Hadassah,
The key reason I no longer post on the LN Listserve is bc of smack-downs like this when someone asks a question.
I've been helping mothers breastfeed for almost 30 years and I'm very good at it. But, 25 years ago, when tongue-tie started to really come on my radar, it was all about a simple snip. I had just started to really learn from Dr Coryllos, when I sent a baby for a scissor release to the ENT I always referred to, and that baby never nursed again. That was 13 years ago and it was a huge awakening for me as to how much I did not know about tongue-tie, structure and fascia. Through digging it to understand posterior ties, I finally began to understand my own 5 year breastfeeding journey with my daughter whose tie had gone undiagnosed. I began to understand how these ties impacted the whole body and how they were different from what I had been taught a tie was.
I think because I had already been working with a chiropractor and other bodyworkers for a decade at that point, I was very much aware that there is much about neuro-muscular function and fascia we didn't know. I saw babies nurse who have been unable after one or two chiropractic adjustments over and over again. I began to be aware of how much lactation skills are simply support for compensations, that never allow the baby to achieve functional competency. But, I also saw many babies who could only nurse once ties were released. I asked Cliff O'Callahan to release ties, because no one in CT was doing posterior release or lip ties and I had to send them all to Dr Coryllos. I saw the difference in outcomes immediately. So did he. We tried to be as "conservative" as possible, but kept having to send babies back for whatever release hadn't been done. We got babies who were FTT eating and got babies off feeding tubes. It became very obvious to me, as we formed IATP and continued to learn, that it takes a team to attain function.
Dr Coryllos did only scissor release and referred all toddlers and older children for laser release. Laser does not cause a burn. At least the Co2 does not. But, if we don't change the neuromuscular wiring, we aren't going to improve function. Just making function possible (which is really all the release does) does not make it happen. We need oral exercises (not the same as what are referred to as "stretching") and bodywork before and after release. We often need reflex integration. And we need to keep the tongue elevated, but I never use the term "stretch", bc no stretching is being done, just a simple elevation. I see a lot of incomplete scissor releases where babies never gain full function and the mother is still compensating for the baby. Too often, I see the assumption that the release is all that's needed. I see a lot of ineffective laser releases, too bc anyone with a laser (or pair of scissors) can release with little training and no collaboration. I think there are now more poorly trained release provider out there than well-trained ones, all across the globe.
When I became a myofunctional therapist in 2013, in my clients at every age, I saw the consequences of leaving babies to compensate. I saw kids who'd been in speech therapy for years no longer need therapy once ties were released. I saw kids breathe and sleep better, focus better, no longer be labeled "picky eaters" or "ASD" or even "ADHD". Tongue-tie release is not overblown or overdone. If anything, the opposite it true.
If we believe only 4-10% of babies are tied (which I do not), we can still see that we are under-diagnosing and undertreating. If ONLY 4% of babies have TT, that would mean that 40 of every 1000 babies born each year would need a TT release. The study from Australia, lamenting that TT releases have unnecessarily increased by 420% in children *ages 0-4* between 2006-2016, from 1.22 per 1000 to 6.35 per 1000 argues that too many babies are being released. But, if you take that 4% and apply it to those numbers, the real conclusion is that only 16% of those 4% are even being released. We are under-diagnosing and under-treating and parents are rightly angry.
Tongue-tie has whole body consequences and cannot be addressed with a simple procedure. It needs integrative whole body habilitation. It is so discouraging to see babies every day whose mothers have been told there is something wrong with them or their bodies, that their babies are not tied, that a tie is "minor" and not affecting feeding, that there is no such thing as buccal ties (I have seen several babies now who were FTT until their buccals were released), that bodywork is not "evidence-based" (neither is much of what is done in many fields of medicine). It's difficult to haul these families back from the brink many months later because HCPs do not want to believe mothers or bc of territorial battles with dentists.
If I had known my own daughter was tied, her entire childhood would have been different. Breastfeeding was hellish with 6 bouts of mastitis, she hated to nurse bc she was constantly waterboarded, she swallowed air and had reflux and was miserable whenever she ate, her sleep was horrible and she could not tolerate a carseat. And yes, all of it, every symptom, was a consequence of that oral restriction. That translated into many myofunctional disorders that only resolved when she was finally released at 19. So many mothers like me have similar stories, and it's just not ok to minimize them because we don't want to believe they are real.
I have never had a baby who did not have oral aversion prior to release refuse to nurse after a laser release. I do not think a competent release can cause oral aversion, but I do think failure to provide pre and post care can and does.
In my practice, I do what works clinically. All babies are given oral exercises (not only suck training, which many don't need) and referred for bodywork before release and they are followed up until feeding is functional and competent, not compensatory. That means they see someone who releases all the ties, including buccals when needed and they do wound care as well as reflex integration and all intervention we need to eliminate compensations, normalize milk supply and address any inflammation or food intolerances. Because it's very rare that any baby only has a tongue-tie and no other issues to be addressed. I really dislike sending rebased babies back for more release, but I often have to bc of failure to do any oral exercises BEFORE and after release, failure to do bodywork and failure to do wound care. I am not alone. This is a common lament among very experienced private practice IBCLCs like me.
So, to Hadassahm, sure you can do oral exercises and bodywork months later, but more than likely if it wasn't done before, the new frenum is short and restricted like the original one, in which case a second release might be necessary.
Jennifer Tow, BFA, MA, IBCLC, RLC, CSOM
Intuitive Parenting Network, LLC
Holistic Lactation Consultant, Holistic Health Coach (focus in nutrition), founder Holistic Lactation Institute
| There is absolutely no objective evidence that stretching underneath a tongue after frenotomy is necessary or even helpful. I have done hundreds of frenotomies with scissors, and never asked anyone to stretch after.
We do not know…maybe laser frenotomy causes more inflammation (as it is a burn, not a slice) and causes more scarring. There is no research on that either. But stretching months later will certainly not be helpful.
Please stop recommending torture of babies by manipulating burns in their mouth. It has to be very painful, and has caused oral aversion/refusal to eat/failure to thrive in my community. There is not other situation where stretching a wound after a surgical procedure is recommended. IF the baby is using their tongue correctly, they will naturally stretch it by suckling. It is my opinion that the babies who “reattach” or “scar down” do so because their tongue is not functioning normally, even post-release.
I have been doing bf medicine for 18 years. Frenotomy can be helpful in babies who truly need it! But the frenetic overuse of laser frenotomy for tongue and lip tie (and buccal tie????) has caused a huge backlash against frenotomy in the medical community that saddens me. Posterior frenulae are very common, but not always the cause of breastfeeding difficulty.
Stepping off of soapbox…
Kathy Leeper, MD, IBCLC, FABM
Breastfeeding Medicine Specialist
Medical Director
|
Date: Tue, 18 Jun 2019 21:20:20 -0400
From: Hadassah Mann <[log in to unmask]>
Subject: exercises after frenectomy-delayed
i was in touch with a mother today who's baby had a frenectomy about 2 months ago at 3 months of age. she was not advised to do any stretching or exercises after (no comment...). is it to late for her to affect any change by doing exercises? i have not seen baby as he is in a different location. thank you
Hadassah Mann, IBCLC
(513) 999-6162
www.MilkyWeighLactation.com
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