If all is going very well for a tongue tied infant and mom with 
breastfeeding, I just encourage mom to be watchful and make sure she's 
allowing baby to feed often enough and for as long as he needs to 
(tongue-tied babies who are using compensatory tongue movements are not 
as efficient, and generally need longer times to feed, and sometimes 
more feedings per day). If mom understands this, all can be well for 
breastfeeding.

If the palate remains narrow, mom can be advised to consult with an 
orthodontist when her child is 10 or 11 years old. The palate can be 
expanded then (maxillary expansion is the name of the technique). If a 
baby is breastfeeding very well but has a narrow palate, I will 
encourage mom and dad to remember those two words for the future if 
still needed.

Another possible concern is that alternative tongue and jaw movements 
may cause facial pain later in life (TMJ syndrome, trigeminal neuralgia, 
and chronic "sinusitis" are all just beginning to be investigated in 
terms of the muscle activation used in chewing motions). There are 
several ways to activate the facial muscles to open the jaw, close the 
jaw, etc. and perhaps some of these are better than others for long term 
comfort and health. There are a few recent EMG (electromyogram) studies 
that examine these questions, but none that factored in whether or not 
the subjects were breastfed, or whether or not they have a tight lingual 
frenulum. This is an avenue for future study.

Until we know a lot more, we don't know how to counsel parents of 
children who are breastfeeding effectively in terms of frenotomy for 
prevention of future problems. I generally encourage parents to look at 
Dr Brian Palmer's website (http://www.brianpalmerdds.com) and decide for 
themselves.

My own feeling from the outcomes I've seen so far is that if the palate 
is relatively normal and breastfeeding is going well, leave it alone; 
but if the palate is very narrow that can cause difficulties with room 
for the teeth and restrict the nasal airspace and frenotomy may help 
reduce future problems.

I usually refer babies right away for evaluation:
if we can't get the latch comfortable for mom using good technique
if baby can't keep tongue tip over gum ridge consistently while sucking 
a (gloved) finger
if baby has little ability to elevate his tongue tip (more likely to 
cause speech problems later)
or if baby has a very abnormal palate (which means the tongue has done a 
very poor job of shaping it).

Catherine Watson Genna, IBCLC NYC

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

Archives: http://community.lsoft.com/archives/LACTNET.html
Mail all commands to [log in to unmask]
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or [log in to unmask])
To unsubscribe: unsubscribe lactnet or ([log in to unmask])
To reach list owners: [log in to unmask]