Re: Re: Tongue tie

[Guest guest]

Oh, , I am so envious. Tell us more.

Ellen Simpson, BS, IBCLC

Tampa, Florida

[Guest guest]

My brain is on overload! but the main thing I learned is I've been doing a pretty good job dx tongue ties! so it was really affirming and exciting. 's pictures were the best I've seen---I think that was the most helpful thing. Also seeing the hazelbaker assessment tool in action was super helpful. I'll be using that and faxing it to peds.I'm hoping to blog about it if I find the energy/time... sigh! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: RE: Re: Tongue tieTo: Date: Friday, September 16, 2011, 7:01 PM

Oh, , I am so envious. Tell us more. Ellen Simpson, BS, IBCLC Tampa, Florida

[Guest guest]

This is definitely an area in which I am lacking.  How do I find out wen and where this kind of training will be taking place in the future?Lynn in Missouri

[Guest guest]

In NYC we have 2 points of view about PTT - er, 3 if you count those who say it does not exist.One idea is the Type 3 or 4 as described by Coryllos, et al in 2004. One of our local ENTs says there is no TT rather the chin is very recessed - she still does a frenulectomy as well as snipping the upper frenulum. She tells the parents it helps the baby to get a deeper latch.In my mind this boils down to semantics - she does the procedure when others won't but she the babies are no TT.Yes, there needs to be lots of research.Leigh AnneSent from my Verizon Wireless BlackBerrySender: Date: Sat, 17 Sep 2011 17:07:57 -0000To: < >ReplyTo: Subject: Re: Tongue tie What I would like to hear about his further research on posterior tongue tie I'm sure that is evolving. Did either speak about any recent research or findings re: posterior TT? The last session I took from this was an area that really required further focus.Resources in our area re: posterior release? ( and I live in the PNW).Thanks,> > > Subject: RE: Re: Tongue tie> To: > Date: Friday, September 16, 2011, 7:01 PM> > > > > > > > > > > > > > > > >  > > > > > > > > > > > > > > > > > > Oh, , I am so envious. Tell us more. > > Ellen Simpson, BS, IBCLC > > Tampa, Florida > > > >   > >  >

[Guest guest]

more and more are doing it. Dr. O'Hara of course. Isabella knox and some ENT's as well. I'm getting much better at finding them too. yesterday and today just made me much more confident about what I already know but wasn't sure that I knew. Ya know? Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- On Sat, 9/17/11, popikins

wrote:Subject: Re: Tongue tieTo: Date: Saturday, September 17, 2011, 10:07 AM

What I would like to hear about his further research on posterior tongue tie I'm sure that is evolving.

Did either speak about any recent research or findings re: posterior TT? The last session I took from this was an area that really required further focus.

Resources in our area re: posterior release? ( and I live in the PNW).

Thanks,

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> Oh, , I am so envious. Tell us more.

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> Ellen Simpson, BS, IBCLC

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> Tampa, Florida

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[Guest guest]

In a different direction maybe. I had a baby have a (delayed due to too many opinions) PTT yesterday. Mom had been a pumping fool and has a stockpile of EBM in the freezer. The baby takes the bottle poorly (yes bottle long story) with a lot of dribbling around the nipple. However, mom still wants to give her the bottles (vs breast) for reassurance of quantity. I think she should nix the pump and bottle supps at the least for weekend to allow baby to (re)learn how to BREASTfeed. What do you think? What would you do? Is that too drastic to go "cold turkey" from the breast? I want to see the mom again now since the release but she tells me she cannot pay me until she gets reimbursed for the visits I have done. I talk to her

AT LEAST 3-4 times a day via email if not more. I don't want to abandon her but I told her I cannot give the best advice without seeing what's going on (moan). I really want to help this couple but it's tiring (is that bad to say?) 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: popikins To: Sent: Saturday, September 17, 2011 7:29 PMSubject: Re: Tongue tie

are they doing posterior though? In the past I thought that said neither were taking on posterior. Either I misunderstood or they have changed.

I think the challenge for a lot of my clients with the posterior is that there is nobody in our area to release.

>

> more and more are doing it. Â Dr. O'Hara of course. Â Isabella knox and some ENT's as well. Â I'm getting much better at finding them too. Â yesterday and today just made me much more confident about what I already know but wasn't sure that I knew. Â Ya know?

>

> Beebe, M.Ed., IBCLC

> Lactation Consultant/Postpartum Doula

>

> www.second9months.comBreastfeeding Between the Lines: Â http://second9months.wordpress.com/

>

[Guest guest]

oh yeah, they both do and have done posteriors for quite awhile. One of my clients when to a group health ENT with info about posterior TT's (after I spotted it) and he clipped it for her. I think he did a decent job too. He wasn't convinced at first, but looked up the info on the web, saw that it was a real "thing" and clipped it. I was impressed! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: Tongue tieTo: Date: Saturday, September 17, 2011, 4:29 PM

are they doing posterior though? In the past I thought that said neither were taking on posterior. Either I misunderstood or they have changed.

I think the challenge for a lot of my clients with the posterior is that there is nobody in our area to release.

>

> more and more are doing it. Â Dr. O'Hara of course. Â Isabella knox and some ENT's as well. Â I'm getting much better at finding them too. Â yesterday and today just made me much more confident about what I already know but wasn't sure that I knew. Â Ya know?

>

> Beebe, M.Ed., IBCLC

> Lactation Consultant/Postpartum Doula

>

> www.second9months.comBreastfeeding Between the Lines: Â http://second9months.wordpress.com/

>

[Guest guest]

bad, very bad. JK!!! If she's dribbling from the bottle (assuming mom is helping baby to pace the feed) she probably doesn't have a good vacuum/tongue mobility. If baby CAN breastfeed, I would say to let baby breastfeed. If she hasn't been successful there, I would say work toward that. Cold turkey isn't fair if baby hasn't been successful in the past.Is mom doing stretching of the tongue to make sure frenotomy doesn't scar down? Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: Re: Tongue tieTo: " " < >Date: Saturday, September 17, 2011, 4:38 PM

In a different direction maybe. I had a baby have a (delayed due to too many opinions) PTT yesterday. Mom had been a pumping fool and has a stockpile of EBM in the freezer. The baby takes the bottle poorly (yes bottle long story) with a lot of dribbling around the nipple. However, mom still wants to give her the bottles (vs breast) for reassurance of quantity. I think she should nix the pump and bottle supps at the least for weekend to allow baby to (re)learn how to BREASTfeed. What do you think? What would you do? Is that too drastic to go "cold turkey" from the breast? I want to see the mom again now since the release but she tells me she cannot pay me until she gets reimbursed for the visits I have done. I talk to her

AT LEAST 3-4 times a day via email if not more. I don't want to abandon her but I told her I cannot give the best advice without seeing what's going on (moan). I really want to help this couple but it's tiring (is that bad to say?) 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: popikins To: Sent: Saturday, September 17, 2011 7:29 PMSubject: Re: Tongue tie

are they doing posterior though? In the past I thought that said neither were taking on posterior. Either I misunderstood or they have changed.

I think the challenge for a lot of my clients with the posterior is that there is nobody in our area to release.

>

> more and more are doing it. Â Dr. O'Hara of course. Â Isabella knox and some ENT's as well. Â I'm getting much better at finding them too. Â yesterday and today just made me much more confident about what I already know but wasn't sure that I knew. Â Ya know?

>

> Beebe, M.Ed., IBCLC

> Lactation Consultant/Postpartum Doula

>

> www.second9months.comBreastfeeding Between the Lines: Â http://second9months.wordpress.com/

>

[Guest guest]

Yes she is doing the exercises. How do you advise someone about increasing breastfeeding when they are reluctant to get away from the bottle? OY, I feel like this is a slippery slope. If she bottle feeds and dribbles and has a poor seal that seems very stressful for baby. If she breastfeeds and doesn't transfer well, that seems very stressful for baby. I introduced finger feeding but the parents want to use the bottle instead. Oy again... 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: Beebe To: Sent: Saturday, September 17, 2011 7:44 PMSubject: Re: Re: Tongue

tie

bad, very bad. JK!!! If she's dribbling from the bottle (assuming mom is helping baby to pace the feed) she probably doesn't have a good vacuum/tongue mobility. If baby CAN breastfeed, I would say to let baby breastfeed. If she hasn't been successful there, I would say work toward that. Cold turkey isn't fair if baby hasn't been successful in the past.Is mom doing stretching of the tongue to make sure frenotomy doesn't scar down? Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: Re: Tongue tieTo: " " < >Date: Saturday, September 17, 2011, 4:38 PM

In a different direction maybe. I had a baby have a (delayed due to too many opinions) PTT yesterday. Mom had been a pumping fool and has a stockpile of EBM in the freezer. The baby takes the bottle poorly (yes bottle long story) with a lot of dribbling around the nipple. However, mom still wants to give her the bottles (vs breast) for reassurance of quantity. I think she should nix the pump and bottle supps at the least for weekend to allow baby to (re)learn how to BREASTfeed. What do you think? What would you do? Is that too drastic to go "cold turkey" from the breast? I want to see the mom again now since the release but she tells me she cannot pay me until she gets reimbursed for the visits I have done. I talk to her

AT LEAST 3-4 times a day via email if not more. I don't want to abandon her but I told her I cannot give the best advice without seeing what's going on (moan). I really want to help this couple but it's tiring (is that bad to say?) 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: popikins To: Sent: Saturday, September 17, 2011 7:29 PMSubject: Re: Tongue tie

are they doing posterior though? In the past I thought that said neither were taking on posterior. Either I misunderstood or they have changed.

I think the challenge for a lot of my clients with the posterior is that there is nobody in our area to release.

>

> more and more are doing it. Â Dr. O'Hara of course. Â Isabella knox and some ENT's as well. Â I'm getting much better at finding them too. Â yesterday and today just made me much more confident about what I already know but wasn't sure that I knew. Â Ya know?

>

> Beebe, M.Ed., IBCLC

> Lactation Consultant/Postpartum Doula

>

> www.second9months.comBreastfeeding Between the Lines: Â http://second9months.wordpress.com/

>

[Guest guest]

I don't see any advantage to finger feeding over bottle feeding. IMO it's even more unlike the breast. All you can do is encourage her to try breastfeeding and see how it goes and remember you can set limits on your time!!!!Hugs, Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- On Sat, 9/17/11, Dana Schmidt

wrote:Subject: Re: Re: Tongue tieTo: " " < >Date: Saturday, September 17, 2011, 4:47 PM

Yes she is doing the exercises. How do you advise someone about increasing breastfeeding when they are reluctant to get away from the bottle? OY, I feel like this is a slippery slope. If she bottle feeds and dribbles and has a poor seal that seems very stressful for baby. If she breastfeeds and doesn't transfer well, that seems very stressful for baby. I introduced finger feeding but the parents want to use the bottle instead. Oy again... 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: Beebe To: Sent: Saturday, September 17, 2011 7:44 PMSubject: Re:

Re: Tongue

tie

bad, very bad. JK!!! If she's dribbling from the bottle (assuming mom is helping baby to pace the feed) she probably doesn't have a good vacuum/tongue mobility. If baby CAN breastfeed, I would say to let baby breastfeed. If she hasn't been successful there, I would say work toward that. Cold turkey isn't fair if baby hasn't been successful in the past.Is mom doing stretching of the tongue to make sure frenotomy doesn't scar down? Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: Re: Tongue tieTo: " " < >Date: Saturday, September 17, 2011, 4:38 PM

In a different direction maybe. I had a baby have a (delayed due to too many opinions) PTT yesterday. Mom had been a pumping fool and has a stockpile of EBM in the freezer. The baby takes the bottle poorly (yes bottle long story) with a lot of dribbling around the nipple. However, mom still wants to give her the bottles (vs breast) for reassurance of quantity. I think she should nix the pump and bottle supps at the least for weekend to allow baby to (re)learn how to BREASTfeed. What do you think? What would you do? Is that too drastic to go "cold turkey" from the breast? I want to see the mom again now since the release but she tells me she cannot pay me until she gets reimbursed for the visits I have done. I talk to her

AT LEAST 3-4 times a day via email if not more. I don't want to abandon her but I told her I cannot give the best advice without seeing what's going on (moan). I really want to help this couple but it's tiring (is that bad to say?) 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: popikins To: Sent: Saturday, September 17, 2011 7:29 PMSubject: Re: Tongue tie

are they doing posterior though? In the past I thought that said neither were taking on posterior. Either I misunderstood or they have changed.

I think the challenge for a lot of my clients with the posterior is that there is nobody in our area to release.

>

> more and more are doing it. Â Dr. O'Hara of course. Â Isabella knox and some ENT's as well. Â I'm getting much better at finding them too. Â yesterday and today just made me much more confident about what I already know but wasn't sure that I knew. Â Ya know?

>

> Beebe, M.Ed., IBCLC

> Lactation Consultant/Postpartum Doula

>

> www.second9months.comBreastfeeding Between the Lines: Â http://second9months.wordpress.com/

>

[Guest guest]

Hello, Dana.

For some mothers, going aslittle as 24 hrs without proper breast stimulation is enough to significantly drop milk supply. Others get 2-3 days before the drop. I would feel very uncomfortable telling this mother to stop pumping, since the baby doesnot seem to be one of those "miracle" babies who can immediately nurse perfectly as soon as the TT is clipped. (I figure you would have reported that if it were so, but you say baby still needs to re-learn.) I would advise this mother to continue pumping until baby shows he can get all he needs without supplementation.

I am also uncomfortable telling a baby how much he needs. If he iswilling to come to breast, I would see if he can do active sucking for 10-15 minutes/breast. Remnd the mother that she needs to still hear a swallow with about every 4-5th suck, not just see him moving his jaw. If he doesactive sucking for 10-15 min/breast, then she can offer bottle supplement. Ifhe filled himself up, he won't take the supplement. Either he won't open his mouth for the bottle, or he'll put the nipple in hismouth but won't suck. Remind mother that she is *offering*, not forcing the bottle. She should keep a diaperlog during the transition. But offering the bottle after breastfeeding should give her a nice visual that baby is getting more from breast if he leaves more in the bottle than he usually does. Thiswill help to reassure mother if he is doing well, but make it obvious if he still isn't sucking

effectively.

No, not bad to admit that some clients drain us. This mother is uncomfortable using your services without being able to pay you. Try to see this as a good thing--she is not trying to take advantage of you. If the above plan lets her see for herself that her baby is doing well, she will stop calling/emailing so often. If it lets her see her baby still isn't feeding well, she may be more inclined to reach out for an appt, since you have honestly told her that your suggestions are limited if you can't see what the baby is doing. Perhaps you could consider suggesting that she write a post-dated check for the amount of a follow-up consultation, with the date being the next family paycheck or some other date that works for both of you. Depending on your fee, maybe you would want to suggest she write two checks, each for one-half of your fee, one for the next paycheck and one dated for the second

paycheck.

Dee Kassing

a (delayed due to too many opinions) PTT yesterday. Mom had been a pumping fool and has a stockpile of EBM in the freezer. The baby takes the bottle poorly (yes bottle long story) with a lot of dribbling around the nipple. However, mom still wants to give her the bottles (vs breast) for reassurance of quantity. I think she should nix the pump and bottle supps at the least for weekend to allow baby to (re)learn how to BREASTfeed. What do you think? What would you do? Is that too drastic to go "cold turkey" from the breast?

I want to see the mom again now since the release but she tells me she cannot pay me until she gets reimbursed for the visits I have done. I talk to her AT LEAST 3-4 times a day via email if not more. I don't want to abandon her but I told her I cannot give the best advice without seeing what's going on (moan). I really want to help this couple but it's tiring (is that bad to say?)

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.aspx

To: Sent: Saturday, September 17, 2011 7:29 PMSubject: Re: Tongue tie

are they doing posterior though? In the past I thought that said neither were taking on posterior. Either I misunderstood or they have changed.I think the challenge for a lot of my clients with the posterior is that there is nobody in our area to release.>> more and more are doing it. Â Dr. O'Hara of course. Â Isabella knox and some ENT's as well. Â I'm getting much better at finding them too. Â yesterday and today just made me much more confident about what I already know but wasn't sure that I knew. Â Ya know?> > Beebe, M.Ed., IBCLC > Lactation Consultant/Postpartum Doula > >

www.second9months.comBreastfeeding Between the Lines: Â http://second9months.wordpress.com/>

[Guest guest]

I honestly like the bottle better than finger-feeding. A finger is not nearly as wide as a mouthful of areola. A finger has a bone in it, so is much firmer than the breast. I have seen many finger-fed babies have a tough time transitioning to breast. The bottle nipple is firmer than the breast but not as firm as a finger. The narrow-based bottle nipple inserted all the way into baby's mouth is almost as wide as a mouth-ful of breast and definitely wider than a finger. Seems a better transition to breastfeeding to me than finger-feeding.

Dee Kassing

Yes she is doing the exercises. How do you advise someone about increasing breastfeeding when they are reluctant to get away from the bottle? OY, I feel like this is a slippery slope. If she bottle feeds and dribbles and has a poor seal that seems very stressful for baby. If she breastfeeds and doesn't transfer well, that seems very stressful for baby. I introduced finger feeding but the parents want to use the bottle instead. Oy again...

Dana Schmidt, BS, RN, IBCLC

[Guest guest]

and with ff ing baby can straw suck. not good. Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: Re: Tongue

tieTo: Date: Saturday, September 17, 2011, 8:41 PM

I honestly like the bottle better than finger-feeding. A finger is not nearly as wide as a mouthful of areola. A finger has a bone in it, so is much firmer than the breast. I have seen many finger-fed babies have a tough time transitioning to breast. The bottle nipple is firmer than the breast but not as firm as a finger. The narrow-based bottle nipple inserted all the way into baby's mouth is almost as wide as a mouth-ful of breast and definitely wider than a finger. Seems a better transition to breastfeeding to me than finger-feeding.

Dee Kassing

Yes she is doing the exercises. How do you advise someone about increasing breastfeeding when they are reluctant to get away from the bottle? OY, I feel like this is a slippery slope. If she bottle feeds and dribbles and has a poor seal that seems very stressful for baby. If she breastfeeds and doesn't transfer well, that seems very stressful for baby. I introduced finger feeding but the parents want to use the bottle instead. Oy again...

Dana Schmidt, BS, RN, IBCLC

[Guest guest]

Hi Dee, can I send what you wrote? I usually feel so confident but this mother takes advise from so

many people that now I feel confused and uncertain. It would help me to use your plan as a guide for me.I don't want to calorie deprive this baby but my hesitation with using the bottle all the time is that mom was breastfeeding pretty well and then supplementing with poor feedings (at least until the frenotomy). Then she went to another LC for another opinion. When she came back to me, she was not breastfeeding at

all - only pumping and giving bottles. Her husband wanted her to continue that but she wanted to BreastFeed. The baby also refluxes terribly at the bottle (and breast but has a better seal). We've switched bottles a few times and now she is using the breastflow because she was dribbling with the smaller nipples. The baby is now taking probiotics and mom is on the elimination diet. I've encouraged her to go for CST for the jaw AND the

reflux. We haven't used the FF since she the first time I saw her. She was 4 days old and difficult to arouse after 7 hours of sleeping. She would not suck and swallow even though latch at the breast at the time. She gagged and dribbled at the bottle. This was an unmedicated NSVD - no forceps no vacuum.I had to get some calories into her so I used the FF, I just was wondering if I should revisit the FF because this is getting to be such a complicated case, especially via email. I haven't suggested the FF to mom as of late. Also dad is encouraging mom to sleep at night and he gets up to give the bottles. Mom had been pumping so much that now she wonders if she has over supply. Baby gags when she goes to the breast because mom is so full. I advised her to hand express first and then put baby to breast in a semi upright position as opposed to supine due to the choking and

reflux.Thank you, Dana 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.aspx

[Guest guest]

I showed mom the tt (after I lifted the tongue and exposed it) and talked about functionality so mom was really educated. I don't know what else the doc looked at. but I sent mom the Genna article in the AAP newsletter so she could see pics, etc. from now on I'm filling out the score sheet and sending that with every fax to every dr.! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: Tongue tieTo: Date: Sunday, September 18, 2011, 7:46 AM

Hi ,

Great meeting and working with you this weekend!

Quick question: I have been trying to educate a ped and an ENT here in Vancouver, WA, about PTT. I spent a huge amount of time gathering reputable info that I thought might convince a medical person, but I really couldn't find much that was absolutely convincing. I sent what I had to them, but I don't believe it made believers of them.

What info did you send via your client? Please share. Perhaps there is something that I missed.

Thanks,

Fay

Fay Bosman, IBCLC

www.nwmothernurture.com, Vancouver, WA

>

> oh yeah, they both do and have done posteriors for quite awhile. Â One of my clients when to a group health ENT with info about posterior TT's (after I spotted it) and he clipped it for her. Â I think he did a decent job too. Â He wasn't convinced at first, but looked up the info on the web, saw that it was a real "thing" and clipped it. Â I was impressed!

>

> Beebe, M.Ed., IBCLC

[Guest guest]

i do the same thing, (great minds think alike). I finally have really released my "agenda." as hard as it is when we know something will help a baby and parents don't want to do it. It's not my baby. I can only give my best suggestions, then it's up to them! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- On Sun, 9/18/11, popikins

wrote:Subject: Re: Tongue tieTo: Date: Sunday, September 18, 2011, 9:04 AM

I'm curious about this because I think we all face this at times. I have my own approach but I'd love to hear what other folks are doing.

If you're making a recommendation that is not feasible for her to incorporate either because she doesn't embrace the idea philosophically or she can't or wont do it I think we need to change the plan. She wants to give bottles because it reassures her, as a clinician you think she should focus on helping the baby to breastfeed.

I would really explore her intentions about 'breast'feeding the baby and see if it is anything she is interested in exploring, and if she agrees, then comes the support and education re: how to accomplish this (I'm sure this has been incorporated, just thinking outloud).

If after support and education she is still committed to only pumping and bottles, the plan changes and your counseling goes into the record. I can't see continuing to advise her about how to get the baby back to the breast if she wants to bottle feed, then it becomes about our agenda and not her desires. And I'm also not implying that we should abandon discussing 'breast'feeding with the client but after this has been fully explored, support and education are offered, and she doesn't embrace it I change the plan. It can be revisited.

And I fully agree with whomever posted that to remove a baby who has not been effectively at the breast cold turkey from the supplement doesn't always work well. It can in some cases but not always so there needs to be a transition plan.

>

> In a different direction maybe. I had a baby have a (delayed due to too many opinions) PTT yesterday. Mom had been a pumping fool and has a stockpile of EBM in the freezer. The baby takes the bottle poorly (yes bottle long story) with a lot of dribbling around the nipple. However, mom still wants to give her the bottles (vs breast) for reassurance of quantity. I think she should nix the pump and bottle supps at the least for weekend to allow baby to (re)learn how to BREASTfeed. What do you think? What would you do? Is that too drastic to go "cold turkey" from the breast?

>

> I want to see the mom again now since the release but she tells me she cannot pay me until she gets reimbursed for the visits I have done. I talk to her AT LEAST 3-4 times a day via email if not more. I don't want to abandon her but I told her I cannot give the best advice without seeing what's going on (moan). I really want to help this couple but it's tiring (is that bad to say?)

>

> Â

>

> Dana Schmidt, BS, RN, IBCLC

> Cradlehold, Director

> Breastfeeding Education & Support

>

> www.cradlehold.net

> www.facebook.com/CradleholdBreastfeedingEducationandsupport

>

> Providing the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby

>

> How Were YOU Supported to Breastfeed?

> http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspx

>

[Guest guest]

To sum it up, I sent the articles and make recommendations based on all of your knowledge. Mother told me baby is latching deeper and gulping and swallowing. I'll go see her tomorrow (gratis probably) just be sure everything is ok.Words cannot express my thanks for this group and allowing me to think out loud ~ 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: popikins To: Sent: Sunday, September 18, 2011 12:04 PMSubject: Re: Tongue tie

I'm curious about this because I think we all face this at times. I have my own approach but I'd love to hear what other folks are doing.

If you're making a recommendation that is not feasible for her to incorporate either because she doesn't embrace the idea philosophically or she can't or wont do it I think we need to change the plan. She wants to give bottles because it reassures her, as a clinician you think she should focus on helping the baby to breastfeed.

I would really explore her intentions about 'breast'feeding the baby and see if it is anything she is interested in exploring, and if she agrees, then comes the support and education re: how to accomplish this (I'm sure this has been incorporated, just thinking outloud).

If after support and education she is still committed to only pumping and bottles, the plan changes and your counseling goes into the record. I can't see continuing to advise her about how to get the baby back to the breast if she wants to bottle feed, then it becomes about our agenda and not her desires. And I'm also not implying that we should abandon discussing 'breast'feeding with the client but after this has been fully explored, support and education are offered, and she doesn't embrace it I change the plan. It can be revisited.

And I fully agree with whomever posted that to remove a baby who has not been effectively at the breast cold turkey from the supplement doesn't always work well. It can in some cases but not always so there needs to be a transition plan.

>

> In a different direction maybe. I had a baby have a (delayed due to too many opinions) PTT yesterday. Mom had been a pumping fool and has a stockpile of EBM in the freezer. The baby takes the bottle poorly (yes bottle long story) with a lot of dribbling around the nipple. However, mom still wants to give her the bottles (vs breast) for reassurance of quantity. I think she should nix the pump and bottle supps at the least for weekend to allow baby to (re)learn how to BREASTfeed. What do you think? What would you do? Is that too drastic to go "cold turkey" from the breast?

>

> I want to see the mom again now since the release but she tells me she cannot pay me until she gets reimbursed for the visits I have done. I talk to her AT LEAST 3-4 times a day via email if not more. I don't want to abandon her but I told her I cannot give the best advice without seeing what's going on (moan). I really want to help this couple but it's tiring (is that bad to say?)

>

> Â

>

> Dana Schmidt, BS, RN, IBCLC

> Cradlehold, Director

> Breastfeeding Education & Support

>

> www.cradlehold.net

> www.facebook.com/CradleholdBreastfeedingEducationandsupport

>

> Providing the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby

>

> How Were YOU Supported to Breastfeed?

> http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspx

>

[Guest guest]

Hi, Dana.

You can forward it, but don't forget to remove the payment ideas first unless you are okay with them.

Are you sure it's oversupply? If baby gags at bottle, maybe the gagging at breast has nothing to do with amount/letdown. The shaft of the BreastFlow isnot long, if I remember correctly. So maybe she doesn't gag and doesn't dribble, because it doesn't go back as far as it should to mimic breastfeeding?? What amount does mother pump and how long between pumping sessions? And how much does this baby weigh? Is that weight appropriate due to bottle-feeding or is she still on the low side for what her birth weight was? You mayhave mentioned that, but it's not attached to this email for me to easily check, and I've forgotten the details of what I read last night. I find that babies tend to eat for the amount they *should* weigh, not the amount they *do* weigh.

Dee Kassing

Hi Dee, can I send what you wrote? I usually feel so confident but this mother takes advise from so many people that now I feel confused and uncertain. It would help me to use your plan as a guide for me.I don't want to calorie deprive this baby but my hesitation with using the bottle all the time is that mom was breastfeeding pretty well and then supplementing with poor feedings (at least until the frenotomy). Then she went to another LC for another opinion. When she came back to me, she was not breastfeeding at all - only pumping and giving bottles. Her husband wanted her to continue that but she wanted to BreastFeed. The baby also refluxes terribly at the bottle (and breast but has a better seal). We've switched bottles a few times and now she is using the breastflow because she

was dribbling with the smaller nipples. The baby is now taking probiotics and mom is on the elimination diet. I've encouraged her to go for CST for the jaw AND the reflux. We haven't used the FF since she the first time I saw her. She was 4 days old and difficult to arouse after 7 hours of sleeping. She would not suck and swallow even though latch at the breast at the time. She gagged and dribbled at the bottle. This was an unmedicated NSVD - no forceps no vacuum.I had to get some calories into her so I used the FF, I just was wondering if I should revisit the FF because this is getting to be such a complicated case, especially via email. I haven't suggested the FF to mom as of late. Also dad is encouraging mom to sleep at night and he gets up to give the bottles. Mom had been pumping so much that now she wonders if she has over supply. Baby gags when she goes to the breast

because mom is so full. I advised her to hand express first and then put baby to breast in a semi upright position as opposed to supine due to the choking and reflux.Thank you, Dana

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.aspx

[Guest guest]

when she was exclusively pumping she was stopping at 3 ounces per side every 3 hours. Today I talked to her and baby has been breastfeeding all day. She asked me if it was normal for the other breast to leak while she was nursing? Poor dear, I don't think she's experienced that to date. She's going to supplement at night but she is happy now anyway. Baby's weight was great with bottle feeding. I"m going to go out tomorrow for a weight check with all this breastfeeding today. This is a tough job. You can't leave it "at the office" because you care so deeply about these girls and you are their number 1 cheerleader! I've had mothers decide that the breast - feeding wasn't for them and went to pumped milk. I encourage them to feed

the way that they will be happiest with. Some moms just don't like it! But this mom does and I'm rooting for her! 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: Dee Kassing To: Sent: Sunday, September 18, 2011 6:06 PMSubject: Re: Re: Tongue tie

Hi, Dana.

You can forward it, but don't forget to remove the payment ideas first unless you are okay with them.

Are you sure it's oversupply? If baby gags at bottle, maybe the gagging at breast has nothing to do with amount/letdown. The shaft of the BreastFlow isnot long, if I remember correctly. So maybe she doesn't gag and doesn't dribble, because it doesn't go back as far as it should to mimic breastfeeding?? What amount does mother pump and how long between pumping sessions? And how much does this baby weigh? Is that weight appropriate due to bottle-feeding or is she still on the low side for what her birth weight was? You mayhave mentioned that, but it's not attached to this email for me to easily check, and I've forgotten the details of what I read last night. I find that babies tend to eat for the amount they *should* weigh, not the amount they *do* weigh.

Dee Kassing

Hi Dee, can I send what you wrote? I usually feel so confident but this mother takes advise from so many people that now I feel confused and uncertain. It would help me to use your plan as a guide for me.I don't want to calorie deprive this baby but my hesitation with using the bottle all the time is that mom was breastfeeding pretty well and then supplementing with poor feedings (at least until the frenotomy). Then she went to another LC for another opinion. When she came back to me, she was not breastfeeding at all - only pumping and giving bottles. Her husband wanted her to continue that but she wanted to BreastFeed. The baby also refluxes terribly at the bottle (and breast but has a better seal). We've switched bottles a few times and now she is using the breastflow because she

was dribbling with the smaller nipples. The baby is now taking probiotics and mom is on the elimination diet. I've encouraged her to go for CST for the jaw AND the reflux. We haven't used the FF since she the first time I saw her. She was 4 days old and difficult to arouse after 7 hours of sleeping. She would not suck and swallow even though latch at the breast at the time. She gagged and dribbled at the bottle. This was an unmedicated NSVD - no forceps no vacuum.I had to get some calories into her so I used the FF, I just was wondering if I should revisit the FF because this is getting to be such a complicated case, especially via email. I haven't suggested the FF to mom as of late. Also dad is encouraging mom to sleep at night and he gets up to give the bottles. Mom had been pumping so much that now she wonders if she has over supply. Baby gags when she goes to the breast

because mom is so full. I advised her to hand express first and then put baby to breast in a semi upright position as opposed to supine due to the choking and reflux.Thank you, Dana

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.aspx

[Guest guest]

You go girl! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/--- Subject: Re: Re: Tongue tieTo: " "

< >Date: Sunday, September 18, 2011, 10:27 AM

To sum it up, I sent the articles and make recommendations based on all of your knowledge. Mother told me baby is latching deeper and gulping and swallowing. I'll go see her tomorrow (gratis probably) just be sure everything is ok.Words cannot express my thanks for this group and allowing me to think out loud ~ 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: popikins To: Sent: Sunday, September 18, 2011 12:04 PMSubject: Re: Tongue tie

I'm curious about this because I think we all face this at times. I have my own approach but I'd love to hear what other folks are doing.

If you're making a recommendation that is not feasible for her to incorporate either because she doesn't embrace the idea philosophically or she can't or wont do it I think we need to change the plan. She wants to give bottles because it reassures her, as a clinician you think she should focus on helping the baby to breastfeed.

I would really explore her intentions about 'breast'feeding the baby and see if it is anything she is interested in exploring, and if she agrees, then comes the support and education re: how to accomplish this (I'm sure this has been incorporated, just thinking outloud).

If after support and education she is still committed to only pumping and bottles, the plan changes and your counseling goes into the record. I can't see continuing to advise her about how to get the baby back to the breast if she wants to bottle feed, then it becomes about our agenda and not her desires. And I'm also not implying that we should abandon discussing 'breast'feeding with the client but after this has been fully explored, support and education are offered, and she doesn't embrace it I change the plan. It can be revisited.

And I fully agree with whomever posted that to remove a baby who has not been effectively at the breast cold turkey from the supplement doesn't always work well. It can in some cases but not always so there needs to be a transition plan.

>

> In a different direction maybe. I had a baby have a (delayed due to too many opinions) PTT yesterday. Mom had been a pumping fool and has a stockpile of EBM in the freezer. The baby takes the bottle poorly (yes bottle long story) with a lot of dribbling around the nipple. However, mom still wants to give her the bottles (vs breast) for reassurance of quantity. I think she should nix the pump and bottle supps at the least for weekend to allow baby to (re)learn how to BREASTfeed. What do you think? What would you do? Is that too drastic to go "cold turkey" from the breast?

>

> I want to see the mom again now since the release but she tells me she cannot pay me until she gets reimbursed for the visits I have done. I talk to her AT LEAST 3-4 times a day via email if not more. I don't want to abandon her but I told her I cannot give the best advice without seeing what's going on (moan). I really want to help this couple but it's tiring (is that bad to say?)

>

> Â

>

> Dana Schmidt, BS, RN, IBCLC

> Cradlehold, Director

> Breastfeeding Education & Support

>

> www.cradlehold.net

> www.facebook.com/CradleholdBreastfeedingEducationandsupport

>

> Providing the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby

>

> How Were YOU Supported to Breastfeed?

> http://www.usbreastfeeding.org/LegislationPolicy/ActionCampaigns/SupportStories/tabid/198/Default.aspx

>