglossia at 6 wks (office procedure, no anesthesia.)  Baby still has a chomping, vertical suck, a very small angle when suckling at breast and mom still has very sore nipples.  Mom does not want to stop breastfeeding, even temporarily to heal, and is having mood issues so I'm treading lightly.  Mom's milk supply is a little low and is supplementing with a small amount of formula after most feedings to keep baby's weight up.
Baby has much more motion to the tongue since frenotomy (extends past lips, lateralizes) but I still have not witnessed the baby touching the tongue to the roof of the mouth.
I sent mom home with the following plan:
-watch to see if baby uses tongue to touch roof of mouth
-mupirocin to nipples
-take some feedings off to heal nipples
-continue bottle feeding with expressed breast milk and/or formula if baby seems hungry afterward (slow flow nipple)
-tried a 24mm nipple shield to reduce mother's pain
-cranio-sacral therapy for baby
-counseling for mom for mood issues
Does anyone have other ideas?  
Thanks for your input.
Annie Brown, FNP, IBCLC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome