Re: Help needed before morning...

[Guest guest]

And now -- baby wants NOTHING to do with breast... Apparently, he screams when brought to breast, will barely latch and if he does, it is for a second and then stops. I am to have a followup tomorrow and am just at a loss of how to approach this... all ideas welcome! Thanks, Ann

Do NOT attempt to put baby to breast. JUST do STS -- for as long as mom is willing to do it -- an hour or two at a time, several times a day. Let the baby lead totally as to when he is willing to bob over in that direction and see if after a few days of JUST STS with no "putting" to the breast he'll go on his own. Have her get in the tub w/ him, let him relax on her abdomen with daddy slooshing warm water over both.

Continue to pump and feed however she has been doing it.....

Ann, these are tough ones, and mom always wants you to fix it NOW. Good luck!!

Jan BLactation Education Consultants My blog Year of the MC See what's new at AOL.com and Make AOL Your Homepage.

[Guest guest]

This baby has had trauma to his mouth on top of the discomfort, fatigue, frustration with how it used to work. Now it really hurts. It takes 3-4 days for the tongue to heal according the Dr. Betty. However, I did a f/u assessment today on a baby whose Type 3 had been clipped on Thursday. 5 days later, when I did a gentle sweep under his tongue, his saliva was still slightly tinted with blood on my finger. So, my guess is that it actually takes maybe 7 days or longer for complete healing.

When a TT or formerly TT baby goes on strike you need to do all the things that help the baby know mom is a good and safe place to be. STS, Baby lead breastfeeding, cobathing, all the things that have been pointed out already.

In addition, he may not make the connection between an untethered tongue and an improved ability to breastfeed. The muscles of his tongue are over- and underdeveloped and need to be balanced and he needs to be encouraged to repattern his sucking. CST will help this.

He probably still has a Variation in Infant Palate (VIP). I find a huge number of high, domed palates and a much smaller number of bubble palates, but usually some variation. These will make breastfeeding a continuing source of frustration. CST helps to gently reshape the palate.

So, CST is definitely an important tool in your box.

Finger feeding might help, especially if he has only had bottles before. OR use whatever feeding method mother has been using and that he will accept. What we have also found is that there is a lesser degree of success among women who do not have sufficient milk production. These babies have no patience for really working the breast at first when it is still a challenge.

Also, if baby is not put to breast rather quickly after the clipping and breastfeeds fairly regularly post op, it is possible that the tongue may not stretch as far as it would if the baby had been breastfeeding and you may get the wound healing in exactly the same shape as before it was clipped, in other words, not a big boost to ROM.

So, you might want to try some FFing to see if that will help the tongue extend and groove more than a bottle would.

What a colleague and I have found w/ posterior TT babies is that these babies present with many more problems than babies w/ anterior TTs. I think it is because of the over- and under development of the tongue. And it is harder for them to put the fact that they now have greater ROM together with the suck/swallow process.

The longer it has been for release to occur, the greater the difficulty afterward. Think about it: if the tongue forms somewhere between, what the 7th to 12th week gestation, that is a huge amount of time for this baby to be maneuvering the tongue under these conditions.

I had a client early on whose baby started to strike shortly after I had assessed the TT. It took us almost 5-6 weeks to get it successfully clipped (needed to do it 2x). Baby was striking before and after. Mom was doing intensive STS, cobathing, before clipping and after and also seeing a CS Therapist.

She was FFing, and had been since my initial consult, so I told her not even to attempt to put baby to breast nor allow her to go to breast until she was seeing/feeling the baby consistently extending and grooving her tongue and dropping the posterior tongue. Once that was happening consistently, she could start encouraging baby to take the breast b/c the baby would use these skills at the breast and realize it was different now.

It took her 2 weeks past clipping to achieve this. We talked almost every day. I told her it would happen even when I doubted it myself. I just knew if any baby would do it, it would be this one b/c the whole family was involved: dad, big brother and big sister. And this mom was doing everything to encourage the baby...not force, but encourage.

Hope this helps, Ann.

Ann , who has the dubious distinction of having a practice almost exclusively involved with posterior TTs. They're everywhere, they're everywhere.

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[Guest guest]

yes - baby led latch for sure - that was going to be my exact recommendation.

[sPAM] Re: Help needed before morning...

In a message dated 10/30/2007 8:05:48 P.M. Central Daylight Time, aconsmithaol writes:

And now -- baby wants NOTHING to do with breast... Apparently, he screams when brought to breast, will barely latch and if he does, it is for a second and then stops. I am to have a followup tomorrow and am just at a loss of how to approach this... all ideas welcome! Thanks, Ann

Do NOT attempt to put baby to breast. JUST do STS -- for as long as mom is willing to do it -- an hour or two at a time, several times a day. Let the baby lead totally as to when he is willing to bob over in that direction and see if after a few days of JUST STS with no "putting" to the breast he'll go on his own. Have her get in the tub w/ him, let him relax on her abdomen with daddy slooshing warm water over both.

Continue to pump and feed however she has been doing it.....

Ann, these are tough ones, and mom always wants you to fix it NOW. Good luck!!

Jan BLactation Education Consultants My blog Year of the MC

See what's new at AOL.com and Make AOL Your Homepage.

[Guest guest]

Ann , who has the dubious distinction of having a practice almost exclusively involved with posterior TTs. They're everywhere, they're everywhere.

i feel like they are everywhere all of a sudden too! what percentage of your clients are you suspecting or seeing a posterior tt? i am beginning to doubt my assessment skills...when every 3rd baby seems to have it - geez!

Lyla

..

[Guest guest]

i feel like they are everywhere all of a sudden too! what percentage of your clients are you suspecting or seeing a posterior tt? i am beginning to doubt my assessment skills...when every 3rd baby seems to have it - geez!

Lyla

Thank heavens I have a colleague who has had plenty of experience finding them in her practice as before I started realizing what I was dealing with. She reassured me that it is not something I am creating, but instead they are there, crying to be discovered.

It is the way of the Universe to send them to people to teach them. Look at Marasco and PCOS, Frances Andrusiak and OMERs, Chele Marmet and suck assessment and i am sure there are others in the field, who ended up seeing a pattern either in mothers or babies, IDed it and started coming up with a way of dealing with it. They started to 'get' it when several of the same kinds of problems were showing up 'on their doorstep'. Usually the mothers are literally crying because I am anywhere from the 2nd to the 6th LC they have seen. So, the persistent, determined ones find us.

This is the part of experience based information that must remain a part of this field, that can't be validated by research b/c the research is not there. Thank heavens for WG and Dr. Betty Coryllos and the work they are doing and publishing. If it weren't for them, I would have nothing to send to pedis with my reports. (I have started Xeroxing and sending the chapter that Dr. Coryllos wrote abt clipping the hidden TTs in CWGs new book on Sucking Skills. THAT got the attention of one of the docs to whom I sent my report. Much more than the AAP article from 2004!)

The next stage after stopping to doubt yourself is to try and figure out how to help them achieve a surgical resolution to this situation. Pedis don't recognize or acknowledge them, even when a detailed report is sent. It took one client 5 pedis to get one to give a referral.

And the ENTs aren't much better. They frequently don't validate the impact of this tether on breastfeeding OR they diminish how important Bfing is to the baby OR they sg the mom just pump. Some will clip a Type 3, but if it's not done completely, won't reclip. Most won't acknowledge or do Type 4s.

So, figuring out who will do what and whose insurance will cover what...that is a terrible challenge.

As I am hearing more and more LCs repeat the same story (as I did in CWG's session at ILCA this year), I am having more questions, the next stage.

WHY? Have these always been there? Have the Type 4s always been recognized by savvy birth practitioners? OR was there always a percentage of the population of infants who struggled with nonspecific sucking issues (all the things we see: can't open mouth wide enough, can't latch easily or well, can't maintain the latch, takes forever to feed, slow weight gain or weight faltering, incredibly sore nipples, etc.) that were or were not resolved.

And then, why? Why do we see what appears to be a significant number of infants. Are the numbers quoted in the ABM protocol for TT accurate? I don't think so b/c they don't acknowledge the posterior ones at all.

Questions, questions and more questions...

Don't doubt your skilled observations, Lyla. Once I have completed my check list and shared the info with the parents as I am assessing the baby and show them pics from the Breastfeeding Atlas and give them the packet of information they become educated advocates for their own baby. Especially when they go to Dr. Palmer's website.

But the followup is significant, and the support for every step of the way. There are NO easy ones when the baby has a posterior TT.

AnnSee what's new at AOL.com and Make AOL Your Homepage.

[Guest guest]

Sorry I didn't get to this earlier - I too am seeing way too many tt's in my practice - I am so so fortunate to live in Long Island with Dr Coryllos and Genna - I have been to Betty's many times and I too find myself questioning these tongue tie babies. "ARE they ALL tongue tied??" I think what I do is if it is a real easy one (string right there) and the mom or baby is having difficulty -(why else would I be there?) then I refer all the time. If it more posterior and I am not sure - but mom is sore and her nipples are misshapen then I would refer also. If mom is not having pain and baby is fine - I give the info and tell them to do their research.

After attending the Winthrop/Parkside conference this weekend - I feel I have even more knowledge in knowing (of course not dxing) -(but we do!) a posterior type 4 hidden TT. We also have an oral surgeon here that is doing "laser surgery" on these babies. From what I have now learned - the symptoms to look for (and I might miss a few) are : high palate, nursing blister, line down the center of the tongue on top, heart shape in the front of tongue, white mucosal tissue under tongue, flat tongue - does not move up to palate at all, can stick out just not up. Not to mention moms nipples and pain.

I encourage you all to educate yourselves - get 's new book, and go armed to these doctors. Even here we have peds that still do not believe us. Rome was not build in a day - so continue on.

Ann, hope this consult went well for you - these are the hard ones - when mom is looking for immediate relief - I am so happy when the "magic wand" works

Happy Halloween to all

Donna B. Kimick, IBCLC, RLCMassapequa Park, NY See what's new at AOL.com and Make AOL Your Homepage.

[Guest guest]

From what I have now learned - the symptoms to

> look for (and I might miss a few) are : high palate, nursing

blister, line down

> the center of the tongue on top, heart shape in the front of tongue,

white

> mucosal tissue under tongue, flat tongue - does not move up to

palate at all,

> can stick out just not up. Not to mention moms nipples and pain.

I love your list and have added it to my information. However, all

during this last year and a half of the deluge of TTs, I have rarely

seen any heart shaped tongues: shovel shape, flat with a bit of a

notch, but no heart shapes.

So, I would say, don't be fooled into thinking it is not a TT if there

is no heart shape to the tongue. I think the heart shape comes more

with the anterior TTs not the posterior.

Ann R.

[Guest guest]

yes! and that is what cathy genna's book says too - but even with the anterior tt, i rarely see a heart - usually a little notch. and my biggest challenge, that i am wondering if it is a posterior tt are the tongues that barely curl up to the palate - they curl at the tip, but there is only like 1 cm or so of "free tongue" the rest is "part of the lower jaw" or so it appears...that is what i am needing to learn if it is clippable...cathy genna is coming here in two weeks and i can't wait to meet her again and speak with her about this, and then get out there and educate/collaborate with doctors.

thanks for all the insight/input!

Lyla

[sPAM] Re: Help needed before morning...

From what I have now learned - the symptoms to > look for (and I might miss a few) are : high palate, nursing blister, line down > the center of the tongue on top, heart shape in the front of tongue, white > mucosal tissue under tongue, flat tongue - does not move up to palate at all, > can stick out just not up. Not to mention moms nipples and pain.I love your list and have added it to my information. However, all during this last year and a half of the deluge of TTs, I have rarely seen any heart shaped tongues: shovel shape, flat with a bit of a notch, but no heart shapes. So, I would say, don't be fooled into thinking it is not a TT if there is no heart shape to the tongue. I think the heart shape comes more with the anterior TTs not the posterior.Ann R.

[Guest guest]

Hi Ann and Donna

Could you expand a bit on the nursing blister? Is that on the babys top lip?

I didnt realise that was a sign of post tt. I've ordered the book and was wondering is it ok to copy pages out of it

for parents and doctors?

Thanks

Nicola

Nicola O'Byrne

IBCLC, RGN, RCN

Personal Breastfeeding Support

www.breastfeedingsupport.ie

From: [mailto: ] On Behalf Of Ann Sent: 31 October 2007 20:49To: Subject: Re: Help needed before morning...

From what I have now learned - the symptoms to > look for (and I might miss a few) are : high palate, nursing blister, line down > the center of the tongue on top, heart shape in the front of tongue, white > mucosal tissue under tongue, flat tongue - does not move up to palate at all, > can stick out just not up. Not to mention moms nipples and pain.I love your list and have added it to my information. However, all during this last year and a half of the deluge of TTs, I have rarely seen any heart shaped tongues: shovel shape, flat with a bit of a notch, but no heart shapes. So, I would say, don't be fooled into thinking it is not a TT if there is no heart shape to the tongue. I think the heart shape comes more with the anterior TTs not the posterior.Ann R.

[Guest guest]

i thought that was a sign of restricted superior labial frenum, although i suppose compensatory lip movements with tongue tie could cause that as well...

has anyone had luck with getting labial frenums clipped?

[sPAM] RE: Re: Help needed before morning...

Hi Ann and Donna

Could you expand a bit on the nursing blister? Is that on the babys top lip?

I didnt realise that was a sign of post tt. I've ordered the book and was wondering is it ok to copy pages out of it

for parents and doctors?

Thanks

Nicola

Nicola O'Byrne

IBCLC, RGN, RCN

Personal Breastfeeding Support

www.breastfeedingsupport.ie

From: [mailto: ] On Behalf Of Ann Sent: 31 October 2007 20:49To: Subject: Re: Help needed before morning...

From what I have now learned - the symptoms to > look for (and I might miss a few) are : high palate, nursing blister, line down > the center of the tongue on top, heart shape in the front of tongue, white > mucosal tissue under tongue, flat tongue - does not move up to palate at all, > can stick out just not up. Not to mention moms nipples and pain.I love your list and have added it to my information. However, all during this last year and a half of the deluge of TTs, I have rarely seen any heart shaped tongues: shovel shape, flat with a bit of a notch, but no heart shapes. So, I would say, don't be fooled into thinking it is not a TT if there is no heart shape to the tongue. I think the heart shape comes more with the anterior TTs not the posterior.Ann R.