> Fingerfeeding for a few more
> days, some tug of war games with a gel filled cyllindrical pacifier to
> strengthen the tongue
>
>
> hmmm. this is new to me.  thanks! is this something that i could
> suggest or
> are there caveats involved and shoudl someone who's done it before work
> with mom?


Of course mom is not to do this if it upsets baby, but use it as a
prefeeding game (if baby is just slightly hungry, pick baby up at the
first wiggle or squeek) that might strengthen the tongue.  The mom
tickles the baby's philtrum area (above the upper lip) till baby opens
up, gives the pacifier, waits for baby to start sucking, then gives
gentle tugs to encourage the baby to tug back.  Can also gently twist
the pacifier very slightly clockwise, then very slightly
counterclockwise while baby sucks, to further stimulate tongue grooving.

I have also found that sometimes no amount of clipping fully fixes a
tongue tie, especially if the jaw is short and the entire tongue
attachment is more anterior than it should be.  Extreme asymmetrical
latch can help, a little sublingual pressure or support (on the soft
underside of the chin) during sucking can sometimes help the baby
organize tongue movements better.  And perhaps this baby will do better
with a Lact-aid than an SNS.  (I have pretty much switched to Lact-aids,
just have better results with them.  I just keep a few SNS's around for
moms who have used them before and don't want to try something new...)
 Since the Lact aid is not gravity fed, the baby really needs to suck in
order to get milk from it.  (If the baby is not capable, then of course
you want to use whatever gets the baby food.)

Other midline defects include abnormal positioning of the larynx and/or
epiglottis;  heart defects, urinary tract defects (specifically the
central organs- bladder, uterus (which is embryologically a part of the
urinary tract), penis, scrotum, or vagina), imperforate anus. There are
others, but I am not "up" on them all.
Good luck with this tough baby.  I agree with Barbara that maturation
often helps, and keeping the breast associated with food is very helpful
in the long run, at least in normalizing the situation for mom.
Catherine Watson Genna, BS, IBCLC  (who really should stop
writing/reading Lactnet and get some sleep).  'Night!

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