Dear Lactnet Colleagues
I would like to hear your thoughts on if bodywork is always needed for tongue tied infants. Tie released  at 18 days of age: no obvious asymmetry and mom says he's doing well transitioning back from bottle to breast. I will see them tomorrow--should I encourage bodywork/CST even if things are going well? 
Melinda Harris - Moulton ARNP Washington




Sent from my iPad

> On May 7, 2014, at 5:54 PM, "Jennifer Tow, IBCLC" <[log in to unmask]> wrote:
> 
> Mary,
> I work with a lot of TTd babies, too and I send every baby for bodywork before revision as well as post-revision. I think it's important to be honest with mothers and I tell them that the purpose of revision is to normalize function. There are three aspects to normalizing function. The first is bodywork, the second revision and aftercare and the third lactation support.  Without any one of the these components there is no reason to expect recovery. Releasing the tongue does not realease the fascial restrictions nor does it release birth trauma. This is why so many people think TT revisions fail. You would never undertake a surgical procedure that depends upon physical therapy if the patient refused to do the therapy. The same is true here. When you add the vacuum extraction (which is more likely to be a source of significant trauma than simply disorganizaton), this baby has little chance to regulate the nervous system, which in part depends upon release of fascial tension. My guess is this "alert baby who does not sleep" is stuck in a sympathetic state and will not be able to manage any organization until he can regulate transitioning between sympathetic and parasympathetic states. 
> 
> 
> Jennifer Tow, IBCLC, USA & France
> Intuitive Parenting Network, LLC
> 
> 
> 
> Date:    Tue, 6 May 2014 17:49:18 -0400
> From:    "Mary Jozwiak BS, IBCLC, RLC" <[log in to unmask]>
> Subject: Re: Resistant TT and Labial Frenulum case
> 
> No, no CST as of yet. It has been suggested. Mom is seriously overwhelmed with a 
> very alert baby who doesn't sleep much, and intermittent severe nipple pain plus 
> two surgical revisions.
> 
> A referral to several of the CSTs we work with will be offered tomorrow. 
> (Included in original case presentation.)  I don't blame new parents, who don't 
> have the same culture of those of us who are LCs to be given many suggestions 
> for things to be done to/for their baby that many have never heard of before. 
> There was some resistance to the DDS referral for the revisions (he had two on 
> two separate occasions, the tight labial frenulum first and then a week later 
> the posterior tongue tie) I have found over more than 20 years of practice that 
> resistance met with too much force results in shut down of many clients. I want 
> to keep the lines of communication open with this mom. 
> 
> I'm trying to respect this mom as much as possible. My intervention today most 
> likely prevented baby from being put on a bottle for a week to "let the nipples 
> heal." Mom is exhausted, near burn out and very frustrated. I have to tread 
> lightly at this stage. 
> 
> Gently offering a CST referral will be done. Obviously, this baby is mildly 
> disorganized due to the birth, the suction device used on his head, the deep 
> suctioning of his airway etc during a difficult birth. I hope Mom will take the 
> offer of a CST referral.
> 
> Thank you for weighing in. I appreciate it. 
> 
> Warmly,
> 
> Mary Jozwiak, IBCLC, RLC
> Board Certified Lactation Consultant, Post Partum Doula 
> Birthwaysinc. 
> Chicago IL 
> 
> 
> 
> 
> 
> 
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> 
> 
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