Re: structural issues

[Guest guest]

Hello, .

I tend to figure that if a baby's structural issues haven't sorted themselves out by one week of age (tight frenulum that some might say will stretch, stiff neck, etc.), then there is too much risk that mom won't be able to "hang in there" and breastfeeding will be lost. Anything that is still obvious at one week (or older--some clients don't get to me until their babies are several weeks old), I explain to parents and give them names of practitioners who can work with those issues

[Guest guest]

I do see babies that have similar sucking inefficiencies : chompy-->unless Mom is doing breast compressions to stimulate MER , which elicits swallowing / coordination / tongue function to guide flow/swallow of milk bolus.

Tincture of time is recommended, but I question  intervention at which point -->esteemed colleagues?? I " m referring to pain with restrictive tongue extension(chompy to recessed chins, short tongues)I am asking for your intervention time lines.I respect that, each Dyad is unique, 

Just asking, and concerned about F/U with inductions, VAVD,FAVD, Breech C/S or just plain old Short to tight frenulums.....I guess case sharing   & outcomes is what I'm asking. In the spirit of of CST or alternative interventions to support feeding at the breast always.

Be Well. SCWatkins 

 

I see a lot of babies immediate postpartum to day 3, and do some private consulting as well, plus I get to see how the babies I observe inpatient are followed with outpatient lactation as well.

Some of the structural issues and feeding characteristics I observe immediate postpartum resolve with time, but do you find a period you feel is most reliable for evaluating these characteristics? It's not uncommon to observe a baby <12 hours of age with significant facial/jaw asymmetry for example and then observe at 36 hours and I would never believe this was even the same baby! KWIM?

[Guest guest]

Shari said,

<<These traumatic births are so hard on these peanuts esp. the vacuum ... ugh...>>

I wish we had some statistics on numbers of babies that have structural issues (who are not tongue tied) and then look at what happens during labor and birth. Is it more prevalent in C/Sections? Vacuum? Epidurals? Long pushing?

The reason I left out TT is because that is obviously something that occurs long before the insult of the American Way of Birth, and has its own issues....

Jan

[Guest guest]

When I see a baby who has any structural issues it has

become my practice to refer immediately. Why wait? Generally, in my

experience, tight muscles don’t resolve fully – they may resolve to

one degree or another – but the resting muscle tension never gets to

where it should have been in the first place. I don’t worry about their

age at all – in fact, I prefer to get them as young as possible as the

resolution with treatment is considerably faster than a baby who is 3 wks + in

age whose body has had lots of time to settle in to a state of muscular

dysfunction.

There is one LC here who will not refer for a minimum of 6

wks to 6 months. I got my butt chewed by her year or so ago about referring

too early. I asked her when she would refer and that is what she told me. Sad

to say I see many of her clients after the fact…when they have waited so

long, and have spent so much time and money with no improvements. Then the

Parent’s are angry and I am left shaking my head because here is another

baby who could have been taken care of early on with significantly less expense

to the family. I don’t get it. She’s on LN – she sees

others talking about this - she just seems to refuse to ‘get it’.

Babies born with serious asymmetries to the face are an

Urgent referral on my part specifically because those muscles may look better

on the outside, but I have learned to know what is going on on the inside by

feeling the muscles and knowing what is proper resting muscle tension and what

is not. Yes, some can breastfeed despite it and even not cause mom pain –

but I look at the long term possible effects. Why take the risk that there is

some tightness/dysfunction that we may not see but that may very well cause a

problem in the long term?

Here is one thing you can all look for: Feel the back of

your head, at the base of your skull. You should have a ‘divot’

there – it’s called the Inion (sp?). The divot should feel soft

and kind of squishy and the cranial bones around it will feel like an upside

down “V”. The baby should have the same thing. IF baby has a hard

flat area where the divot should be – you have a problem. That little

one has tight neck muscles that will wrap around to the baby’s jaw –

perhaps pulling it back so it is recessed more than it should be, and also

likely causing tightness to the muscles under the jaw and IN the mouth. When I

first hold a baby my fingers go there first – if I feel hard and flat at

the base of the skull and NO divot – I look further – for T-T, for asymmetry

in the face, jaw, etc. I feel the muscles – do the feel firm or soft?

Do they feel like ropes in the back? Then we have a problem. And I refer to

my gal Judy ASAP.

I want to thank the others who explained why they use who

they use – I see clearly now that it is an ‘area’ situation –

who do you have who can do what you need… I get it. Thank you very much

for that! It seems like some of us are very lucky to have who we do and others

of us really need someone who can do what we need them to do…

Warmly,

Jaye

Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net

[Guest guest]

Thank you Jaye.. I totally agree.  Here in San diego we have a wonderful chiro, PT, CST that has an advanced degree in babies and infants.  She is wonderful and knows suck, brfding and babies.I refer immediately no mater what the age.  She started working on my grandpeanut at 2 hours of age.

Not only do I refer for body issues but post clipping she can turn around the suck in half the time with no therapy.my question is Why wait????  for the body to tighten to make the therapy last longer and cost more? do not understand the theory about lets wait and see.  It will not totally resolved on it's own.  maybe get somewhat better but not totally.

These traumatic births are so hard on these peanuts esp. the vacuum ... ugh...Waiting is like having a cast on your leg for months and when the cast is taken off. Saying lets wait on PT maybe I can walk straight on my own in time.  Just maybe I will run my marathon next week without Pt.

Don't get me started, I can go on with this forever.Shari Siladyin sunny cool San Diego

 

When I see a baby who has any structural issues it has

become my practice to refer immediately.  Why wait?  Generally, in my

experience, tight muscles don’t resolve fully – they may resolve to

one degree or another – but the resting muscle tension never gets to

where it should have been in the first place.  I don’t worry about their

age at all – in fact, I prefer to get them as young as possible as the

resolution with treatment is considerably faster than a baby who is 3 wks + in

age whose body has had lots of time to settle in to a state of muscular

dysfunction.

 

There is one LC here who will not refer for a minimum of 6

wks to 6 months.  I got my butt chewed by her year or so ago about referring

too early.  I asked her when she would refer and that is what she told me.  Sad

to say I see many of her clients after the fact…when they have waited so

long, and have spent so much time and money with no improvements.  Then the

Parent’s are angry and I am left shaking my head because here is another

baby who could have been taken care of early on with significantly less expense

to the family.  I don’t get it.  She’s on LN – she sees

others talking about this - she just seems to refuse to ‘get it’. 

 

Babies born with serious asymmetries to the face are an

Urgent referral on my part specifically because those muscles may look better

on the outside, but I have learned to know what is going on on the inside by

feeling the muscles and knowing what is proper resting muscle tension and what

is not.  Yes, some can breastfeed despite it and even not cause mom pain –

but I look at the long term possible effects.  Why take the risk that there is

some tightness/dysfunction that we may not see but that may very well cause a

problem in the long term?

 

Here is one thing you can all look for:  Feel the back of

your head, at the base of your skull.  You should have a ‘divot’

there – it’s called the Inion (sp?).  The divot should feel soft

and kind of squishy and the cranial bones around it will feel like an upside

down “V”.  The baby should have the same thing.  IF baby has a hard

flat area where the divot should be – you have a problem.  That little

one has tight neck muscles that will wrap around to the baby’s jaw –

perhaps pulling it back so it is recessed more than it should be, and also

likely causing tightness to the muscles under the jaw and IN the mouth.  When I

first hold a baby my fingers go there first – if I feel hard and flat at

the base of the skull and NO divot – I look further – for T-T, for asymmetry

in the face, jaw, etc.  I feel the muscles – do the feel firm or soft? 

Do they feel like ropes in the back?  Then we have a problem.  And I refer to

my gal Judy ASAP.

 

I want to thank the others who explained why they use who

they use – I see clearly now that it is an ‘area’ situation –

who do you have who can do what you need…  I get it.  Thank you very much

for that!  It seems like some of us are very lucky to have who we do and others

of us really need someone who can do what we need them to do…

 

Warmly,

Jaye

 

Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net

 

-- ~~~~~~~~~~ Shari Silady ~~~~~~~~~~~~~ " Mothers have as powerful an influence over the welfare of future generations as all other earthly causes combined. "

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

[Guest guest]

Shari wrote:

I would like to see the stats as well. It seems like every

baby I see has

birth trauma. Some pretty involved negatively effecting suck. And the Ped

says it is normal and will go away on its own.

I not only do a suck assessment but a body assessment as well. As the body

and head all impact suck. I rarely see a baby who does not need body work

and usually a TT is

involved.

Jaye again: Boy am I in the same boat! I have

seen only one baby in the last 8 months who had NO issues – perfectly fine

kid. Mom has positioning challenges so it was a super quick fix and a

visit I could have done in my sleep.

Saw a baby just over 17 months ago whose head tilted to the

right (ear on the shoulder), spine curved to the right and her legs/hips went

off to the right at nearly a 45 degree angle! The Dr had seen her that

morning and declared her fine. ??? Anyway, she got in to treatment

immediately, and at 10.5 weeks was finally able to latch and get milk.

Why do Docs (or LC’s) miss these obvious structural

issues? I can see missing the subtle ones, but that obvious? I

think it is because birth injuries are now the new normal. So many babies

come out with structural issues due to position prior to birth, stressful pregnancy,

forceps, vacuum, pitocin, epidural, etc…that docs and nurses see it as

normal. Also, they do NOT see mom struggle for weeks and weeks –

they are not in the trenches with these moms and so I think they tell them the

baby will be fine because 1) they are trying to reassure and 2) they have NO F’ING

CLUE that the baby will NOT be fine!

The other reason I refer asap is because if the muscles are

compromised they will at some point start to compensate (if they haven’t

started already). We will see this initially with the suck: The lip

blisters, the negative suction, and chompy jaw. Muscles that are doing

whatever they can to just feed the baby. Later though, as the body starts

to move into gross motor development we will see other issues start to crop up

when the muscles have been compromised early and not treated. What do we

see? Inability to roll over, inability to raise arms over head, inability

to crawl (properly, if at all), inability to weight bear on legs. Also,

lack of weight gain even when there is enough documented intake (I’ve

seen this one a handful of times!). Walking – with a limp, a foot

dragging, etc… I could go on…because I’ve seen all of

the above and more.

I explain it to parents like this: When muscle A cannot do

its job, Muscle B will come over and help. Well, that leaves Muscle B

unable to do its job, so Muscle C comes over to help. Muscle D shows up

to help Muscle C and so and on and so on…This sets up a chain reaction of

long term muscle dysfunction that can end up being a lifelong problem.

I just want to say thank you to those of you who are saying

and seeing the same thing I am. I often feel quite alone here –

there are only 2 LC’s (besides me) who have a clue about this stuff in my

area. And while I like them very, very well and they do a good job on

most things, the education has a long way to go and as a result, many babies

are inadvertently missed and do not get the treatment they need when they need

it. I am trying to figure out how to provide that education as I seem to

be the only one with the level of education and experience I have (which really

sucks!!!) Our community needs it desperately. I have offered over

the past year or two one on one or even group training at no cost – and Nothing.

I don’t get it. This information is lightly tossed around by our

experts at conferences in bits and pieces and isn’t nearly encompassing

enough. I’m working on a way to fix that.

Anyway – thank you for helping me to feel less

alone. I have gotten to meet in person a couple other LC’s in person,

and , who truly get it and observe the same things I do, look for

the same things I do and then refer out for appropriate treatment as I do.

I can tell you – it was amazing!

Warmly,

Jaye

Who will be checking in one 3 babies with serious issues

today…

Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net