tongue-tie

[Guest guest]

I see so many tongue-ties. Many families do not want to release the posterior tongue-ties because I am the only one actually saying it is there - even if all the symptoms are there and I have a nice stack of studies I send - I keep the AAP article on hand - I am running out of ink from printing it so often.Anyway, I have noticed that some of these seem to resolve with continued breastfeeding. One local doctor theorized that a short chin causes the tongue to be restricted - I thought it was the other way around. It seems to be a chicken and egg thing.Either way, some of the babies are having releases with continued breastfeeding or craniosacral and not with frenotomy. I have two moms with babies with PTT and they are using a 24mm contact nipple shield which helps with pain, and the babies are growing. I had another mom who was completely undermined in the hospital and then at home with a "baby nurse" and when I saw her 3 weeks later this baby's tongue was actually moving beautifully - my theory - more breastfeeding helped stretch the tongue. Her milk supply seems completely compromised at this point but we continue to work on it. I have a nephew with PTT - he lives in NC where my sister could not get a release - one session only with CST. He is 15 months old - thriving, growing huge, nursing champ but drives my sister crazy because he has always stayed in her arms and nursed constantly ( she has three others that she is homeschooling)!Anyway, tongue-tie comes in all sizes, shapes, presentations and so do families. Having a thorough understanding of all of the possible ways of managing it and all the ways it can present are important. Just some ramblings - which seems to be the way I post things.Leigh Anne in NYC Leigh Anne O'Connor, IBCLCleighanne625@...www.leighanneoconnor.com

[Guest guest]

Excellent

point, Leigh Anne. I see a lot of tongue ties too and different families choose

to treat it in different ways. It is a delicate balance to present all the info

so the families can make a fully informed choice. One bit of info that I

have found helps parents is when I let them know about several of my clients

who choose not to clip early on but then issues cropped up later. Several of the

ones that chose not to clip, or couldn’t find a provider to do so, or

breastfed fine despite the tongue restrictions, did end up regretting not

clipping early on. As their babies got teeth (and tongue wouldn’t cover

the gum line), as their babies developed digestive problems or dental issues,

speech, etc. Some of the families w/ older babies are now considering clipping

their kiddos (ages range from 8mos-3yrs) because of problems that cropped up

later. Sometimes just sharing that there can be issues down the line can be

crucial for parents on the fence about clipping.

Cole

[Guest guest]

Teaching hand expression? In a hospital setting! O my I'd say very progressive and ambitious. kudos! I wish that were the norm....We all have to vent. If not here, where?warmly, Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: tongue-tieTo: Date: Saturday, April 24, 2010, 2:18 PM

And I know I would benefit from following you , and I appreciate your clarification. I'm trying to be responsible for how I feel, but just kind of venting myself I suppose, and certainly not directed to any one person in particular. And not on this listserve, necessarily but I hear this almost every week on Lactnet.

My system is rather progressive, we have a good bf protocol, our staff uses skin to skin, and we are trying to improve their ability to teach hand expression skills to mothers so if it's just a matter of sleepy baby, they know to put them skin to skin and we may eventually hand express and spoon feed a bit.

I think you would probably not have too much trouble following me around these days being I am working in a boot with a ruptured achilles tendon but that is a story for another day

>

[Guest guest]

I do home visits. I have toyed with performing consults out of my home as well,

or starting an office practice, but I'm not sure I'm cut out to be a very

effective business person. I struggle with the prospect of a fluctuating

schedule/income. Some people thrive in that capacity, I'm just not sure it

aligns well with my strengths.

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> michelle are you in private practice as well?

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> lyla

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[Guest guest]

, how do you do home visits AND work nearly full time at a hospital? Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: tongue-tieTo: Date: Saturday, April

24, 2010, 8:23 PM

I do home visits. I have toyed with performing consults out of my home as well, or starting an office practice, but I'm not sure I'm cut out to be a very effective business person. I struggle with the prospect of a fluctuating schedule/income. Some people thrive in that capacity, I'm just not sure it aligns well with my strengths.

>

> michelle are you in private practice as well?

>

> lyla

>

[Guest guest]

In a message dated 4/24/2010 9:44:53 PM Pacific Daylight Time, writes:

For those of you who go with family to frenotomy - do you charge for your time? How do you fit it in your schedule? Leigh Anne Sent from my Verizon

Yes, I do charge for my time and to cover costs, like the parking charge at the Medical Center and travel. I schedule just like any other high priority situation. I explain that is part of my services at the initial consult when I have explained what I have found that is causing the baby to struggle at breast. First they have to decide if a surgical option is their first choice. Then they have to check their insurance as to which of the ped ENTs in the county is covered.

So if I already have someone scheduled at the time of the clipping, I will reschedule to other mom to a later or earlier appt.

I also help them schedule the appt. if they are going to the high volume ped ENT office because I have developed a rapport with the surgical coordinators in the practice. Frequently when parents cold call for an appt. they are told 3-5 weeks out. I tell them to go ahead, make that appt., let me know. Then I call the surgical coordinator, give more detail (like the mother is pumping blood) and that gets the baby to the top of the list and usually a sooner appt.

I also send a report to the ENT, from which they have learned much and asked many questions. The two MDs in the high volume ped ENT practice are in the process of writing an article for the Intl Ped ENT journal about PTTs. Be still my heart.

I also bring a few small crescent pillows with me so I can get the mom in a more laid back position post clipping. The chairs in the exam rooms had to have been designed by a sadist, when it comes to breastfeeding at least.

And I help with positioning for optimum latch, which the mom probably forgot in this high adrenaline situation and wants to start head pushing again.

And I demonstrate suck training exercises, on myself, and have parents return demonstrate. And I write them up. And we talk about pain management for the next two weeks, when it is a PTT. Currently, in addition to Tylenol if they are inclined to use it, I am recommending a triple combination of homeopathic remedies that a local homeopath has put together. It not only helps control pain, it helps to speed healing. I have found that a significant number of babies don't want to move their tongues much until the eschar is gone or almost gone, and that is close to 2 weeks. This has been an important tool for parents whose pedi refuses to recommend or give dosage info for any infants under the age of 6 months. She also recommends a remedy for babies resisting latching on Day 1 post-frenotomy. It has been very helpful also.

And I schedule a f/u appt. to do a check within 3-5 days post-liberation to make sure it is not scarring down or if it has, what we can do about it. Had one baby that was clipped on Friday and had scarred down by Sunday.

Ann

[Guest guest]

I used to be a .8 (4 days a week) and now I am a .6(remember that cut back

thingy?)so I am on 3 days a week :)I also teach for a local college but that is

sporadic as well. So I guess you could say it only qualifies as part time. And I

don't do a lot of home visits, it's mostly for homebirth clients that I have

gotten referrals from doulas I have trained or LM's.

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> Date: Saturday, April 24, 2010, 8:23 PM

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[Guest guest]

I don't charge for my time. I only go to the appt if I don't have a client at that time. I feel it's a learning exp, for me, good karma, and the md doing the clipping gets to see me work and knows I'm an LC she can trust to work with her patients. but more power to the LC's who can bill for this! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- On Sun, 4/25/10, anntarus@...

wrote:Subject: Re: tongue-tieTo: Date: Sunday, April 25, 2010, 10:03 AM

In a message dated 4/24/2010 9:44:53 PM Pacific Daylight Time, @yahoogroup s.com writes:

For those of you who go with family to frenotomy - do you charge for your time? How do you fit it in your schedule? Leigh Anne Sent from my Verizon

Yes, I do charge for my time and to cover costs, like the parking charge at the Medical Center and travel. I schedule just like any other high priority situation. I explain that is part of my services at the initial consult when I have explained what I have found that is causing the baby to struggle at breast. First they have to decide if a surgical option is their first choice. Then they have to check their insurance as to which of the ped ENTs in the county is covered.

So if I already have someone scheduled at the time of the clipping, I will reschedule to other mom to a later or earlier appt.

I also help them schedule the appt. if they are going to the high volume ped ENT office because I have developed a rapport with the surgical coordinators in the practice. Frequently when parents cold call for an appt. they are told 3-5 weeks out. I tell them to go ahead, make that appt., let me know. Then I call the surgical coordinator, give more detail (like the mother is pumping blood) and that gets the baby to the top of the list and usually a sooner appt.

I also send a report to the ENT, from which they have learned much and asked many questions. The two MDs in the high volume ped ENT practice are in the process of writing an article for the Intl Ped ENT journal about PTTs. Be still my heart.

I also bring a few small crescent pillows with me so I can get the mom in a more laid back position post clipping. The chairs in the exam rooms had to have been designed by a sadist, when it comes to breastfeeding at least.

And I help with positioning for optimum latch, which the mom probably forgot in this high adrenaline situation and wants to start head pushing again.

And I demonstrate suck training exercises, on myself, and have parents return demonstrate. And I write them up. And we talk about pain management for the next two weeks, when it is a PTT. Currently, in addition to Tylenol if they are inclined to use it, I am recommending a triple combination of homeopathic remedies that a local homeopath has put together. It not only helps control pain, it helps to speed healing. I have found that a significant number of babies don't want to move their tongues much until the eschar is gone or almost gone, and that is close to 2 weeks. This has been an important tool for parents whose pedi refuses to recommend or give dosage info for any infants under the age of 6 months. She also recommends a remedy for babies resisting latching on Day 1 post-frenotomy. It has been very helpful also.

And I schedule a f/u appt. to do a check within 3-5 days post-liberation to make sure it is not scarring down or if it has, what we can do about it. Had one baby that was clipped on Friday and had scarred down by Sunday.

Ann

[Guest guest]

Sorry I've already forgotten the name of the poster who asked for pictures of anterior vs posterior TT but if you go to kiddsteeth.com (Larry Kotlow, DDS) and click on articles he has pictures of both. Genna's book, "Sucking Skills..." also does and her book is a must have, IMHO.

Barbara Latterner (who suffers from short-term memory loss and is only in her sixtieth decade!)

[Guest guest]

Many thanks.The kiddsteeth.com web site had great information re: different types of tongue tie.

I found the article- Diagnosis and Treatment of Newborn Nursing Difficulties- Published in 2009, to be excellent. What great photo's.

Thanks for sharing this Barbara,

Denniston, Alamo CA tongue-tie

Sorry I've already forgotten the name of the poster who asked for pictures of anterior vs posterior TT but if you go to kiddsteeth.com (Larry Kotlow, DDS) and click on articles he has pictures of both. Genna's book, "Sucking Skills..." also does and her book is a must have, IMHO.

Barbara Latterner (who suffers from short-term memory loss and is only in her sixtieth decade!)