Hi Kristen,
I rarely see oral aversion in relation to post frenectomy stretches, but likely because I work closely with parents pre and post revision. I have seen aversion when the revision is done very early and bf is not well established, when parents are doing the stretches too aggressively, when baby is a 0-60/stuck in fight/flight and nervous system isn't regulated, and when there is no skilled IBCLC support for the bf family and the revision is done without any preparation. From my experience, aversion typically happens during the immediate days after revision, or possibly a week or so in. The aversion lasts at most a day or two (in the meantime, emergency measures like syringe feeding, dripping the bottle into the mouth are used). Being really diligent with pain relief and backing off frequency and firmness of stretches is important.
So to me, with your dyad, it would be good to parse out what exactly has happened with this family to see whether these factors leading to aversion were at play. The fact that aversion has occurred 6 weeks later, that baby won't feed from either breast or bottle and needs a tube -- it makes me wonder whether something else is going on. Babies are of course wired to eat. Is there some new illness, malacia, etc.? Was the revision done completely to begin with? Could oral function actually be worse?
My first suggestion would be to refer this family to an LC who has excellent training in structure and function, oral habilitation, and ties, to get to the bottom of what happened, what baby's oral function looks like right now, to be able to figure out where to go next.
Overall though, in this case I would suggest skin to skin as much as possible, frequent bodywork 100%,and rhythmic movements, to help baby calm down and regulate.
Katherine Havener IBCLC RLCStar Lactation Roanoke
On Saturday, December 4, 2021, 05:52:51 AM EST, Kristen Bell <[log in to unmask]> wrote:
Hi
Wondering if anyone had any suggestions regarding an interesting case.
Baby had tongue tie release at 2.5 months. Parents did the stretches after deeds for 6 weeks after.
All of a sudden a week ago baby decided to stop eating. Won’t take a bottle or breast will take a soother.
Baby had to be hospitalized to get a tube for feeding.
My initial thoughts is possibly oral aversion from 6 weeks of exercises after feeds. Baby is otherwise healthy no sickness happy and well
Any thoughts on how to get this baby to eat again? I suggested ski to skin and lots of access to breasts with no stress. Perhaps try dipping the soother in milk? Also suggests some bodywork and massage
Would appreciate any other thoughts.
Kristen
Kristen Bell. RN IBCLC
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