I have permission to post.

I have been helping a mother who has suffered from very sore nipples and thrush.  Her 1 month old infant takes 40-50 minutes to feed and frequently leaves her nipples mis-shapen after feeds.  He also wakes up screaming and arches away from the breast with frustration.  He nurses approximately 10 times a day.

He lost 11% of his birth-weight but was back up to birth-weight at 12 days with exclusive breastfeeding.  His weight gain since then has been slow averaging 3.9 ounces per week.

We tried biological nurturing positions to some advantage.  Mother's nipples looked good after the one feed I observed.  Later that day the mom let me know that it was their most difficult day yet.  Laid-back feeding was frustrating the baby and her nipples were sometimes compressed so she alternated positions to keep baby happy.

I examined his mouth to look for any problems and discovered that he leaves his tongue on the floor of his mouth when crying.  His tongue will cover his lower gums but doesn't reach to his lower lip and it appears short.  It was very difficult to do an oral assessment because he wanted to latch onto and suck my finger even after he had fed.  I was not able to determine if he could lateralize his tongue because he just wanted to latch.  I was able to sweep under his tongue and I felt a very tight frenulum.  I was also able to see it far back at the base of his tongue.  I also found that he has a very thick labial frenulum that has a wide attachment at the gums.

I recommended that the mom ask for a referral for an evaluation for a possible frenotomy.  I let her know that I think he has a type 3 or possibly type 4 tongue tie.  Her doctor did not think there was a problem but mom was very persistant and her physician agreed to refer her to an ENT who agreed to a lingual and a labial frenotomy.

I recommended the tongue lifting exercises and sucking exercises to mom for after the frenotomy but her ENT told her that the tongue lifting exercises are unnecessary with laser frenotomy.  I told her I would check with all of you to see if he is correct or if she should do the exercises.

Thank-you!
-Laura Spitzfaden LLLL, IBCLC

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