Linda shares one down side of sharing reports of consults with physicians.
It can and sometimes does, provoke angry responses when there are
differences of opinion.  Careful wording is essential, as is a clear
understanding of where the line between specialties is, and of course, tact.
I have learned that brief citations of research helps a lot in situations
that I suspect will be controversial.   If a physician phones me upset about
a report (which sometimes happens) I offer to send the relevant research
that underpins my assessment.  Then I do send it, with a very friendly note
thanking the doctor for the opportunity to share ideas.  One can't always
make others happy; so in these situations, simply being careful that you can
back up your practice with evidence is essential.  If there is no evidence
and I am sharing experience, I say so:  "It has been my clinical observation
that..." etc.  Below is a section of one of my reports on a tongue-tied
baby.

Baby X's affect at breast is unusual, and he feeds unlike Mrs X's other
children who gained weight robustly at the breast.   His jaw excursions are
short and choppy.  Scant swallowing occurs.  He falls asleep at breast after
a few minutes (once the milk let-down subsides.)  When removed from breast,
he cries.  During some 24 hour periods the mother has logged as many as 20
breastfeeds, and yet the baby's weight gain averages 2-3 oz/week and he
appears thin and distressed.  At the feeding I observed, the baby took a
total of 2.2 oz  in a 2 hr period that was marked by almost continuous
feeding.  (Weights performed on a scale sensitive to 2 g.) I observed that
the  baby has a moderate tongue-tie.  The frenulum is short and attached at
the mid-section of the tongue.  Both extension and lift appear compromised
by the lack of full range-of-motion. The pediatric literature describes
impaired breastfeeding ability in a percentage of tongue-tied infants
(Messner, 2000; Ballard, 2002.)   Evaluation by a pediatric ENT might be
useful to ascertain how much the tight frenulum is affecting X's feeding
behavior.  Maternal milk supply has down-regulated over the first 4 weeks
postpartum, probably due to the baby's poor milk removal capability,...

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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