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Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 8 Feb 2001 08:22:43 -0600
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Linda Tandy wrote about finding refs for the ped.  The best is the Anna
Messner article (which is in the Lactnet archives).  I and others have
written numerous posts about this issue, also in archives.  Briefly, the
thing I have seen that best educates docs is a very short LC summary sent to
doc immed. after consultation that describes the problem:  "Baby has tight
lingual frenulum that is attached at tongue tip.  The characteristic
distortion of the the tongue tip when infant attempts to elevate the tongue
is present.  Due to limited range of motion of the tongue, the infant
appears to be compensating by applying increased positive and negative
pressure to the fragile nipple tissue to hold the breast in the mouth and to
strip the gland.  Mother has blisters along a crease line across the face of
both nipples that are inflamed and painful. This tissue damage and pain
during bfg has persisted after attempts to re-position the baby.  She was
advised to seek further consulation from her medical care providers for
remedy of the baby's restricted tongue."  Then I'd include the first pg
(abstract summary) from the Messner article.

The rest of the info I'd communicate directly to the patient, who is
completely at liberty to seek solutions (which it sounds like she did).  The
patient should be encouraged to tell the doctor that the bfg. didn't work
and hurt her prior to the frenotomy, and worked for her and the baby after
it.  It was the feedback from pts that has changed the minds of more doctors
I know than anything I said.

BTW, I had a doctor tell me point blank that it was her perogative to tell
her pts about referrals not mine.  I agreed, said "yes, m'mam, it won't
happen again."  I write her LC reports as above.  I don't tell her pts "go
see so and so" but I still describe the problem and the solution, and when
enough pts go back to their MDs and say "The LC told me to ask you what to
do next" then there will be some pressure on the MDs to come up with some
solutions.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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