Re: Tongue-ties

December 30, 2010

Anne, would you be willing to share your handout about what to expect

after the procedure?

Also, are any of you recommending stretching after the clipping?

Dr. Jim has been recommending this and I really think it improves

outcomes, but I wonder if anyone else is recommending it?

At 08:34 AM 12/30/2010, Anne Grider wrote:

Dear June,

I do what Carroll does and also tell parents that I

have a list of mothers who have been through the experience who have

given permission for me to give their names and phone numbers if a family

needs to speak to someone who has been there. I also give them a handout

I made up on what to expect after frenotomy- while explaining that I see

a lot of tongue-ties. In my vicinity there is a lot of good bf help

available, so moms don't often contact a private practice LC unless

they've exhausted other sources of help. My guess is that about 90%

(partly because I have a reputation as the go-to-lady to check them out

if other LCs were suspicious) of the babies I see have a tongue-tie and

close to 95% of those go on to have it clipped. Not all are fully

resolved and very few seek a second clipping. I've worked hard to get

here. Just a few years ago all my clients who chose to clip went to NY to

Dr. Coryllos against the advice of local professionals.

Anne Grider, IBCLC, LLLL

Atlanta, GA Metro Area

December 30, 2010

I’ve been following /Genna’s exercises in their book.June , RN, IBCLC, LLLL From: [mailto: ] On Behalf Of West, IBCLCSent: Thursday, December 30, 2010 9:40 AMTo: Subject: Re: Tongue-ties Anne, would you be willing to share your handout about what to expect after the procedure? Also, are any of you recommending stretching after the clipping? Dr. Jim has been recommending this and I really think it improves outcomes, but I wonder if anyone else is recommending it?At 08:34 AM 12/30/2010, Anne Grider wrote: Dear June, I do what Carroll does and also tell parents that I have a list of mothers who have been through the experience who have given permission for me to give their names and phone numbers if a family needs to speak to someone who has been there. I also give them a handout I made up on what to expect after frenotomy- while explaining that I see a lot of tongue-ties. In my vicinity there is a lot of good bf help available, so moms don't often contact a private practice LC unless they've exhausted other sources of help. My guess is that about 90% (partly because I have a reputation as the go-to-lady to check them out if other LCs were suspicious) of the babies I see have a tongue-tie and close to 95% of those go on to have it clipped. Not all are fully resolved and very few seek a second clipping. I've worked hard to get here. Just a few years ago all my clients who chose to clip went to NY to Dr. Coryllos against the advice of local professionals. Anne Grider, IBCLC, LLLLAtlanta, GA Metro Area

December 30, 2010

Hi and all,The main person who clips here in Israel is Dr. Ayal Botzer- he definitely has started saying to stretch it, and Dr. Corryles also told mothers to lift. I think it is extremely important even though (as one who has been there personally) very difficult to do and sometimes traumatic for parents to do. You will sometimes even get fresh blood. The baby usually screams, and it is hard to get under there to lift. But that being said, I think it improves the results significantly, otherwise many grow back and the situation regresses. Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of West, IBCLCSent: Thursday, December 30, 2010 4:40 PMTo: Subject: Re: Tongue-ties Anne, would you be willing to share your handout about what to expect after the procedure? Also, are any of you recommending stretching after the clipping? Dr. Jim has been recommending this and I really think it improves outcomes, but I wonder if anyone else is recommending it?At 08:34 AM 12/30/2010, Anne Grider wrote: Dear June, I do what Carroll does and also tell parents that I have a list of mothers who have been through the experience who have given permission for me to give their names and phone numbers if a family needs to speak to someone who has been there. I also give them a handout I made up on what to expect after frenotomy- while explaining that I see a lot of tongue-ties. In my vicinity there is a lot of good bf help available, so moms don't often contact a private practice LC unless they've exhausted other sources of help. My guess is that about 90% (partly because I have a reputation as the go-to-lady to check them out if other LCs were suspicious) of the babies I see have a tongue-tie and close to 95% of those go on to have it clipped. Not all are fully resolved and very few seek a second clipping. I've worked hard to get here. Just a few years ago all my clients who chose to clip went to NY to Dr. Coryllos against the advice of local professionals. Anne Grider, IBCLC, LLLLAtlanta, GA Metro Area __________ Information from ESET NOD32 Antivirus, version of virus signature database 5556 (20101022) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

December 30, 2010

Hi, ,

I only have Dr. Scheflan on my list for Israel. Can you

forward (privately) Dr. Botzer's contract info so I can add him (I'm

assuming he does posteriors)?

I have not had the experience of babies screaming. In fact, most do

not seem to notice. I think I'm doing it right -- I am definitely

putting firm pressure on the push in and the lift and have been following

the video Dr. made, but maybe not. Any chance you could make

a video of what you are doing?

Thanks for responding, !

At 11:33 AM 12/30/2010, you wrote:

Hi and all,

The main person who clips here in Israel is Dr. Ayal Botzer- he

definitely has started saying to stretch it, and Dr. Corryles also told

mothers to lift. I think it is extremely important even though (as

one who has been there personally) very difficult to do and sometimes

traumatic for parents to do. You will sometimes even get fresh

blood. The baby usually screams, and it is hard to get under

there to lift. But that being said, I think it improves the results

significantly, otherwise many grow back and the situation

regresses.

Billowitz, IBCLC

Israel

Dear June,

I do what Carroll does and also tell parents that I have a list of

mothers who have been through the experience who have given permission

for me to give their names and phone numbers if a family needs to speak

to someone who has been there. I also give them a handout I made up on

what to expect after frenotomy- while explaining that I see a lot of

tongue-ties. In my vicinity there is a lot of good bf help

available, so moms don't often contact a private practice LC unless

they've exhausted other sources of help. My guess is that about 90%

(partly because I have a reputation as the go-to-lady to check them out

if other LCs were suspicious) of the babies I see have a tongue-tie and

close to 95% of those go on to have it clipped. Not all are fully

resolved and very few seek a second clipping. I've worked hard to get

here. Just a few years ago all my clients who chose to clip

December 30, 2010

Last time I looked at my 8mo grandsons mouth I thought (gee that looks like it's restricted again :-( ) but I didn't say anything to his parents. Dr.Cliff OCallahan in CTclipped it originally and explained the exercises to stretch but I dont think they were

done, as it was stated by , it was hard to do and made baby unhappy andwe weren't sure we were " doing it right " . I'm not sure I should approach it with mom/dadbut I want to say something just not sure how to word it so it's not taken the wrong way.

(It's my DIL not my daughter)Ilene Fabisch, IBCLC

Hi and all,The main person who clips here in Israel is Dr. Ayal Botzer- he definitely has started saying to stretch it, and Dr. Corryles also told mothers to lift. I think it is extremely important even though (as one who has been there personally) very difficult to do and sometimes traumatic for parents to do. You will sometimes even get fresh blood. The baby usually screams, and it is hard to get under there to lift. But that being said, I think it improves the results significantly, otherwise many grow back and the situation regresses.

Billowitz, IBCLCIsrael

From: [mailto: ] On Behalf Of West, IBCLC

Sent: Thursday, December 30, 2010 4:40 PMTo: Subject: Re: Tongue-ties

Anne, would you be willing to share your handout about what to expect after the procedure? Also, are any of you recommending stretching after the clipping? Dr. Jim has been recommending this and I really think it improves outcomes, but I wonder if anyone else is recommending it?

At 08:34 AM 12/30/2010, Anne Grider wrote: Dear June, I do what Carroll does and also tell parents that I have a list of mothers who have been through the experience who have given permission for me to give their names and phone numbers if a family needs to speak to someone who has been there. I also give them a handout I made up on what to expect after frenotomy- while explaining that I see a lot of tongue-ties. In my vicinity there is a lot of good bf help available, so moms don't often contact a private practice LC unless they've exhausted other sources of help. My guess is that about 90% (partly because I have a reputation as the go-to-lady to check them out if other LCs were suspicious) of the babies I see have a tongue-tie and close to 95% of those go on to have it clipped. Not all are fully resolved and very few seek a second clipping. I've worked hard to get here. Just a few years ago all my clients who chose to clip went to NY to Dr. Coryllos against the advice of local professionals.

Anne Grider, IBCLC, LLLLAtlanta, GA Metro Area

__________ Information from ESET NOD32 Antivirus, version of virus signature database 5556 (20101022) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

-- Ilene Fabisch, Brockton, MA " Each day is a blank canvas waiting for our unique brushstrokes to create a masterpiece. "

December 30, 2010

A friend of mine in Toronto area is doing so and has written a handout for parents re: exercises for after the procedure. I have been using it a bit though usually just write up my own info in the care plan I give to parents. Camilla, are you out there????

beth IBCLC LLLC leader

Ottawa, Canada

Re: Tongue-ties

Anne, would you be willing to share your handout about what to expect after the procedure? Also, are any of you recommending stretching after the clipping? Dr. Jim has been recommending this and I really think it improves outcomes, but I wonder if anyone else is recommending it?At 08:34 AM 12/30/2010, Anne Grider wrote:

Dear June, I do what Carroll does and also tell parents that I have a list of mothers who have been through the experience who have given permission for me to give their names and phone numbers if a family needs to speak to someone who has been there. I also give them a handout I made up on what to expect after frenotomy- while explaining that I see a lot of tongue-ties. In my vicinity there is a lot of good bf help available, so moms don't often contact a private practice LC unless they've exhausted other sources of help. My guess is that about 90% (partly because I have a reputation as the go-to-lady to check them out if other LCs were suspicious) of the babies I see have a tongue-tie and close to 95% of those go on to have it clipped. Not all are fully resolved and very few seek a second clipping. I've worked hard to get here. Just a few years ago all my clients who chose to clip went to NY to Dr. Coryllos against the advice of local professionals. Anne Grider, IBCLC, LLLLAtlanta, GA Metro Area

December 30, 2010

Dear All,

Please look over my list of docs who do posterior frenotomies and see

if you would add or NOT include anyone based on your experience with

them. I really want this to be a reliable list for parents and practioners.

http://lowmilksupply.org/frenotomy.shtml

Thanks for your help!

December 30, 2010

Don't see anyone from North Carolina and we have a FINE one here in Wilmington...how can we add him?

Vicki Carlson

Oak Island, NC

To: From: dwest@...Date: Thu, 30 Dec 2010 12:00:03 -0500Subject: RE: Tongue-ties

Dear All,Please look over my list of docs who do posterior frenotomies and see if you would add or NOT include anyone based on your experience with them. I really want this to be a reliable list for parents and practioners.http://lowmilksupply.org/frenotomy.shtmlThanks for your help!

December 30, 2010

Preferred: Dr. Greg Notestine, DDS2149 North Fairfield Rd.Beavercreak, OH 454311-Accepts Medicaid:Dr. Bob Muster, DDSABC Dental, LLC8376 Old Troy PikeHuber Heights, OH 45424 Both in the Dayton area June , RN, IBCLC, LLLL From: [mailto: ] On Behalf Of West, IBCLCSent: Thursday, December 30, 2010 12:00 PMTo: Subject: RE: Tongue-ties Dear All,Please look over my list of docs who do posterior frenotomies and see if you would add or NOT include anyone based on your experience with them. I really want this to be a reliable list for parents and practioners.http://lowmilksupply.org/frenotomy.shtmlThanks for your help!

December 30, 2010

Dr Larry Kotlow, in Albany NY, recommends exercises to prevent scar tissue forming and reattaching the tongue tie. He says there is sometimes blood when the exercises are done, and that many parents are naturally reluctant to cause their babies pain.

One of my clients who went to him did not follow his recommendations, and the baby needed to have the whole procedure all over again.Norma Ritter, IBCLC, RLCBreastfeeding Matters in the Capital Regionwww.NormaRitter.com

Join us on Facebook for the latest birthing and breastfeeding news and views:http://tinyurl.com/BMCRonFB

December 30, 2010

,I have another NYC doctor - he is in Brooklyn. I just e-mailed him to discuss further his take on posterior TT - he has released many simple and classic TT. His name is Dr. Levitin,101 Broadway, Suite 201Brooklyn, NY 11211 Dear All,Please look over my list of docs who do posterior frenotomies and see if you would add or NOT include anyone based on your experience with them. I really want this to be a reliable list for parents and practioners.http://lowmilksupply.org/frenotomy.shtmlThanks for your help! Leigh Anne O'Connor, IBCLCleighanne625@...www.leighanneoconnor.com

December 30, 2010

I just want to mention that my opinion until I see otherwise is that the posteriors probably only affect BF- my son had one that was clipped 3 times- he never BF- and I expected all sorts of problems with solids, etc- but so far, all was perfect. He is only 2 now, but talking beautifully also. Our ENT who is a big fan of clipping for BF has also said that they just seem to kind of “outgrow” them. Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of Ilene FabischSent: Thursday, December 30, 2010 6:56 PMTo: Subject: Re: Tongue-ties Last time I looked at my 8mo grandsons mouth I thought (gee that looks like it's restricted again :-( ) but I didn't say anything to his parents. Dr.Cliff OCallahan in CTclipped it originally and explained the exercises to stretch but I dont think they weredone, as it was stated by , it was hard to do and made baby unhappy andwe weren't sure we were " doing it right " . I'm not sure I should approach it with mom/dadbut I want to say something just not sure how to word it so it's not taken the wrong way.(It's my DIL not my daughter)Ilene Fabisch, IBCLC Hi and all,The main person who clips here in Israel is Dr. Ayal Botzer- he definitely has started saying to stretch it, and Dr. Corryles also told mothers to lift. I think it is extremely important even though (as one who has been there personally) very difficult to do and sometimes traumatic for parents to do. You will sometimes even get fresh blood. The baby usually screams, and it is hard to get under there to lift. But that being said, I think it improves the results significantly, otherwise many grow back and the situation regresses. Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of West, IBCLCSent: Thursday, December 30, 2010 4:40 PMTo: Subject: Re: Tongue-ties Anne, would you be willing to share your handout about what to expect after the procedure? Also, are any of you recommending stretching after the clipping? Dr. Jim has been recommending this and I really think it improves outcomes, but I wonder if anyone else is recommending it?At 08:34 AM 12/30/2010, Anne Grider wrote: Dear June, I do what Carroll does and also tell parents that I have a list of mothers who have been through the experience who have given permission for me to give their names and phone numbers if a family needs to speak to someone who has been there. I also give them a handout I made up on what to expect after frenotomy- while explaining that I see a lot of tongue-ties. In my vicinity there is a lot of good bf help available, so moms don't often contact a private practice LC unless they've exhausted other sources of help. My guess is that about 90% (partly because I have a reputation as the go-to-lady to check them out if other LCs were suspicious) of the babies I see have a tongue-tie and close to 95% of those go on to have it clipped. Not all are fully resolved and very few seek a second clipping. I've worked hard to get here. Just a few years ago all my clients who chose to clip went to NY to Dr. Coryllos against the advice of local professionals. Anne Grider, IBCLC, LLLLAtlanta, GA Metro Area __________ Information from ESET NOD32 Antivirus, version of virus signature database 5556 (20101022) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com-- Ilene Fabisch, Brockton, MA " Each day is a blank canvas waiting for our unique brushstrokes to create a masterpiece. " __________ Information from ESET NOD32 Antivirus, version of virus signature database 5556 (20101022) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

December 30, 2010

,Quick look at your comprehensive list of TT docs - you have at VT doc under the CT section! She's also under the VT section so I'm sure it's just an oversight but thought you'd want to know.

-- Ilene Fabisch, IBCLC

December 30, 2010

Hi ,

just a couple of edits to your Washington contacts:

Isabella Knox: Maternity & Infant Care Clinic at UWMC. Schedule by calling her on her cell phone: .

email is iknox@...

Ann O'Hara - office line to schedule, she doesn't schedule via her cell anymore.7337 35th Avenue NE

while I love Dr. O'Hara and she is a good friend, at this point, I prefer Dr. Knox for posterior TT.

Dr. O'Hara spends hours with the family and can help with all aspects of breastfeeding, Dr. Knox is a neonatologist and doesn't do latch/position/full-term baby/normal breastfeeding stuff. Dr. Knox can often get patients in sooner than Dr. O'Hara can.

thanks, Healy

Seattle, WA

Dear All,Please look over my list of docs who do posterior frenotomies and see if you would add or NOT include anyone based on your experience with them. I really want this to be a reliable list for parents and practioners.

http://lowmilksupply.org/frenotomy.shtmlThanks for your help!

December 30, 2010

Diane,You asked if any of us are doing the stretching. I am certainly doing the stretching and then some with families post-frenotomy. I also teach families how to do some basic oral motor exercises to correct/improve/strengthen tongue functionality. With many of the tongue tie cases I see, a release of the tongue is not enough. The tongue needs to be re-trained to do the right thing. So often there is extensive cranial and oral neuromuscular impingements affecting the quality of suck and tongue motion as well so it can really take some time to see results. I give a lot of anticipatory guidance on what to expect and what not to expect and do a lot of hand-holding and close follow up. Luckily parents do understand that when a baby has been sucking a certain way (and/or squished a certain way) in utero and beyond that it can make undoing suboptimal suck patterns a little time. In a nutshell here’s my usual routine:1)Meet with families for initial visit, identify tongue tie, offer Bf initial support/care plan 2) call and make the ENT appt for them so they can get in asap 3)follow up w/in 1 day of frenotomy to start stretches/oral motor work, encourage/refer to appropriate CST/bodyworkers, etc 4) touch base almost daily by phone and do in person visits as needed until Bf well established. Most all the tongue ties cases I support in this manner are doing much better by week 1-2 post-frenotomy. A few more need more time and therapy. A few easy ones do better almost immediately. And just one (so far) that I have worked with had issues so severe that she never could directly breastfeed , even after 8+ mos of intense work (this was due mostly to nerve damage from in utero positioning and not just the TT I believe). Speaking of older TT nurslings…the ENT I refer to recently clipped a 2yr old labial frenum for me (no anesthesia was needed and results were great) but I think every older TT patient’s needs will be different in terms of meds/pain relief/wiggling, etc. Also when moms of older babies/kids present w/ recurrent mastitis, blebs, yeast, etc there’s often a TT baby/kiddo in the picture (not always but frequently). Sometimes those moms don’t feel like treating the TT at the point but just decide to treat the symptoms because the child is doing well enough. Moms can be such martyrs when it comes to their own pain, right? But still I offer insight and resources re: TT so they can be fully informed about the root cause. I’d love to see some of the post-frenotomy handouts some of you have created and I will share my own when I get it typed up. Cole

December 30, 2010

comment about Dr. Knox. I referred a baby to her recently. she clipped, but not enough. We needed to clip again with O'Hara. Dr. O'Hara, was very gracious about it--saying that it would have been easy to miss, since it was quite posterior, but after that, I have more confidence in Ann! Funny that we have such different experiences! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- On Thu,

12/30/10, Healy wrote:Subject: Re: Tongue-tiesTo: Date: Thursday, December 30, 2010, 11:16 AM

Hi ,

just a couple of edits to your Washington contacts:

Isabella Knox: Maternity & Infant Care Clinic at UWMC. Schedule by calling her on her cell phone: .

email is iknox@...

Ann O'Hara - office line to schedule, she doesn't schedule via her cell anymore.7337 35th Avenue NE

while I love Dr. O'Hara and she is a good friend, at this point, I prefer Dr. Knox for posterior TT.

Dr. O'Hara spends hours with the family and can help with all aspects of breastfeeding, Dr. Knox is a neonatologist and doesn't do latch/position/full-term baby/normal breastfeeding stuff. Dr. Knox can often get patients in sooner than Dr. O'Hara can.

thanks, Healy

Seattle, WA

Dear All,Please look over my list of docs who do posterior frenotomies and see if you would add or NOT include anyone based on your experience with them. I really want this to be a reliable list for parents and practioners.

http://lowmilksupply.org/frenotomy.shtmlThanks for your help!

December 30, 2010

I would love to see that handout, too!

At 11:57 AM 12/30/2010, Beth McMillan wrote:

A friend of mine in Toronto area is doing so and has written

a handout for parents re: exercises for after the procedure. I have

been using it a bit though usually just write up my own info in the care

plan I give to parents. Camilla, are you out there????

beth IBCLC LLLC leader

Ottawa, Canada

December 30, 2010

Great! These both do posteriors?

At 12:37 PM 12/30/2010, and June wrote:

Preferred:

Dr. Greg Notestine, DDS

2149 North Fairfield Rd.

Beavercreak, OH 45431

1-

Accepts Medicaid:

Dr. Bob Muster, DDS

ABC Dental, LLC

8376 Old Troy Pike

Huber Heights, OH 45424

Both in the Dayton area

June , RN, IBCLC, LLLL

December 30, 2010

Just send me his name and contact information! Does he definitely do

posteriors?

At 12:21 PM 12/30/2010, Vicki Carlson wrote:

>

>Don't see anyone from North Carolina and we have a FINE one here in

>Wilmington...how can we add him?

>Vicki Carlson

>Oak Island, NC

December 30, 2010

Dr. Kotlow does recommend exercises, yes, but he recommends them

differently. He says to swipe side to side. Dr. says

to push in against the wound and lift the tongue up. I find that

Dr. 's method offers a better stretch, which seems logically to be

more likely to prevent adhesions.

I truly wish these methods could be objectively researched so that we

have some evidence and data to back up our recommendations. In time

hopefully they will be.

At 12:43 PM 12/30/2010, Norma Ritter wrote:

Dr Larry Kotlow, in Albany NY, recommends exercises to prevent scar

tissue forming and reattaching the tongue tie.

He says there is sometimes blood when the exercises are done, and that

many parents are naturally reluctant to cause their babies pain.

One of my clients who went to him did not follow his recommendations, and

the baby needed to have the whole procedure all over again.

Norma Ritter, IBCLC, RLC

Breastfeeding Matters in the Capital Region

www.NormaRitter.com

Join us on Facebook for the latest birthing and breastfeeding news and

views:

http://tinyurl.com/BMCRonFB

December 30, 2010

Great to know! If you find out he will do posteriors, I'll be very

pleased to add him to my list.

At 01:23 PM 12/30/2010, you wrote:

,

I have another NYC doctor - he is in Brooklyn. I just e-mailed him to

discuss further his take on posterior TT - he has released many simple

and classic TT.

His name is Dr. Levitin,

101 Broadway, Suite 201

Brooklyn, NY 11211

December 30, 2010

I have two sons with posteriors (both breastfed for several years)

who now need a lot of orthodontia for their very high and narrow

palates and crowded teeth. They speak clearly, but not as precisely

as my son who has a tongue with more range of motion. They both

snore and my older son does not. I have met many, many adults whom I

believe to have posterior tongue-ties who do not have clear speech

and have dental and other problems.

This is something that needs to be researched. My feeling is that it

does affect more than just breastfeeding and I would love to know

what a study would show. Anyone out there who could do such a stucy?

>I just want to mention that my opinion until I see otherwise is that

>the posteriors probably only affect BF- my son had one that was

>clipped 3 times- he never BF- and I expected all sorts of problems

>with solids, etc- but so far, all was perfect. He is only 2 now,

>but talking beautifully also. Our ENT who is a big fan of clipping

>for BF has also said that they just seem to kind of " outgrow " them.

>

> Billowitz, IBCLC

>

>Israel

December 30, 2010

Wow -- never noticed that goof! I'll fix it ASAP! Thanks for letting me know!

At 01:43 PM 12/30/2010, Ilene Fabisch wrote:

>

>,

>Quick look at your comprehensive list of TT docs - you have at VT

>doc under the CT section! She's also under the VT section so I'm

>sure it's just an oversight but thought you'd want to know.

>

>--

>Ilene Fabisch, IBCLC

December 30, 2010

Thank you so much for sharing your experiences and handout,

!

At 02:28 PM 12/30/2010, Cole wrote:

Diane,

You asked if any of us are doing the stretching. I am certainly doing the

stretching and then some with families post-frenotomy. I also teach

families how to do some basic oral motor exercises to

correct/improve/strengthen tongue functionality. With many of the tongue

tie cases I see, a release of the tongue is not enough. The tongue needs

to be re-trained to do the right thing. So often there is extensive

cranial and oral neuromuscular impingements affecting the quality of suck

and tongue motion as well so it can really take some time to see results.

I give a lot of anticipatory guidance on what to expect and what not to

expect and do a lot of hand-holding and close follow up. Luckily parents

do understand that when a baby has been ;font-family: " Times New

Roman " , " serif " ; " >

Most all the tongue ties cases I support in this manner are doing much

better by week 1-2 post-frenotomy. A few more need more time and therapy.

A few easy ones do better almost immediately. And just one (so far) that

I have worked with had issues so severe that she never could directly

breastfeed , even after 8+ mos of intense work (this was due mostly to

nerve damage from in utero positioning and not just the TT I

believe).

Speaking of older TT nurslings…the ENT I refer to recently clipped a 2yr

old labial frenum for me (no anesthesia was needed and some of the

post-frenotomy handouts some of you have created and I will share my own

when I get it typed up.

Cole

December 30, 2010