Re: Re: Tongue tie

[Guest guest]

Thanks, Jaye, wonderful post. Last month I saw a 1 wk old baby who had been born at 35 weeks gestation. The oral cavity was so small that I just couldn't be sure about a tongue tie. Hoped ENT could tell. He wasn't sure. Poor mother struggled for another month before calling me back. Lo and behold, there it was - plain as day. ENT saw it clearly, too, and clipped, to mother's great joy. Family had convinced her that SHE was doing something wrong!

Anne Grider

Re: Tongue tie

[Guest guest]

Jaye, all I can say is double ditto.  Ditto on the frustration for when the parents can't / won't do the procedure and ditto on all the information I give and my level of knowledge and skill at recognizing a tt of every variety. So, try to use a pillow when you bang your head so you don't get bruises. LOL

 

To add to it, I understand the parents.  I would easily clip a tt anterior to posterior with visible membrane. Dang, if one of my kids had it I would clip it myself. LOL However, the other kinds where there is more to it than a quick procedure, I do respect their fear of doing it.  There is pain for the baby when we are doing a submucosal tongue tie release or when the posterior tongue tie is so thick and there may likely need stitching. I am honest, and we do the body work and we do try to see if we can manage without the procedure.  Sometimes they can, sometimes not and they go on a hunt begging doctors to do it.  But here, most won't do posterior or submucosal.  One does, most don't and even the one who does is a toss up.  So, for me the frustration is more than the parents it's the hcps who tell the moms no.  Not to mention the peds who say " sure, there is a tt, but those LCs are crazy, that has nothing to do with breastfeeding. " Then I not only bang my head I want to bang theirs!

 

What I try to tell myself is I have been doing this for 20 years.  Back in the day, we had NO ONE clipping anything beyond obvious anterior tongue ties.  And we managed to help babies learn to breastfeed and mothers learn to manage the latch and positioning to make it work.  And we did not even have CST or baby chiro as easily available. This is what I remind myself as I hit the wall.  I do get bruises sometimes, but some ice and a glass of wine and I heal for the next one.

 

Take care,

Pam M.

 

Hi All,

 

Just wanted to respectfully set a couple things straight and then, a note at the bottom of this: J  I have been working in the field for nearly 17 yrs now.  I now specialize in tongue-ties of the strangest variety.  I find the ones many do not know how to recognize and I find ones that have me wondering until after baby gets body work done and then the darn things finally pop out and show themselves and can be clipped. 

 

When I find a tongue-tie I have a set of information I provide the parents with so that they can make an informed decision.  I tell each and every parent about the genetic sequence of how tongue ties come about – how the floor of the mouth and the tongue start off as one and a genetic code sets off the separation (apoptosis) of the two.  If that genetic code fires at 100% - no tongue tie.  If not…then there is a wide range of frenulum ‘left over’ to be seen.  I talk about the 4 types of tongue-tie and how within those 4 types there are variations, and that some absolutely DO affect breastfeeding (and a myriad of other future possibilities) and some do not.  I also describe the difference between circs and frenotomy.  And we talk about doing now vs. doing later – ramifications, etc.  And the baby often needs body work as well, so we discuss the importance of full treatment vs. half…

 

I tell them that I know this is a crazy thing I am suggesting – if sounds nuts, it sounds scary, etc…and I give them lots of information to read and consider and to educate themselves.  We talk about the 2 fabulous practitioners who do frenotomies for my babies – how one uses scissors and one uses a laser, (but contrary to popular belief, the laser does not always cauterize) and that there may very well be a bit of bleeding – looks like a lot with the saliva, but it settles very quickly.  And baby heals very quickly.  And that babies are more pissed off about someone being in their mouth (How RUDE!!) poking around, than they are about the clipping of a piece of tissue that has no nerve endings.   Personally, I have come to prefer the scissors – faster, heals better, and babies (and parents) settle faster.  I give lots of information on how to work with the tongue after frenotomy to promote good tongue function and proper healing, what to watch for, follow-up body work and possible follow-up consult.

 

And then I tell them MY story with a kid whose submucosal frenulum was never diagnosed (even with a bubble palate – clear indication of a tongue-tie) because we didn’t know about those back 17 yrs ago.  They ALWAYS ask if I would have had my son’s clipped if I had known and I tell them that if someone had given me that bit of information I’d have had my son’s frenulum clipped in a heartbeat.  It would have saved a LOT of problems for us during the 3 yrs 2 months that he nursed – and yes there were struggles the entire time.

 

Lastly, I NEVER paint a rosy picture.  I paint a realistic picture.  In some cases it is clear that a frenotomy will absolutely fix it all.  In others there is more that is going on, and sometimes babies need to be clipped more than one time for very specific reasons.  I give them all the information…we spend a good amount of time discussing this – and I give descriptions of different cases I have worked with and give the parents the option of contacting other parents who have been through it.  Support is key.

 

So – what I am saying is that I already do what everyone has suggested.  J  But, the suggestions were fabulous for our newer LC’s who are still learning, so thank you for sharing those.  They will help more than you may ever know.  What I was looking for specifically was just support so I could stop banging my head against a wall…maybe a ‘there, there, Jaye hang in there!”  You know – some pity from those of you who know what I am dealing with because you have dealt with it too.  J  LOL!   Sometimes a mutual pity party is JUST OK!  J

 

Before I go, one of the parents I was so frustrated about had their baby clipped yesterday.  It turned out her hubby was scared of the procedure (bad circ as a baby so now terrified of anything that might damage…understandable).  Judy, my Bowen Specialist, talked to Dad at length at their Bowen appt and he finally understood how important it was.  I met mom at the Dr.s office and helped her and baby through the procedure.  What is so cool, is that Dr listens to me about the muscle stuff – he is learning – he trusts me!  Yea!  I love this guy…!  Anyway, he clipped once – then checked again – and said “Whoa!  More popped out!  Give me the scissors!!” and clipped the second bit of frenulum that had been deeply buried.  This baby, when I first saw them at 6 days (now 10 wks) had no visible frenulum, but I knew it was in there. I could feel it.  But she was SO DAMN TIGHT (horrible birth!!) that it took several weeks of therapy to loosen her up to where the frenulum finally popped out enough to see it.  (but dad has fought against frenotomy for the past 4 wks…)  After the frenotomy, I was playing tongue games with her…sticking my tongue out at her and saying Ahhhh.  J  She was too cute!  This baby really likes me, btw – she will not take her eyes off me even when others are trying to get her attention!  Anyway, she started sticking her tongue out and saying Ahhhh!  And her tongue extension was significantly better than ever before!  Then she started playing with her tongue, holding it with her hands, moving it around…  Now, mom and baby get to get back to work at getting this little one on the breast.  I think they will be fine.  J

 

Ok – that is my story.  J   I thank everyone for their input…you are awesome!

Warmly,

Jaye

 

 

 

Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net

 

-- Pam MazzellaDiBosco, IBCLC, RLCBirthing & Beyond, Inc.Labor Support and Lactation Consultant Services

[Guest guest]

Jaye,Sounds great- you do everything right. I am frustrated with newer LC’s who send almost every mom to have the tongue clipped. This is clearly because it is in vogue and they don’t know how to assess for anything else that may be causing problems- ie torticollis, etc.It has given our profession in my area such a bad name… Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of Jaye Simpson, IBCLCSent: Friday, September 09, 2011 5:53 PMTo: Subject: Re: Tongue tie Hi All, Just wanted to respectfully set a couple things straight and then, a note at the bottom of this: J I have been working in the field for nearly 17 yrs now. I now specialize in tongue-ties of the strangest variety. I find the ones many do not know how to recognize and I find ones that have me wondering until after baby gets body work done and then the darn things finally pop out and show themselves and can be clipped. When I find a tongue-tie I have a set of information I provide the parents with so that they can make an informed decision. I tell each and every parent about the genetic sequence of how tongue ties come about – how the floor of the mouth and the tongue start off as one and a genetic code sets off the separation (apoptosis) of the two. If that genetic code fires at 100% - no tongue tie. If not…then there is a wide range of frenulum ‘left over’ to be seen. I talk about the 4 types of tongue-tie and how within those 4 types there are variations, and that some absolutely DO affect breastfeeding (and a myriad of other future possibilities) and some do not. I also describe the difference between circs and frenotomy. And we talk about doing now vs. doing later – ramifications, etc. And the baby often needs body work as well, so we discuss the importance of full treatment vs. half… I tell them that I know this is a crazy thing I am suggesting – if sounds nuts, it sounds scary, etc…and I give them lots of information to read and consider and to educate themselves. We talk about the 2 fabulous practitioners who do frenotomies for my babies – how one uses scissors and one uses a laser, (but contrary to popular belief, the laser does not always cauterize) and that there may very well be a bit of bleeding – looks like a lot with the saliva, but it settles very quickly. And baby heals very quickly. And that babies are more pissed off about someone being in their mouth (How RUDE!!) poking around, than they are about the clipping of a piece of tissue that has no nerve endings. Personally, I have come to prefer the scissors – faster, heals better, and babies (and parents) settle faster. I give lots of information on how to work with the tongue after frenotomy to promote good tongue function and proper healing, what to watch for, follow-up body work and possible follow-up consult. And then I tell them MY story with a kid whose submucosal frenulum was never diagnosed (even with a bubble palate – clear indication of a tongue-tie) because we didn’t know about those back 17 yrs ago. They ALWAYS ask if I would have had my son’s clipped if I had known and I tell them that if someone had given me that bit of information I’d have had my son’s frenulum clipped in a heartbeat. It would have saved a LOT of problems for us during the 3 yrs 2 months that he nursed – and yes there were struggles the entire time. Lastly, I NEVER paint a rosy picture. I paint a realistic picture. In some cases it is clear that a frenotomy will absolutely fix it all. In others there is more that is going on, and sometimes babies need to be clipped more than one time for very specific reasons. I give them all the information…we spend a good amount of time discussing this – and I give descriptions of different cases I have worked with and give the parents the option of contacting other parents who have been through it. Support is key. So – what I am saying is that I already do what everyone has suggested. J But, the suggestions were fabulous for our newer LC’s who are still learning, so thank you for sharing those. They will help more than you may ever know. What I was looking for specifically was just support so I could stop banging my head against a wall…maybe a ‘there, there, Jaye hang in there!” You know – some pity from those of you who know what I am dealing with because you have dealt with it too. J LOL! Sometimes a mutual pity party is JUST OK! J Before I go, one of the parents I was so frustrated about had their baby clipped yesterday. It turned out her hubby was scared of the procedure (bad circ as a baby so now terrified of anything that might damage…understandable). Judy, my Bowen Specialist, talked to Dad at length at their Bowen appt and he finally understood how important it was. I met mom at the Dr.s office and helped her and baby through the procedure. What is so cool, is that Dr listens to me about the muscle stuff – he is learning – he trusts me! Yea! I love this guy…! Anyway, he clipped once – then checked again – and said “Whoa! More popped out! Give me the scissors!!” and clipped the second bit of frenulum that had been deeply buried. This baby, when I first saw them at 6 days (now 10 wks) had no visible frenulum, but I knew it was in there. I could feel it. But she was SO DAMN TIGHT (horrible birth!!) that it took several weeks of therapy to loosen her up to where the frenulum finally popped out enough to see it. (but dad has fought against frenotomy for the past 4 wks…) After the frenotomy, I was playing tongue games with her…sticking my tongue out at her and saying Ahhhh. J She was too cute! This baby really likes me, btw – she will not take her eyes off me even when others are trying to get her attention! Anyway, she started sticking her tongue out and saying Ahhhh! And her tongue extension was significantly better than ever before! Then she started playing with her tongue, holding it with her hands, moving it around… Now, mom and baby get to get back to work at getting this little one on the breast. I think they will be fine. J Ok – that is my story. J I thank everyone for their input…you are awesome!Warmly,Jaye Jaye Simpson, IBCLC, CIIMBreastfeeding NetworkSacramento, CAwww.breastfeedingnetwork.net __________ Information from ESET NOD32 Antivirus, version of virus signature database 6450 (20110909) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

[Guest guest]

I'm a new LC and I send nearly all my babies for evaluation of tongue tie but I don't do it because I think it's in vogue. That would be cruel. I do it because I think it will help. Jeez. Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.netwww.facebook.com/CradleholdBreastfeedingEducationandsupportProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and babyHow Were YOU Supported to Breastfeed?http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspxFrom: Shaya & Billowitz To: Sent: Saturday, September 10, 2011 2:11 PMSubject: RE: Re: Tongue tie

Jaye,Sounds great- you do everything right. I am frustrated with newer LC’s who send almost every mom to have the tongue clipped. This is clearly because it is in vogue and they don’t know how to assess for anything else that may be causing problems- ie torticollis, etc.It has given our profession in my area such a bad name… Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of Jaye Simpson, IBCLCSent: Friday, September 09, 2011 5:53 PMTo: Subject: Re: Tongue tie Hi All, Just wanted to respectfully set a couple things straight and then, a note at the bottom of this: J I have been working in the field for nearly 17 yrs now. I now specialize in tongue-ties of the strangest variety. I find the ones many do not know how to recognize and I find ones that have me wondering until after baby gets body work done and then the darn things finally pop out and show themselves and can be clipped. When I find a tongue-tie I have a set of information I provide the parents with so that they can make an informed decision. I tell each and every parent about the genetic sequence of how tongue ties come about – how the floor of the mouth and

the tongue start off as one and a genetic code sets off the separation (apoptosis) of the two. If that genetic code fires at 100% - no tongue tie. If not…then there is a wide range of frenulum ‘left over’ to be seen. I talk about the 4 types of tongue-tie and how within those 4 types there are variations, and that some absolutely DO affect breastfeeding (and a myriad of other future possibilities) and some do not. I also describe the difference between circs and frenotomy. And we talk about doing now vs. doing later – ramifications, etc. And the baby often needs body work as well, so we discuss the importance of full treatment vs. half… I tell them that I know this is a crazy thing I am suggesting – if sounds nuts, it sounds scary, etc…and I

give them lots of information to read and consider and to educate themselves. We talk about the 2 fabulous practitioners who do frenotomies for my babies – how one uses scissors and one uses a laser, (but contrary to popular belief, the laser does not always cauterize) and that there may very well be a bit of bleeding – looks like a lot with the saliva, but it settles very quickly. And baby heals very quickly. And that babies are more pissed off about someone being in their mouth (How RUDE!!) poking around, than they are about the clipping of a piece of tissue that has no nerve endings. Personally, I have come to prefer the scissors – faster, heals better, and babies (and parents) settle faster. I give lots of information on how to work with the tongue after frenotomy to promote good tongue function and proper healing, what to watch for, follow-up body work and possible follow-up consult. And then I tell them MY story with a kid whose submucosal frenulum was never diagnosed (even with a bubble palate – clear indication of a tongue-tie) because we didn’t know about those back 17 yrs ago. They ALWAYS ask if I would have had my son’s clipped if I had known and I tell them that if someone had given me that bit of information I’d have had my son’s frenulum clipped in a heartbeat. It would have saved a LOT of problems for us during the 3 yrs 2 months that he nursed – and yes there were struggles the entire time. Lastly, I NEVER paint a rosy picture. I paint a realistic picture. In some cases it is clear

that a frenotomy will absolutely fix it all. In others there is more that is going on, and sometimes babies need to be clipped more than one time for very specific reasons. I give them all the information…we spend a good amount of time discussing this – and I give descriptions of different cases I have worked with and give the parents the option of contacting other parents who have been through it. Support is key. So – what I am saying is that I already do what everyone has suggested. J But, the suggestions were fabulous for our newer LC’s who are still learning, so thank you for sharing those. They will help more than you may ever know. What I

was looking for specifically was just support so I could stop banging my head against a wall…maybe a ‘there, there, Jaye hang in there!†You know – some pity from those of you who know what I am dealing with because you have dealt with it too. J LOL! Sometimes a mutual pity party is JUST OK! J Before I go, one of the parents I was so frustrated about had their baby clipped yesterday. It turned out her hubby was scared of the procedure (bad circ as a baby so now terrified of anything that might damage…understandable). Judy, my Bowen Specialist, talked to Dad at length at their

Bowen appt and he finally understood how important it was. I met mom at the Dr.s office and helped her and baby through the procedure. What is so cool, is that Dr listens to me about the muscle stuff – he is learning – he trusts me! Yea! I love this guy…! Anyway, he clipped once – then checked again – and said “Whoa! More popped out! Give me the scissors!!†and clipped the second bit of frenulum that had been deeply buried. This baby, when I first saw them at 6 days (now 10 wks) had no visible frenulum, but I knew it was in there. I could feel it. But she was SO DAMN TIGHT (horrible birth!!) that it took several weeks of therapy to loosen her up to where the frenulum finally popped out enough to see it. (but dad has fought against frenotomy for the past 4 wks…) After the frenotomy, I was playing tongue games with her…sticking my tongue out at her and saying Ahhhh.

J She was too cute! This baby really likes me, btw – she will not take her eyes off me even when others are trying to get her attention! Anyway, she started sticking her tongue out and saying Ahhhh! And her tongue extension was significantly better than ever before! Then she started playing with her tongue, holding it with her hands, moving it around… Now, mom and baby get to get back to work at getting this little one on the breast. I think they will be fine. J Ok – that is my story. J I thank everyone for their input…you are awesome!Warmly,Jaye Jaye Simpson, IBCLC, CIIMBreastfeeding NetworkSacramento, CAwww.breastfeedingnetwork.net __________ Information from ESET NOD32 Antivirus, version of virus signature database 6450 (20110909) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

[Guest guest]

What's frustrating about your statement Dana is, that every baby should be evaluated for tongue tie IN THE HOSPITAL -- after birth, before discharge.

Why are WE in PP sending the babies for evaluation? Why is this not something that is done routinely, like checking for a fractured clavicle, a cleft palate, or a hip click?

Those are all rhetorical questions, and no one need respond.

I preach this routinely in the courses I teach to hospital staff -- and it falls on deaf ears.

Jan Barger, RN, MA, IBCLC, FILCALactation Education Consultantswww.lactationeducation.com

I'm a new LC and I send nearly all my babies for evaluation of tongue tie but I don't do it because I think it's in vogue. That would be cruel. I do it because I think it will help. Jeez.

Dana Schmidt, BS, RN, IBCLC

[Guest guest]

Because if they can stick their to tongue out, their tongue is fine, according to what moms tell me they heard in the hospitalSent from my iPhone

What's frustrating about your statement Dana is, that every baby should be evaluated for tongue tie IN THE HOSPITAL -- after birth, before discharge.

Why are WE in PP sending the babies for evaluation? Why is this not something that is done routinely, like checking for a fractured clavicle, a cleft palate, or a hip click?

Those are all rhetorical questions, and no one need respond.

I preach this routinely in the courses I teach to hospital staff -- and it falls on deaf ears.

Jan Barger, RN, MA, IBCLC, FILCALactation Education Consultantswww.lactationeducation.com

I'm a new LC and I send nearly all my babies for evaluation of tongue tie but I don't do it because I think it's in vogue. That would be cruel. I do it because I think it will help. Jeez.

Dana Schmidt, BS, RN, IBCLC

[Guest guest]

That is not "evaluating for tongue tie."

Jan

Because if they can stick their to tongue out, their tongue is fine, according to what moms tell me they heard in the hospital

Sent from my iPhone

[Guest guest]

In the past three years, I have only had one baby in my office with a normal frenulum. It's really amazing how many babies have this condition now. Of course, we have to remember that we only see the moms/babies who are having difficulty. When moms ask me "how many babies do you see with difficulties", I always laugh and tell them I have a very skewed view of the breastfeeding world! Moms who are having no trouble nursing their babies don't come to my office!

Dee KassingI'm a new LC and I send nearly all my babies for evaluation of tongue tie but I don't do it because I think it's in vogue. That would be cruel. I do it because I think it will help. Jeez.

Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.netwww.facebook.com/CradleholdBreastfeedingEducationandsupport

[Guest guest]

I don’t have any problem evaluating each baby, that is what should be done, but not all frenulums need to be clipped.  I really believe if it is not broken, no need to fix it.  If there is no pain, baby gaining, milk supply is fine, etc.  If it is not a type 1 or two that will cause dental or speech issues later on, why clip it in every case.  Of course I do all that Jaye says- but I find often there are many issues going on, and they all have to be dealt with.  TT is not the only possibility.  Did not mean to offend anyone!!!!! Billowitz From: [mailto: ] On Behalf Of Dana SchmidtSent: Saturday, September 10, 2011 11:32 PMTo: Subject: Re: Re: Tongue tie I'm a new LC and I send nearly all my babies for evaluation of tongue tie but I don't do it because I think it's in vogue. That would be cruel. I do it because I think it will help. Jeez. Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.netwww.facebook.com/CradleholdBreastfeedingEducationandsupportProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and babyHow Were YOU Supported to Breastfeed?http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspxFrom: Shaya & Billowitz To: Sent: Saturday, September 10, 2011 2:11 PMSubject: RE: Re: Tongue tie Jaye,Sounds great- you do everything right. I am frustrated with newer LC’s who send almost every mom to have the tongue clipped. This is clearly because it is in vogue and they don’t know how to assess for anything else that may be causing problems- ie torticollis, etc.It has given our profession in my area such a bad name… Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of Jaye Simpson, IBCLCSent: Friday, September 09, 2011 5:53 PMTo: Subject: Re: Tongue tie Hi All, Just wanted to respectfully set a couple things straight and then, a note at the bottom of this: J I have been working in the field for nearly 17 yrs now. I now specialize in tongue-ties of the strangest variety. I find the ones many do not know how to recognize and I find ones that have me wondering until after baby gets body work done and then the darn things finally pop out and show themselves and can be clipped. When I find a tongue-tie I have a set of information I provide the parents with so that they can make an informed decision. I tell each and every parent about the genetic sequence of how tongue ties come about – how the floor of the mouth and the tongue start off as one and a genetic code sets off the separation (apoptosis) of the two. If that genetic code fires at 100% - no tongue tie. If not…then there is a wide range of frenulum ‘left over’ to be seen. I talk about the 4 types of tongue-tie and how within those 4 types there are variations, and that some absolutely DO affect breastfeeding (and a myriad of other future possibilities) and some do not. I also describe the difference between circs and frenotomy. And we talk about doing now vs. doing later – ramifications, etc. And the baby often needs body work as well, so we discuss the importance of full treatment vs. half… I tell them that I know this is a crazy thing I am suggesting – if sounds nuts, it sounds scary, etc…and I give them lots of information to read and consider and to educate themselves. We talk about the 2 fabulous practitioners who do frenotomies for my babies – how one uses scissors and one uses a laser, (but contrary to popular belief, the laser does not always cauterize) and that there may very well be a bit of bleeding – looks like a lot with the saliva, but it settles very quickly. And baby heals very quickly. And that babies are more pissed off about someone being in their mouth (How RUDE!!) poking around, than they are about the clipping of a piece of tissue that has no nerve endings. Personally, I have come to prefer the scissors – faster, heals better, and babies (and parents) settle faster. I give lots of information on how to work with the tongue after frenotomy to promote good tongue function and proper healing, what to watch for, follow-up body work and possible follow-up consult. And then I tell them MY story with a kid whose submucosal frenulum was never diagnosed (even with a bubble palate – clear indication of a tongue-tie) because we didn’t know about those back 17 yrs ago. They ALWAYS ask if I would have had my son’s clipped if I had known and I tell them that if someone had given me that bit of information I’d have had my son’s frenulum clipped in a heartbeat. It would have saved a LOT of problems for us during the 3 yrs 2 months that he nursed – and yes there were struggles the entire time. Lastly, I NEVER paint a rosy picture. I paint a realistic picture. In some cases it is clear that a frenotomy will absolutely fix it all. In others there is more that is going on, and sometimes babies need to be clipped more than one time for very specific reasons. I give them all the information…we spend a good amount of time discussing this – and I give descriptions of different cases I have worked with and give the parents the option of contacting other parents who have been through it. Support is key. So – what I am saying is that I already do what everyone has suggested. J But, the suggestions were fabulous for our newer LC’s who are still learning, so thank you for sharing those. They will help more than you may ever know. What I was looking for specifically was just support so I could stop banging my head against a wall…maybe a ‘there, there, Jaye hang in there!†You know – some pity from those of you who know what I am dealing with because you have dealt with it too. J LOL! Sometimes a mutual pity party is JUST OK! J Before I go, one of the parents I was so frustrated about had their baby clipped yesterday. It turned out her hubby was scared of the procedure (bad circ as a baby so now terrified of anything that might damage…understandable). Judy, my Bowen Specialist, talked to Dad at length at their Bowen appt and he finally understood how important it was. I met mom at the Dr.s office and helped her and baby through the procedure. What is so cool, is that Dr listens to me about the muscle stuff – he is learning – he trusts me! Yea! I love this guy…! Anyway, he clipped once – then checked again – and said “Whoa! More popped out! Give me the scissors!!†and clipped the second bit of frenulum that had been deeply buried. This baby, when I first saw them at 6 days (now 10 wks) had no visible frenulum, but I knew it was in there. I could feel it. But she was SO DAMN TIGHT (horrible birth!!) that it took several weeks of therapy to loosen her up to where the frenulum finally popped out enough to see it. (but dad has fought against frenotomy for the past 4 wks…) After the frenotomy, I was playing tongue games with her…sticking my tongue out at her and saying Ahhhh. J She was too cute! This baby really likes me, btw – she will not take her eyes off me even when others are trying to get her attention! Anyway, she started sticking her tongue out and saying Ahhhh! And her tongue extension was significantly better than ever before! Then she started playing with her tongue, holding it with her hands, moving it around… Now, mom and baby get to get back to work at getting this little one on the breast. I think they will be fine. J Ok – that is my story. J I thank everyone for their input…you are awesome!Warmly,Jaye Jaye Simpson, IBCLC, CIIMBreastfeeding NetworkSacramento, CAwww.breastfeedingnetwork.net __________ Information from ESET NOD32 Antivirus, version of virus signature database 6450 (20110909) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 6453 (20110910) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

[Guest guest]

I am always amazed at the “type” of LC’s (excuse me for lack of a better word) who say they never do a suck assessment because it is too invasive- in fact, years ago, CHele Marment lectured about this in Israel. As Jaye says, you really need to get in there and feel and you can learn sooo much!!!I have moms leaving the hospital and call me for a consult because they were told the baby has a tongue tie and there is nothing that a deeper latch and positioning can’t fix. These are often volunteer women or new IBCLC’s who whenever the baby does not feed well in the first few days in the hospital that is always what they say. Big nipples, drugs, molding, swallowing fluids, etc all can cause a baby to feed poorly. And I really believe it is nearly impossible with the 3’s and 4’s and even sometimes with the 1’s and 2’s to know what will be until copious milk has come in. Ever have a mother in pain the first three days and you think the TT will be a problem and then when milk comes in all resolves? Or ever think something was a short/ tied posterior, etc only to have CST and have things adjusted and then have a “different “ tongue after a few sessions? So I send many babies to be clipped. As Dee said, they aint coming to me because all is fine and dandy! But I do evaluate each one, and just this week the mom was told the baby was TT- and really we adjusted postioning and all was fine- I think the TT was slight if any. Now if we tried everything and the baby still could not feed, of course I would send to clip. Because you have got to try everything. I am just saying if the only answer was tongues, things would be a lot simpler. But unfortunately the peds here say “all lactation consultants think all babies are tongue tied, and they are all crazy.” Well, I really resent that, and now I have worked to achieve the rep as one of the only LC’s who does not send everyone to clip- and that is why the peds love referring to me. I mean things became so backward here that I often have to tell the ped it is not that bad and not needed, and latch adjustment did the trick. Remember when some peds went so pro breastfeeding that they were happy to let babies starve, and we were the ones pushing formula supplement? Well, similar thing going on here with TT…. Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of Jaye Simpson, IBCLCSent: Sunday, September 11, 2011 6:23 PMTo: Subject: Re: Tongue tie Jan and Dana – absolutely I agree: There is very little evaluation of t-t in the hospital (if any) and yup – if baby can stick their tongue out they are fine. Let’s take it one step further. How many times has a mom said to me: The LC/Dr/Ped in the hosp/WIC/clinic I went to said there was no tongue tie. I ask if that person actually put their finger IN the baby’s mouth to FEEL and then evaluate range of motion, function, etc. The answer is ALWAYS – NO. They just looked. People – you have to get IN There!! You have to actually evaluate tongue function and you have to actually feel for that frenulum! And if you are encouraging baby to open and latch and that tongue is pulling back – and not coming forward – you might want to properly evaluate for t-t! Sigh… And I was really interested in the ‘tt eval is in vogue” statement. That must be an ‘area’ thing. can you expand on that? Trust me it is NOT in vogue in my area… But I do see A LOT of t-t… Jaye Simpson, IBCLC, CIIMBreastfeeding NetworkSacramento, CAwww.breastfeedingnetwork.net __________ Information from ESET NOD32 Antivirus, version of virus signature database 6454 (20110911) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

[Guest guest]

,

Reminds me of a situation years ago when a mom had very early signs of yeast, and her OB told her that "Jan has yeast on the brain." She was thrilled to go back to him two days later and show him her baby's rampant case of thrush and her very yeasty nipples. Not only did he never say anything like that again, he brought his wife and baby to me when they were having problems with breastfeeding....

Jan Barger, RN, MA, IBCLC, FILCALactation Education Consultantswww.lactationeducation.com

But unfortunately the peds here say “all lactation consultants think all babies are tongue tied, and they are all crazy.â€

[Guest guest]

That is really funny…Speaking of yeast, there is this female ped here, who I have heard is also a lactation consultant, and I will be shocked if that means IBCLC because I have heard some very lousy advice she gives (ie just BF more often (when I assessed that this baby cannot get anything out, etc) but in any case a mom calls me today after seeing this ped looking for Gentian violet which we cannot get here, someone told her I may have it.  Her baby has thrush so she says, and ped says also- but she has treated for 6 days and it is not helping, but only the babies tongue is white, nowhere else, and her nipples do not hurt-  I am skeptical.  In general, I think sometimes we can get caught on one thing.  My attitude is that if you are treating properly for thrush and symptoms are not going away, it probably is not thrush.  Anyone want to comment?  Just a white tongue seems like fatty milk residue- I did not see this baby but I would venture to guess a fat one…What do you guys think- thrush after being treated for 6 days?  Her proof was that baby was more fussy than usual.  Billowitz, IBCLCIsraelFrom: [mailto: ] On Behalf Of ibclc@...Sent: Sunday, September 11, 2011 8:34 PMTo: Subject: Re: Re: Tongue tie , Reminds me of a situation years ago when a mom had very early signs of yeast, and her OB told her that " Jan has yeast on the brain. " She was thrilled to go back to him two days later and show him her baby's rampant case of thrush and her very yeasty nipples. Not only did he never say anything like that again, he brought his wife and baby to me when they were having problems with breastfeeding.... Jan Barger, RN, MA, IBCLC, FILCALactation Education Consultantswww.lactationeducation.com But unfortunately the peds here say “all lactation consultants think all babies are tongue tied, and they are all crazy.†__________ Information from ESET NOD32 Antivirus, version of virus signature database 6455 (20110911) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

[Guest guest]

>Just a white tongue seems like fatty milk residue<

My rule of thumb is that if you can wipe the white stuff away (gently, with a damp cloth,) then it is milk residue.Easy and quick!normaNorma Ritter, IBCLC, RLCBreastfeeding Matters in the Capital Region

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

[Guest guest]

, can you explain a bit more about a peds trying to censor LC's about TT and about PUMPING? What's up with that? There are a lot of peds around the US of A that want to censor IBCLCs about anything other than straightforward get the baby latched. Never discuss or mention TT, never talk about herbs or other galactogogues (those are the two biggies). But pumping???

Jan www.grammiesawards.blogspot.com

I have to say that I see a range of responses to potential tongue ties. I see a few LCs who refer everyone very quickly to the ENT here before really evaluating how the baby is attaching and yes, I absolutely see many of these resolve completely with appropriate attachment. We also have a pediatrician who is now trying to CENSOR IBCLCs about tongue ties and about pumping. Furthermore, I rarely see the complicated tongue ties resolve quickly. To date, I have not seen solid research that really shows whether the procedure improved the situation or whether some of the other accompanying support therapies improved the situation or what combination of supporting therapies work when. Genna has some really good theories on the windows of opportunity for doing the procedure. I do know that the ENT doesn't really like to see anything but the really straightforward tongue ties when the baby is younger than a week because it is very difficult to assess function. I personally find that it is impossible to assess function on a baby who is not gaining well. Very often they are so fatigued that the cannot feed well. Once they bounce back by taking sufficient calories, I have seen many babies have a perfectly fine suck --- and then others who really then clearly need the procedures and sometimes supportive therapies.Best regards, E. Burger, MHS, PhD, IBCLC

[Guest guest]

How can anyone say "censor" in todays world of information. I realize it has but a dent in their god complex but oh wow women can read! When a mom reads that tt affects bf and doc says it doesn't. Doc looks like an idiot. It is not my fault women read. Pam MazzellaDiBoscoPam MazzellaDiBosco. IBCLCFrom: ibclc@...Sender: Date: Mon, 12 Sep 2011 08:47:33 -0400 (EDT)To: < >ReplyTo: Subject: Re: Re: Tongue tie , can you explain a bit more about a peds trying to censor LC's about TT and about PUMPING? What's up with that? There are a lot of peds around the US of A that want to censor IBCLCs about anything other than straightforward get the baby latched. Never discuss or mention TT, never talk about herbs or other galactogogues (those are the two biggies). But pumping??? Jan www.grammiesawards.blogspot.com In a message dated 9/12/2011 7:34:22 A.M. Central Daylight Time, sburgernutr@... writes: I have to say that I see a range of responses to potential tongue ties. I see a few LCs who refer everyone very quickly to the ENT here before really evaluating how the baby is attaching and yes, I absolutely see many of these resolve completely with appropriate attachment. We also have a pediatrician who is now trying to CENSOR IBCLCs about tongue ties and about pumping. Furthermore, I rarely see the complicated tongue ties resolve quickly. To date, I have not seen solid research that really shows whether the procedure improved the situation or whether some of the other accompanying support therapies improved the situation or what combination of supporting therapies work when. Genna has some really good theories on the windows of opportunity for doing the procedure. I do know that the ENT doesn't really like to see anything but the really straightforward tongue ties when the baby is younger than a week because it is very difficult to assess function. I personally find that it is impossible to assess function on a baby who is not gaining well. Very often they are so fatigued that the cannot feed well. Once they bounce back by taking sufficient calories, I have seen many babies have a perfectly fine suck --- and then others who really then clearly need the procedures and sometimes supportive therapies.Best regards, E. Burger, MHS, PhD, IBCLC

[Guest guest]

Ok, so, where can one get trained to properly evaluate tt?  palate?   I've recently seen a group of moms whose babies appeared to have very obvious tt.  They all got clipped when I sent to Dr Kotlow.  What I've learned has really been on my own through books, lecture and just me sticking my fingers in baby's mouths to see what I can feel.  I would love the opportunity to spend a week at a busy clinic with a seasoned IBCLC to learn more.

-Jeannine s, B.A., IBCLCwww.capitalareabreastfeedingsupport.com

[Guest guest]

This looks like a good conference especially with Jan Ellen Brown. I need to learn more about TTs too!http://library.constantcontact.com/download/get/file/1101686237870-15/flyer2012.pdf Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.netwww.facebook.com/CradleholdBreastfeedingEducationandsupportProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and babyHow Were YOU Supported to Breastfeed?http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspxFrom: Jeannine s To: Sent: Monday, September 12, 2011 1:20 PMSubject: Re: Re: Tongue tie

Ok, so, where can one get trained to properly evaluate tt? palate? I've recently seen a group of moms whose babies appeared to have very obvious tt. They all got clipped when I sent to Dr Kotlow. What I've learned has really been on my own through books, lecture and just me sticking my fingers in baby's mouths to see what I can feel. I would love the opportunity to spend a week at a busy clinic with a seasoned IBCLC to learn more.

-Jeannine s, B.A., IBCLCwww.capitalareabreastfeedingsupport.com

[Guest guest]

Hi All, I generally try to read and learn from you all and keep quiet. But I have to speak up on this one. I have worked both PP and currently work in a hospital. I have read a lot about the hosp. IBCLC and I have got to say, some may be true, but as much of it is true too of some of the PP LC's. BUT, I do think the hospital IBCLC is "censored" (so to speak), the most. I have seem LC's fired over mentioning TT, as well as galactogogues. Pumping has been an issue as well, but so far LC's have the backing of enough of the pedi's on that. I do believe that do to the fear installed over the potential firing, the LC's in our hospital mention TT less and ask the pedi's to look at the "limited tongue movement". Even at that we are on the edge. Slowly we make steps, 2 steps forward, one step back. One baby and mom at a time. Hope this all makes sence. Nannette

How can anyone say "censor" in todays world of information. I realize it has but a dent in their god complex but oh wow women can read! When a mom reads that tt affects bf and doc says it doesn't. Doc looks like an idiot. It is not my fault women read. Pam MazzellaDiBoscoPam MazzellaDiBosco. IBCLCFrom: ibclc@...

Sender:

Date: Mon, 12 Sep 2011 08:47:33 -0400 (EDT)To: < >ReplyTo:

Subject: Re: Re: Tongue tie

, can you explain a bit more about a peds trying to censor LC's about TT and about PUMPING? What's up with that? There are a lot of peds around the US of A that want to censor IBCLCs about anything other than straightforward get the baby latched. Never discuss or mention TT, never talk about herbs or other galactogogues (those are the two biggies). But pumping???

Jan www.grammiesawards.blogspot.com

I have to say that I see a range of responses to potential tongue ties. I see a few LCs who refer everyone very quickly to the ENT here before really evaluating how the baby is attaching and yes, I absolutely see many of these resolve completely with appropriate attachment. We also have a pediatrician who is now trying to CENSOR IBCLCs about tongue ties and about pumping. Furthermore, I rarely see the complicated tongue ties resolve quickly. To date, I have not seen solid research that really shows whether the procedure improved the situation or whether some of the other accompanying support therapies improved the situation or what combination of supporting therapies work when. Genna has some really good theories on the windows of opportunity for doing the procedure. I do know that the ENT doesn't really like to see anything but the really straightforward tongue ties when the baby is younger than a week because it is very difficult to assess function. I personally find that it is impossible to assess function on a baby who is not gaining well. Very often they are so fatigued that the cannot feed well. Once they bounce back by taking sufficient calories, I have seen many babies have a perfectly fine suck --- and then others who really then clearly need the procedures and sometimes supportive therapies.Best regards, E. Burger, MHS, PhD, IBCLC

[Guest guest]

Nannette, my point is every baby needs to be evaluated for tongue tie. It doesn't have to be the IBCLC. It needs to be the pediatrician when they are doing their exam. It needs to be the RN when she is doing her exam, and it needs to be the IBCLC when she is doing her exam. The baby should be examined physically at least three times -- completely head to toe by the RN and the MD/DO, and at least the head/mouth/tone by the IBCLC.

I hear you about the censoring of the IBCLC in the hospital from saying anything about fenugreek or tt or a host of other things. But censoring the IBCLC and her fear of being fired if she doesn't toe the line does not exempt the RN and the MD/DO -- and I'll add midwife to this too -- from making this part of the physical exam.

Jan Barger, RN, MA, IBCLC, FILCA

Hi All, I generally try to read and learn from you all and keep quiet. But I have to speak up on this one. I have worked both PP and currently work in a hospital. I have read a lot about the hosp. IBCLC and I have got to say, some may be true, but as much of it is true too of some of the PP LC's. BUT, I do think the hospital IBCLC is "censored" (so to speak), the most. I have seem LC's fired over mentioning TT, as well as galactogogues. Pumping has been an issue as well, but so far LC's have the backing of enough of the pedi's on that. I do believe that do to the fear installed over the potential firing, the LC's in our hospital mention TT less and ask the pedi's to look at the "limited tongue movement". Even at that we are on the edge. Slowly we make steps, 2 steps forward, one step back. One baby and mom at a time. Hope this all makes sence.

Nannette

How can anyone say "censor" in todays world of information. I realize it has but a dent in their god complex but oh wow women can read! When a mom reads that tt affects bf and doc says it doesn't. Doc looks like an idiot. It is not my fault women read. Pam MazzellaDiBosco

Pam MazzellaDiBosco. IBCLC

From: ibclc@...

Sender:

Date: Mon, 12 Sep 2011 08:47:33 -0400 (EDT)

To: < >

ReplyTo:

Subject: Re: Re: Tongue tie

, can you explain a bit more about a peds trying to censor LC's about TT and about PUMPING? What's up with that? There are a lot of peds around the US of A that want to censor IBCLCs about anything other than straightforward get the baby latched. Never discuss or mention TT, never talk about herbs or other galactogogues (those are the two biggies). But pumping???

Jan www.grammiesawards.blogspot.com

I have to say that I see a range of responses to potential tongue ties. I see a few LCs who refer everyone very quickly to the ENT here before really evaluating how the baby is attaching and yes, I absolutely see many of these resolve completely with appropriate attachment. We also have a pediatrician who is now trying to CENSOR IBCLCs about tongue ties and about pumping. Furthermore, I rarely see the complicated tongue ties resolve quickly. To date, I have not seen solid research that really shows whether the procedure improved the situation or whether some of the other accompanying support therapies improved the situation or what combination of supporting therapies work when. Genna has some really good theories on the windows of opportunity for doing the procedure. I do know that the ENT doesn't really like to see anything but the really straightforward tongue ties when the baby is younger than a week because it is very difficult to assess function. I personally find that it is impossible to assess function on a baby who is not gaining well. Very often they are so fatigued that the cannot feed well. Once they bounce back by taking sufficient calories, I have seen many babies have a perfectly fine suck --- and then others who really then clearly need the procedures and sometimes supportive therapies.Best regards, E. Burger, MHS, PhD, IBCLC

[Guest guest]

, this is just dreadful. Who on earth is monitoring this pediatrician -- don't his colleagues notice there is something wrong? AWFUL!!! and to think this IBCLC (????) is falling right in with this. She should be reported as well...this is what self-monitoring of our profession is all about. Yikes.

Poor moms/poor babies. And poor who is doing all this mopping up!!

Jan

Hi Jan:It is one specific pediatric practice. Several IBCLCs have quit over this issue. Basically they were told that they shouldn't be telling mothers to pump. He had had complaints about moms not wanting to pump. It was sparked by one mom whose baby really was not feeding well at all, lost a lot of weight and the pediatrician had told her the baby was fine -- which the baby wasn't. So the mom got info she didn't want to hear when the IBCLC gently explained that pumping would provide the baby with extra milk to get the baby growing again. I can't tell you how many times I've mopped up after him telling mothers that their babies were fine and they weren't. Other IBCLCs have told me they have seen many babies rehospitalized for dehydration or jaundice where they work because he tells them their babies are fine when they are not.One IBCLC that still works there also told one of my clients (who I sent to their clinic before I knew the other IBCLC quit) that she should not pump, the baby was doing fine and she was NOT going to tell her how much the baby took because it would stress her out. I sent this mother to that clinic because I thought the IBCLC who quit was doing the group that day and would be able to really assess whether this baby was ready to feed without needing supplementation and whether the mother needed to continue to pump. The baby wasn't quite ready yet, the mother still needed to pump and the mother was really annoyed that she wasted her money on someone who had a scale but refused to provide information to her. So, now he has an IBCLC who doesn't feel she ever needs to tell mothers to pump if the mom doesn't bring it up herself. She also doesn't feel she needs to assess intake either. I see more failure to thrive babies from his practice than any practice in the city. The worst case was two babies that were falling off the growth curves and are now permanently stunted. The mother reported to me that when the babies fell off the charts, she should feed them less frequently because feeding them was preventing them from sleeping enough to grow. At that point she was only feeding them 6 times per 24 hours. The mom was spectacular and worked very hard to get these babies back up onto a curve that was lower than they should have been, but at least it was a steady upward climb along A curve. Best regards, E. Burger, MHS, PhD, IBCLC

[Guest guest]

I give this quote to all parents I talk to

about TT.

It is from the International Affiliation

of Tongue Tie Professionals:

The

IATP recommends early assessment and treatment of *all*babies regardless of feeding method.

The

IATP has added this statement also:

The

IATP recommends screening of all babies for tongue-tie after the first

feed and a three hour period of skin-to-skin contact post-birth. A more

thorough assessment in flagged infants should be undertaken as soon as is

feasible to prevent the development of feeding problems.

Ellen

Simpson, BS, IBCLC

Nannette, my

point is every baby needs to be evaluated for tongue tie. It doesn't have

to be the IBCLC. It needs to be the pediatrician when they are doing

their exam. It needs to be the RN when she is doing her exam, and it

needs to be the IBCLC when she is doing her exam. The baby should be

examined physically at least three times -- completely head to toe by the RN

and the MD/DO, and at least the head/mouth/tone by the IBCLC.

I hear you about

the censoring of the IBCLC in the hospital from saying anything about fenugreek

or tt or a host of other things. But censoring the IBCLC and her fear of

being fired if she doesn't toe the line does not exempt the RN and the MD/DO --

and I'll add midwife to this too -- from making this part of the physical exam.

Jan Barger, RN, MA, IBCLC, FILCA

[Guest guest]

It can be a slippery slope when prescribing, diagnosing. Even as  RN cannot prescribe any medication/lactogenic herbs & a Physician's documentation is essential to have any invasive procedure covered by HMO's, Insurance Co

It will be a win once an IBCLC  is licensed/registered & recognized by our Fellow Colleagues(Pediatricians) & HMO's as an independent diagnostician of BF Norms versus Abnormal Dynamics. 

Just a thoughtSCWAtkins IBCLC,RLC.

 

I give this quote to all parents I talk to

about TT.

It is from the International Affiliation

of Tongue Tie Professionals:

 

The

IATP recommends early assessment and treatment of *all*babies regardless of feeding method.

 

The

IATP has added this statement also:

The

IATP recommends screening of all babies for tongue-tie after the first

feed and a three hour period of skin-to-skin contact post-birth. A more

thorough assessment in flagged infants should be undertaken as soon as is

feasible to prevent the development of feeding problems.

Ellen

Simpson, BS, IBCLC

 

 

 

Nannette, my

point is every baby needs to be evaluated for tongue tie.  It doesn't have

to be the IBCLC.  It needs to be the pediatrician when they are doing

their exam.  It needs to be the RN when she is doing her exam, and it

needs to be the IBCLC when she is doing her exam.  The baby should be

examined physically at least three times -- completely head to toe by the RN

and the MD/DO, and at least the head/mouth/tone by the IBCLC.

 

I hear you about

the censoring of the IBCLC in the hospital from saying anything about fenugreek

or tt or a host of other things.  But censoring the IBCLC and her fear of

being fired if she doesn't toe the line does not exempt the RN and the MD/DO --

and I'll add midwife to this too -- from making this part of the physical exam.

 

Jan Barger, RN, MA, IBCLC, FILCA

[Guest guest]

Point well put. Agreed.

Nannette, my point is every baby needs to be evaluated for tongue tie. It doesn't have to be the IBCLC. It needs to be the pediatrician when they are doing their exam. It needs to be the RN when she is doing her exam, and it needs to be the IBCLC when she is doing her exam. The baby should be examined physically at least three times -- completely head to toe by the RN and the MD/DO, and at least the head/mouth/tone by the IBCLC.

I hear you about the censoring of the IBCLC in the hospital from saying anything about fenugreek or tt or a host of other things. But censoring the IBCLC and her fear of being fired if she doesn't toe the line does not exempt the RN and the MD/DO -- and I'll add midwife to this too -- from making this part of the physical exam.

Jan Barger, RN, MA, IBCLC, FILCA

Hi All, I generally try to read and learn from you all and keep quiet. But I have to speak up on this one. I have worked both PP and currently work in a hospital. I have read a lot about the hosp. IBCLC and I have got to say, some may be true, but as much of it is true too of some of the PP LC's. BUT, I do think the hospital IBCLC is "censored" (so to speak), the most. I have seem LC's fired over mentioning TT, as well as galactogogues. Pumping has been an issue as well, but so far LC's have the backing of enough of the pedi's on that. I do believe that do to the fear installed over the potential firing, the LC's in our hospital mention TT less and ask the pedi's to look at the "limited tongue movement". Even at that we are on the edge. Slowly we make steps, 2 steps forward, one step back. One baby and mom at a time. Hope this all makes sence.

Nannette

How can anyone say "censor" in todays world of information. I realize it has but a dent in their god complex but oh wow women can read! When a mom reads that tt affects bf and doc says it doesn't. Doc looks like an idiot. It is not my fault women read. Pam MazzellaDiBoscoPam MazzellaDiBosco. IBCLC

From: ibclc@...

Sender:

Date: Mon, 12 Sep 2011 08:47:33 -0400 (EDT)

To: < >

ReplyTo:

Subject: Re: Re: Tongue tie

, can you explain a bit more about a peds trying to censor LC's about TT and about PUMPING? What's up with that? There are a lot of peds around the US of A that want to censor IBCLCs about anything other than straightforward get the baby latched. Never discuss or mention TT, never talk about herbs or other galactogogues (those are the two biggies). But pumping???

Jan www.grammiesawards.blogspot.com

I have to say that I see a range of responses to potential tongue ties. I see a few LCs who refer everyone very quickly to the ENT here before really evaluating how the baby is attaching and yes, I absolutely see many of these resolve completely with appropriate attachment. We also have a pediatrician who is now trying to CENSOR IBCLCs about tongue ties and about pumping. Furthermore, I rarely see the complicated tongue ties resolve quickly. To date, I have not seen solid research that really shows whether the procedure improved the situation or whether some of the other accompanying support therapies improved the situation or what combination of supporting therapies work when. Genna has some really good theories on the windows of opportunity for doing the procedure. I do know that the ENT doesn't really like to see anything but the really straightforward tongue ties when the baby is younger than a week because it is very difficult to assess function. I personally find that it is impossible to assess function on a baby who is not gaining well. Very often they are so fatigued that the cannot feed well. Once they bounce back by taking sufficient calories, I have seen many babies have a perfectly fine suck --- and then others who really then clearly need the procedures and sometimes supportive therapies.Best regards, E. Burger, MHS, PhD, IBCLC

[Guest guest]

I find that I cannot make a full assessment until I say baby at breast or bottle. This is what I think is lacking in this statement as I've had many moms (with TTd babies) say, the hospital and pediatrician said his tongue is fine...Then I ask, why are mom's nipples all chewed up and baby's falling in weight? Because he "has to grow into breastfeeding?" Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.netwww.facebook.com/CradleholdBreastfeedingEducationandsupportProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and babyHow Were YOU Supported to Breastfeed?http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspxFrom: Ellen Simpson To: Sent: Tuesday, September 13, 2011 12:02 PMSubject: RE: Re: Tongue tie

I give this quote to all parents I talk to

about TT. It is from the International Affiliation

of Tongue Tie Professionals: The

IATP recommends early assessment and treatment of *all*babies regardless of feeding method. The

IATP has added this statement also: The

IATP recommends screening of all babies for tongue-tie after the first

feed and a three hour period of skin-to-skin contact post-birth. A more

thorough assessment in flagged infants should be undertaken as soon as is

feasible to prevent the development of feeding problems. Ellen

Simpson, BS, IBCLC

Nannette, my

point is every baby needs to be evaluated for tongue tie. It doesn't have

to be the IBCLC. It needs to be the pediatrician when they are doing

their exam. It needs to be the RN when she is doing her exam, and it

needs to be the IBCLC when she is doing her exam. The baby should be

examined physically at least three times -- completely head to toe by the RN

and the MD/DO, and at least the head/mouth/tone by the IBCLC.

I hear you about

the censoring of the IBCLC in the hospital from saying anything about fenugreek

or tt or a host of other things. But censoring the IBCLC and her fear of

being fired if she doesn't toe the line does not exempt the RN and the MD/DO --

and I'll add midwife to this too -- from making this part of the physical exam.

Jan Barger, RN, MA, IBCLC, FILCA

[Guest guest]

I was at a workshop all day with catherine genna and allison hazelbaker. Ask me about tongue tie. Anything!! I feel much more confident using the assessment form now. Though I think it would mostly get in my way, I WILL be scoring babies and sending the assessment along with my usual notes to the peds. Will they read it? find it interesting? who knows. but I've been convinced to do it. I'll make my intern fill it out. haha! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: Tongue tieTo: Date: Friday, September 16, 2011, 1:44 PM

I have found that including the Hazelbaker tongue tie assessment tool along with the referral to a Ped has been a really effective approach for me. It demonstrates I have completed a thorough evaluation and assessment and illustrates the function impairment.

I also include a narrative of the overall case reinforcing the impact of the impaired function.

Sometimes I will include information from the AAP re: tongue tie for the parents, and they share with Ped.

I know that this education has improved the access of clients in my area to practitioners who release that formerly did not.

It's an education thing for them. I need to check out that AAP residency breastfeeding ed again, I can't remember if that had much info re: TT?

Anyone?

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> I find that I cannot make a full assessment until I say baby at breast or bottle. This is what I think is lacking in this statement as I've had many moms (with TTd babies) say, the hospital and pediatrician said his tongue is fine...

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> Then I ask, why are mom's nipples all chewed up and baby's falling in weight? Because he "has to grow into breastfeeding?"