I can really empathize with Julie for much of what I see are babies with
posterior tongue tie (I have a very small private practice, unfortunately).
I've discussed the frequency with which I identify tongue tie with Dr Coryllos
and Cathy, and they assure me it is much more frequent than previously
thought. If baby cannot bring his tongue down and forward with wide gape and keep
it extended during feed, and an exaggerated asymmetrical latch doesn't enable
consistent tongue contact with the breast which then results in poor milk
transfer and/or mom's compressed nipples and resultant pain/damage, then
clipping of the frenulum seems warranted. A submucosal lingual frenulum may take
two snips, the first one being made in the mucosa to get to the frenulum for
clipping.
I have found that finger feeding or for that matter, bottle feeding, gets
baby fed and parents report the tongue stays over the gum line with these
alternative methods, but that's because these methods don't require the necessary
sustained wide gape that breastfeeding does. Upright or prone positioning
can help bring baby's tongue forward but if this still doesn't enable pain free
breastfeeding and good milk transfer, then evaluation for frenotomy and
clipping can help. I'm assuming this baby is doing well with supplementary
feeding now, so that lack of calories and low energy can be ruled out as cause
for ineffective suck at breast. In my experience, most babies who have
restricted tongue movement and struggle with feeding do benefit from frenotomy
though, depending on age, and other confounding factors, may also need tongue
strengthening exercises afterward and continued work on improving latch. Some
babies get by without frenotomy when mom has a very robust milk supply that is
sustained over time, but these babies tend to have reflux, still pop off the
breast repeatedly and mom still has flattened nipples that moms report to me
just seem to stop causing pain despite distorted nipple shape. Then there's
the situations where weaning occurs due to untreated tongue tie and that, of
course, is so sad for both baby and mom.
Hope this helps and feel free to contact me off list for further discussion,
if this would be helpful to you.
Barbara Latterner, BSN, RN, IBCLC
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Date: Tue, 15 Jan 2008 22:10:56 -0800
From: Julie Johnson <[log in to unmask]>
Subject: How to help a posterior Tongue Tie
I can't figure out if I am wanting to blame severe breastfeeding problems my
clients have on posterior tongue ties or that I am getting good at noticing
them and getting them addressed. It seems like I see one baby a
week lately that has all the symptoms and concerns of a 3-4 degree posterior
tongue tie. I haven't been able to get Catherine's book on sucking issues
because I am getting ready for surgery and won't have a brain.
I have a 37 weeker who I first saw on day 4...not voiding, losing weight and
looking jaundance. Mom had sore nipples. We worked on getting moms milk
supply up and lots skin to skin and taught finger feeding to bring in more
calories. Baby would just fall asleep after a few sucks at the breasts but thought
that this baby was just weak from not getting enough food. Now the parents
called today...a week later. Said that the baby
loves the peridontal syringe and cries at the breasts and the few times he
does latch on, the nipple looks like a lip stick afterwards and mom has scabs
on her nipples. Baby does have a bubble palate, a labial frenelum
but his lip can be brought up to his nose and a short, bunched tongue that
likes to stay back The tongue comes out very little. I do not see any membrane
there. Looking up the archives, Catherine mentioned that even with the 4th
degree all it does take is a small snipe at the bottom of the tongue. I know
that the asymmetrical latch helps, but I haven't had much luck with it
personally in these situations. Anything else that may help this mom and baby? Other
than sending her to a ped ENT? Am I jumping to conclusions that all these
babies can have posterior tongue tie? If they fit under all the criteria that
Catherine Watson Genna has provided. I know that Catherine is taking a break
from lactnet at the moment and I appreciate her insights to this but anyone
else find success for a mom and baby with a posterior tongue tie without
snipping? This mom and her partner are the most gentle, patient people I have ever
encountered. They will do anything to make this work.
Thanks again.
Julie; IBCLC
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