Our hope is that this is just a sweet little piece of info so as not to overwhelm Docs who are not really familiar with the consequences of this issue.
Pam

Dear Pediatrician,

Re:

Short-Tight Frenulum

Baby:




Upon evaluation of baby's breastfeeding skills it has been noted that the baby has a short tight frenulum.  This observation was made by the International Board Certified Lactation Consultant  (IBCLC) or the Certified Lactation Counselor (CLC):


*        Type 1:  Classic heart shaped, anterior central tongue tip

*        Type  2:  2-4mm behind the tongue tip: Simple, short frenulum that flattens or bunches the tongue

*        Type 3:  Mid tongue attachment, not as elastic and tighter

*        Type 4:  Against the base of the tongue and is thick, shiny and very inelastic



This finding may contribute to poor milk transfer and prolonged and extreme nipple pain for the mother.   These factors can lead to a poor weight gain in baby.  Please consider this observation if any breastfeeding difficulties may arise during your continued evaluation of the mother-baby pair.


References:
American Academy of Pediatrics, Section on Breastfeeding, Summer 2004

Supporting Sucking Skills in the Breastfeeding Infants, by Catherine Watson Genna, Jones and Barlett Publishers, ISBN-13: 9780763740375, ISBN-10: 0763740373, July 2007

Ankyloglossia, Exclusive Breastfeeding, and Failure to Thrive (Gregory P. Forlenza<http://pediatrics.aappublications.org/search?author1=Gregory+P.+Forlenza&sortspec=date&submit=Submit>, MD, Nicole M. Paradise Black<http://pediatrics.aappublications.org/search?author1=Nicole+M.+Paradise+Black&sortspec=date&submit=Submit>, MD,<http://pediatrics.aappublications.org/content/125/6/e1500#aff-1> Elayne G. McNamara<http://pediatrics.aappublications.org/search?author1=Elayne+G.+McNamara&sortspec=date&submit=Submit>, OTR/L, Sandra E. Sullivan<http://pediatrics.aappublications.org/search?author1=Sandra+E.+Sullivan&sortspec=date&submit=Submit>, MD, IBCLC), Case Report published by Pediatrics, (Official Journal of the American Academy of Pediatrics),  Vol. 125 No. 6 June 1, 2010, pp. e1500 -e1504

Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial (Melissa Buryk<http://pediatrics.aappublications.org/search?author1=Melissa+Buryk&sortspec=date&submit=Submit>, MD, David Bloom<http://pediatrics.aappublications.org/search?author1=David+Bloom&sortspec=date&submit=Submit>, MD, Timothy Shope<http://pediatrics.aappublications.org/search?author1=Timothy+Shope&sortspec=date&submit=Submit>, MD, MPH ), published by Pediatrics,  (Official Journal of the American Academy of Pediatrics), July 18, 2011







Pamela A. Hendrix BA, RN, IBCLC
Lactation Consultant
Family Birthplace
Memorial Hosptial West
Lactation help line: 954-844-9908
All other calls: 954-844-6950
Portable cell: 954-844-3337


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