Mary Kay,
I will stick my neck out with you. I have had many frenulum cases over
the past 10 years, and although I do not always use them, I find that a well
fitting nipple shield saves the day. The shield is longer than the nipple,
saves a lot of wear and tear, and puts a descent amount of pressure on the
tongue. I have had some instances where due to mother and baby anatomical
issues there would not even be a latch without it.
Most recently, a relative gave birth to a tongue tied baby with an
overbite. The upper gum is clearly 2 cm over the lower gum. Babies tongue never
clears the lower gum. Mom's nipples do not protrude very far. One nipple is
borderline flat. I set her up with nipple shields immediately. Milk supply
is in, and the shields are full of milk during feeds. When I work with my
mothers, I do not always have the same exact care plan for each case, but I
am not afraid to use a nipple shield to perpetuate breastfeeding. We all know
what it is like to work with a mother who has reached her LIMIT, and how
frustrating it is for anyone to go on at that point. Nipple shields help these
mothers move on. Paula Meier's research indicates that premie babies may
actually gain weight better with them. I feel that a nipple shield used in the
appropriate time and manner make a BIG difference until a frenotomy is
performed.
My relatives case was further complicated by an early case of thrush
because she was pumped with 2 grams of Ampicillin during her delivery. So we
started an over the counter version of Dr. Jack's cream (equal parts
polysporin, monostat, and cortaid--thanks Pat Lindsey!). Anyhow, not every case will
involve thrush or mastitis, but they do tend to come up because of the wetness
and abrasion.
The psychological part of this process is almost as important as the
physical. Besides needing to protect the nipples from wear and tear
(literally), mom and dad need to come to grips with the decision to do this procedure.
Although LCs know how important they are, doctors and parents aren't always
convinced. Many parents go through a form of denial. As soon as a procedure
is mentioned, they fight it. I had one mom have a melt down and scream that
she was not cutting her son's tongue! I am sure that I am not the first LC
to deal with a ped or parents who don't see the value of the procedure. Often
our opinions are not as valued as the doctors. I have been lucky in my
relative's case, because her ped has been so supportive that he is actually
conversing personally with the pediatric ENT that will do the procedure, but we
all know that all cases don't work that way. For me, it is important to have
doctors that will provide the right information and care. One of my mom's
went to an ENT on her med plan, and he told her he won't do the procedure until
the baby is 6 months old. There goes the breastfeeding! I also heard that
another will not do the procedure until the baby is 10 lbs. Why can they do
a circumcision on 4 and 5 lb babies, but not a frenotomy?
When providing info to parents, I use Brian Palmer's Frenum Presentation
_http://www.brianpalmerdds.com/frenum.htm_
(http://www.brianpalmerdds.com/frenum.htm) , articles about tongue tie from different sources, and I provide
referral's to pediatric ENTs. Most importantly, I provide a list of mom's who
have gone through the procedure, and offer themselves as support. The
frenotomy is not the magic bullet, but it is definitely a great start to an
upward trend. However, it doesn't work without follow-up and support.
To me a tongue tie care plan requires a combination of physical,
psychological, and educational endeavors. Every success story makes it worth all
the effort. My relationships with these mothers often turn into rewarding
friendships because we have worked hard together and they manage to successfully
breastfeed despite the difficulties.
Debbie Albert, RN, Ph.D., IBCLC, RLC
Tampa Lactation Counseling
Tampa, FL
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