Pam,

You are correct in what this Neo told you.  I was the original LC that found
the tight frenulum in one of the twin babies in the NICU.  I work the
evening shift and did mention this to the NICU nurse who did say she would
pass it on in report to the next shift.  Our policy has always been that we
notify the doctor and go through either the Ped or Neo if it's a NICU baby.
At that point, I assumed it would also be passed on to the Neo too.  At that
time, I didn't think of it as a huge issue.  Just something that should be
addressed at some point before the baby went home.

I was then off work for a couple of days.  One of the other LCs was the one
who did give the parents the name of an ENT.  The parents called the ENT on
their own and the ENT called the NICU asking to see the baby.  This was
where the Neo felt "out of the loop".  Another issue:  These parents had had
a "run-in" with one of the Neo docs--I don't even know what about.....so I
wonder if that is also part of this situation.  I suppose there was more
than one break down in communication.  The NICU nurse prehaps didn't share
what I found with the Neo, or perhaps he was made aware and wasn't focusing
on it as an issue at the time.  Not sure what else transpired.  I do agree
however, that we should work as a team and that the policy has always been
to work as a team.  The LC who gave the ENT name, told our supervisor that
"she didn't realize that she needed to go through the Neo".  Interesting, as
that has always been the policy.

So, a big note went up to the Lactation Department as the NICU nursing
supervisor went to our supervisor and told her that we were not to discuss
or diagnose this without talking to the Neo or Ped first.

I do want to say that the Neonatologist did talk with our supervisor and
there was some good dialogue and "clearing of the air".  Mainly, being that
we should all work as a team and that it made it look like we weren't!

That being said, I have had mostly positive experiences in talking with the
doctors, also describing the action of the tongue and explaining how it is
affecting breastfeeding.  I have had Pediatricians change their mind even
when they told me they "didn't believe that it affected feeding".  There
have also been a few that have resolutely stated:  "We don't clip tongues
anymore."  That is when I have given the parents the name of our wonderful
ENTs and tell them when they are discharged to seek a consult.  I personally
do always want to network with the doctor, and even if he/she doesn't agree,
still want the parents to let their Pediatrician know that they want an ENT
consult and why.  I always offer to answer any questions the doctor has
about why I feel the baby is having trouble with breastfeeding and offer
more information.

Thanks for your note!  Also, thanks for the other information others have
posted!  Hopefully, a more positive team approach will be the result of the
recent turn of events.

Connie Chiavario, IBCLC
Rush Copley Medical Center
Aurora, IL

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