Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 A pox on all of them. I vote they all have babies with PP TT and try to breastfeed them. Even the men. Jan Every ENT in our area says that clipping PP tongue ties won’t make a difference. I say go back to the ENT ask that the release be done. Ellen Simpson, BS, IBCLCPrivate Practice Lactation Consultant Tampa, FL From: @...m [mailto:@...m] On Behalf Of LeighAnne625@...mSent: Friday, December 17, 2010 9:28 AMTo: @...mSubject: A challenging case Hello All,I have a hard one. Baby born vaginally, vacuum assisted - large bulge on head for over two weeks, broken clavicle, baby not transferring milk, causing mom pain, posterior TT.Mom pumping, making plenty of milk after. The first 5 days. Mom brought baby for frenotomy, ENT stated it may not make much difference. Mom had CST/OT work on baby. Mom says no difference after this work.Baby is now 4 weeks old, mom says baby will only latch with nipple shield, the feedings are painful and she is making less milk than he is taking. She says her situation is not sustainable much longer.Any ideas?Leigh Anne O'Connor, LLL, IBCLCSent from my Verizon Wireless BlackBerry size=1 width="100%" noshade color="#aca899" align=center> No virus found in this message.Checked by AVG - www.avg.comVersion: 10.0.1170 / Virus Database: 426/3320 - Release Date: 12/16/10 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 Challenging is right! Did the CST person also work on the mother? If the baby is this beat up after delivery, the mom isn't probably in great shape either!! Also, CST, like LC work, may need more than one visit. Is mom guiding baby? Would BN work? Good luck to you! warmly, Nikki Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 Also Chiropractic care. I agree, treatment should be ongoing until resolved. Also, there are some great tongue exercises in “Supporting Sucking Skills” by and Genna.June , RN, IBCLCAlso, CST, like LC work, may need more than one visit.Is mom guiding baby? Would BN work? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 Every ENT in our area says that clipping PP tongue ties won’t make a difference. I say go back to the ENT ask that the release be done. Ellen Simpson, BS, IBCLC Private Practice Lactation Consultant Tampa, FL From: @...m [mailto:@...m] On Behalf Of LeighAnne625@...m Sent: Friday, December 17, 2010 9:28 AM To: @...m Subject: A challenging case Hello All, I have a hard one. Baby born vaginally, vacuum assisted - large bulge on head for over two weeks, broken clavicle, baby not transferring milk, causing mom pain, posterior TT. Mom pumping, making plenty of milk after. The first 5 days. Mom brought baby for frenotomy, ENT stated it may not make much difference. Mom had CST/OT work on baby. Mom says no difference after this work. Baby is now 4 weeks old, mom says baby will only latch with nipple shield, the feedings are painful and she is making less milk than he is taking. She says her situation is not sustainable much longer. Any ideas? Leigh Anne O'Connor, LLL, IBCLC Sent from my Verizon Wireless BlackBerry size=1 width="100%" noshade color="#aca899" align=center> No virus found in this message. Checked by AVG - www.avg.com Version: 10.0.1170 / Virus Database: 426/3320 - Release Date: 12/16/10 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 Also make sure the mother is using a hospital grade pump and that it is comfortable to pump . If she has pain, does she have a break down in her skin or are the breast shields on the pump the correct size? It is interesting how over the years I have seen mothers who have been able to sustain a good milk supply with pumping only with little or nursing. I definitely think that emotions are in play when a mother who has had to turn to pumping because of a “failure” at breastfeeding loses her milk supply. Whereas a mother who had no intention to nurse but pump only can keep up her supply for months even a year. Oh, gee, was that using the good old Classic breast pump? Ellen Hello All, I have a hard one. Baby born vaginally, vacuum assisted - large bulge on head for over two weeks, broken clavicle, baby not transferring milk, causing mom pain, posterior TT. Mom pumping, making plenty of milk after. The first 5 days. Mom brought baby for frenotomy, ENT stated it may not make much difference. Mom had CST/OT work on baby. Mom says no difference after this work. Baby is now 4 weeks old, mom says baby will only latch with nipple shield, the feedings are painful and she is making less milk than he is taking. She says her situation is not sustainable much longer. Any ideas? Leigh Anne O'Connor, LLL, IBCLC Sent from my Verizon Wireless BlackBerry size=1 width= " 100% " noshade color= " #aca899 " align=center> No virus found in this message. Checked by AVG - www.avg.com Version: 10.0.1170 / Virus Database: 426/3320 - Release Date: 12/16/10 size=1 width="100%" noshade color="#aca899" align=center> No virus found in this message. Checked by AVG - www.avg.com Version: 10.0.1170 / Virus Database: 426/3320 - Release Date: 12/16/10 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 Leigh Anne, I know I read somewhere that babies given no restrictions will take more from a bottle than they would if they were at the breast (proven by pre and post weights of each). Paced bottle feeding. Lou Moramarco IBCLC Birth, Breastfeeding & Beyond International Board Certified Lactation Consultant Bradley Childbirth Educator Certified Birth Doula (732) 239-7771 marylou22@... From: [mailto: ] On Behalf Of LeighAnne625@... Sent: Friday, December 17, 2010 9:28 AM To: Subject: A challenging case Hello All, I have a hard one. Baby born vaginally, vacuum assisted - large bulge on head for over two weeks, broken clavicle, baby not transferring milk, causing mom pain, posterior TT. Mom pumping, making plenty of milk after. The first 5 days. Mom brought baby for frenotomy, ENT stated it may not make much difference. Mom had CST/OT work on baby. Mom says no difference after this work. Baby is now 4 weeks old, mom says baby will only latch with nipple shield, the feedings are painful and she is making less milk than he is taking. She says her situation is not sustainable much longer. Any ideas? Leigh Anne O'Connor, LLL, IBCLC Sent from my Verizon Wireless BlackBerry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 How many sessions of CST did she have? Do you know/trust that practitioner? Did the OT recognize the pTT as well?Have you re-assessed tongue function after the CST?It can be hard to encourage mom to insist the ENT release the TT when we can't guarantee that it will be a cure-all, but it seems like she has tried everything else. The risks are minimal and the benefit could be huge. Even if the baby needs more bodywork, it's likely that the pTT is a significant issue for this baby. HealySeattle, WASent from my Verizon Wireless BlackBerryFrom: LeighAnne625@...Sender: Date: Fri, 17 Dec 2010 14:27:31 +0000To: < >ReplyTo: Subject: A challenging case Hello All,I have a hard one. Baby born vaginally, vacuum assisted - large bulge on head for over two weeks, broken clavicle, baby not transferring milk, causing mom pain, posterior TT.Mom pumping, making plenty of milk after. The first 5 days. Mom brought baby for frenotomy, ENT stated it may not make much difference. Mom had CST/OT work on baby. Mom says no difference after this work.Baby is now 4 weeks old, mom says baby will only latch with nipple shield, the feedings are painful and she is making less milk than he is taking. She says her situation is not sustainable much longer.Any ideas?Leigh Anne O'Connor, LLL, IBCLCSent from my Verizon Wireless BlackBerry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 Would this mother be willing to take her baby to another HCP to get the tongue released?Norma Ritter, IBCLC, RLCBreastfeeding Matters in the Capital Regionwww.NormaRitter.com Join us on Facebook for the latest birthing and breastfeeding news and views:http://tinyurl.com/BMCRonFB How many sessions of CST did she have? Do you know/trust that practitioner? Did the OT recognize the pTT as well?Have you re-assessed tongue function after the CST?It can be hard to encourage mom to insist the ENT release the TT when we can't guarantee that it will be a cure-all, but it seems like she has tried everything else. The risks are minimal and the benefit could be huge. Even if the baby needs more bodywork, it's likely that the pTT is a significant issue for this baby. HealySeattle, WA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2010 Report Share Posted December 17, 2010 Hi All,I think I communicated incorrectly - the baby's tongue was released by our favorite ENT. It is unusual for her to say it wouldn't make much difference - but she did say it and it seems to be true. I hope this mom will consider more structural work. I asked her permission to check in with you all. I will share with her.She is an interesting woman - very strong and determined. However, she had very strong physical boundaries when I was there. She was pretty good with her baby but was also very specific - hard to explain. We did discuss biological nurturing. Thank you all for your feedback.Leigh AnneSent from my Verizon Wireless BlackBerrySender: Date: Fri, 17 Dec 2010 16:54:47 -0500To: < >ReplyTo: Subject: Re: A challenging case Would this mother be willing to take her baby to another HCP to get the tongue released?Norma Ritter, IBCLC, RLCBreastfeeding Matters in the Capital Regionwww.NormaRitter.comJoin us on Facebook for the latest birthing and breastfeeding news and views:http://tinyurl.com/BMCRonFBOn Fri, Dec 17, 2010 at 12:32 PM, wrote: How many sessions of CST did she have? Do you know/trust that practitioner? Did the OT recognize the pTT as well?Have you re-assessed tongue function after the CST?It can be hard to encourage mom to insist the ENT release the TT when we can't guarantee that it will be a cure-all, but it seems like she has tried everything else. The risks are minimal and the benefit could be huge. Even if the baby needs more bodywork, it's likely that the pTT is a significant issue for this baby. HealySeattle, WA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2010 Report Share Posted December 18, 2010 Could it be that if the ENT says it won't make much difference, the ENT is not familiar enough with posterior TTs to have known how far back he really needed to cut? If he didn't clip it far enough, there will still be a lot of pain for the mom and ineffective feeds for the baby. Did the CST help the remnants of the large bulge take on a perfectly normal shape? If not, then the practitioner may not be as well-versed in the cranial work as this baby needs, or maybe mom stopped going too soon. Bumps, ridges, crossed sutures--all these contribute to sucking problems by preventing other structures in the mouth (such as hard palate, soft palate, etc.) from moving properly during sucking. Dee KassingHello All,I have a hard one. Baby born vaginally, vacuum assisted - large bulge on head for over two weeks, broken clavicle, baby not transferring milk, causing mom pain, posterior TT.Mom pumping, making plenty of milk after. The first 5 days. Mom brought baby for frenotomy, ENT stated it may not make much difference. Mom had CST/OT work on baby. Mom says no difference after this work.Baby is now 4 weeks old, mom says baby will only latch with nipple shield, the feedings are painful and she is making less milk than he is taking. She says her situation is not sustainable much longer.Any ideas?Leigh Anne O'Connor, LLL, IBCLC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2010 Report Share Posted December 18, 2010 It has been my experience that releasing the PTT does not always magically make things better. Each case is different but most PTT cases I see require some post-frenotomy oral motor work, CST, etc, for a few weeks post-frenotomy in order to see real results. Going beyond the PTT… you mentioned B had a vacuum extraction, broken clavicle, etc. It sounds like there could have been some in utero positioning that wasn’t optimal as well as birth trauma that has just as great an impact on the baby’s ability to Bf as the PTT does, if not more. For some of these little ones that have been really malpositioned, “squished” up and have had loads of birth trauma sometimes a physical therapist/SLP/osteopath/chiro, etc that specializes in peds can do a little more adjusting/cranial manipulation that compliments the CST but goes a bit deeper. It needs to be someone familiar with babies and feeding issues, a tall order I know. Beyond the PTT, the innervation/structural issues can be really challenging and the outcome may or may not be what parents (or the LC) expected depending on the severity of the issues and how much therapy the family can realistically incorporate. Good luck and keep us posted! Cole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2010 Report Share Posted December 18, 2010 Hello All, Some more clarification: the ENT is our " go-to " person. This mother had been told by her pediatrician that the tongue was not an issue, the ped suggested a different ENT who told her the baby was not TT, this mother saw Dr Dahl - the one we love. The CST she saw specializes in breastfeeding issues, she has helped many moms here. The head has returned to " normal. " Mom tells me the clavicle seems to be healing. I believe the issue is that the mom needs to continue the structural work. She says she didn't see any difference after her first visit. This mother spent a lot of time and money on acupuncture trying to get pregnant and conceived this bay through IVF. I believe she is skeptical of " complimentary " therapies. The CST I suggested is also an OT. I will keep you all posted. Thank you, Leigh Anne in NYC Sent from my Verizon Wireless BlackBerry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2010 Report Share Posted December 18, 2010 This is a question that I have had. Why are the ENTs saying that clipping will not help much with posterior TT? I also want to clarify. The ENTs in my area will do the clipping but are essentially talking the parents out of doing the procedure. Ellen Simpson Could it be that if the ENT says it won't make much difference, the ENT is not familiar enough with posterior TTs to have known how far back he really needed to cut? If he didn't clip it far enough, there will still be a lot of pain for the mom and ineffective feeds for the baby. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2010 Report Share Posted December 18, 2010 Ah, *there's* the rub. She didn't see any difference after the first visit. She didn't have the correct idea of what to expect! I always tell mothers to expect to see some change in *postural* issues, such as if the baby looks like a crescent moon when lying on her back, she will probably be able to lie straighter after the first CST visit, or if she couldn't turn her head very far to one side, she will do better at it. But sucking is rarely affected by first visit of CST. I tell them to expect that there will either be NO change at all in sucking after first visit, or there will be *one* wonderfully better nursing session but then everything will be back to the way it has been. After the *second* visit, the mother should start to see some changes to suck, though it often still won't be perfect, or it might be perfect for a day or two but won't "hold" and the baby will have to go back again. I have seen this pattern over and over, with all five of my trusted CST practitioners who are of various "other" backgrounds (ped chiro, massage therapist, physical therapist). And then, even though I have warned the mother, I tell her she *will* forget I said this and she will call me disappointed after the first visit, and I will remind her that I said this would happen. I tell her *every* mother does this and I don't mind the phone call and the necessary reminder, but she'll realize she's heard it before when she calls me to report that "nothing happened". And 95% of the time, this is exactly how it plays out. Dee Kassing Subject: Re: Re: A challenging caseTo: Date: Saturday, December 18, 2010, 6:20 AM Hello All,Some more clarification: the ENT is our "go-to" person. This mother had been told by her pediatrician that the tongue was not an issue, the ped suggested a different ENT who told her the baby was not TT, this mother saw Dr Dahl - the one we love.The CST she saw specializes in breastfeeding issues, she has helped many moms here.The head has returned to "normal." Mom tells me the clavicle seems to be healing.I believe the issue is that the mom needs to continue the structural work. She says she didn't see any difference after her first visit. This mother spent a lot of time and money on acupuncture trying to get pregnant and conceived this bay through IVF. I believe she is skeptical of "complimentary" therapies. The CST I suggested is also an OT.I will keep you all posted. Thank you,Leigh Anne in NYCSent from my Verizon Wireless BlackBerry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2010 Report Share Posted December 18, 2010 I just want to comment that I have one CST practitioner that only does 1-2 sessions and then says all is fine, and I have never seen results- and another that does about 6 average and almost always see results. So although I don’t understand CST there is clearly a difference in practitioners!! Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of lllemhealy@...Sent: Friday, December 17, 2010 7:33 PMTo: Subject: Re: A challenging case How many sessions of CST did she have? Do you know/trust that practitioner? Did the OT recognize the pTT as well?Have you re-assessed tongue function after the CST?It can be hard to encourage mom to insist the ENT release the TT when we can't guarantee that it will be a cure-all, but it seems like she has tried everything else. The risks are minimal and the benefit could be huge. Even if the baby needs more bodywork, it's likely that the pTT is a significant issue for this baby. HealySeattle, WASent from my Verizon Wireless BlackBerryFrom: LeighAnne625@... Sender: Date: Fri, 17 Dec 2010 14:27:31 +0000To: < >ReplyTo: Subject: A challenging case Hello All,I have a hard one. Baby born vaginally, vacuum assisted - large bulge on head for over two weeks, broken clavicle, baby not transferring milk, causing mom pain, posterior TT.Mom pumping, making plenty of milk after. The first 5 days. Mom brought baby for frenotomy, ENT stated it may not make much difference. Mom had CST/OT work on baby. Mom says no difference after this work.Baby is now 4 weeks old, mom says baby will only latch with nipple shield, the feedings are painful and she is making less milk than he is taking. She says her situation is not sustainable much longer.Any ideas?Leigh Anne O'Connor, LLL, IBCLCSent from my Verizon Wireless BlackBerry__________ Information from ESET NOD32 Antivirus, version of virus signature database 5556 (20101022) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2010 Report Share Posted December 18, 2010 Isn’t that fun, Dee? I say and see the exact same thing, and then they think you know how to predict the future J Billowitz, IBCLCIsrael From: [mailto: ] On Behalf Of Dee KassingSent: Saturday, December 18, 2010 6:07 PMTo: Subject: Re: Re: A challenging case Ah, *there's* the rub. She didn't see any difference after the first visit. She didn't have the correct idea of what to expect! I always tell mothers to expect to see some change in *postural* issues, such as if the baby looks like a crescent moon when lying on her back, she will probably be able to lie straighter after the first CST visit, or if she couldn't turn her head very far to one side, she will do better at it. But sucking is rarely affected by first visit of CST. I tell them to expect that there will either be NO change at all in sucking after first visit, or there will be *one* wonderfully better nursing session but then everything will be back to the way it has been. After the *second* visit, the mother should start to see some changes to suck, though it often still won't be perfect, or it might be perfect for a day or two but won't " hold " and the baby will have to go back again. I have seen this pattern over and over, with all five of my trusted CST practitioners who are of various " other " backgrounds (ped chiro, massage therapist, physical therapist). And then, even though I have warned the mother, I tell her she *will* forget I said this and she will call me disappointed after the first visit, and I will remind her that I said this would happen. I tell her *every* mother does this and I don't mind the phone call and the necessary reminder, but she'll realize she's heard it before when she calls me to report that " nothing happened " . And 95% of the time, this is exactly how it plays out. Dee KassingSubject: Re: Re: A challenging caseTo: Date: Saturday, December 18, 2010, 6:20 AM Hello All,Some more clarification: the ENT is our " go-to " person. This mother had been told by her pediatrician that the tongue was not an issue, the ped suggested a different ENT who told her the baby was not TT, this mother saw Dr Dahl - the one we love.The CST she saw specializes in breastfeeding issues, she has helped many moms here.The head has returned to " normal. " Mom tells me the clavicle seems to be healing.I believe the issue is that the mom needs to continue the structural work. She says she didn't see any difference after her first visit. This mother spent a lot of time and money on acupuncture trying to get pregnant and conceived this bay through IVF. I believe she is skeptical of " complimentary " therapies. The CST I suggested is also an OT.I will keep you all posted. Thank you,Leigh Anne in NYCSent from my Verizon Wireless BlackBerry__________ Information from ESET NOD32 Antivirus, version of virus signature database 5556 (20101022) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2010 Report Share Posted December 19, 2010 Giggle! It *is* nice to be able to appear brilliant every once in a while, isn't it! Dee Isn’t that fun, Dee? I say and see the exact same thing, and then they think you know how to predict the future J Billowitz, IBCLC Israel Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2010 Report Share Posted December 20, 2010 I have to confess that I have seen at least one CLC diagnose almost any frenulum as a posterior tongue tie, only to have the mom go through all sorts of craniosacral and other type of work, only to have no results at all. In some of these cases, the underlying cause was something quite different - like not switching breasts for a baby that needed a second breasts In some of these cases, it is murky. I do think that because PTT is the cause du jour that there is some overdiagnosis in our area ass well as underdiagnosis because the pediatrician's are still not as aware of the many types of tongue tie. What one has to keep in mind is that not all treatments work well for all people all of the time. And even sometimes all of the treatments that you can apply still don't fix a situation. This is where it is important for ALL practitioners to periodically assess your drop outs. Not one of us can ever claim to have a 100% success rate even with the most tried and true interventions. Best regards, E. Burger, MHS, PhD, IBCLC Quote Link to comment Share on other sites More sharing options...
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