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Donna Bruschi, IBCLC
Feb 19, 2021
In Parenting Forum
When I work with a family, we always work on positioning first, then use bodywork to help the baby’s body function optimally, and then have a provider look at structure of the mouth. This ensures the least invasive and most far reaching treatments are done first.  Comfortable and effective breastfeeding positions are not widely taught. Proper positioning while breastfeeding solves many problems for both mother and baby. It ensures that nursing is comfortable for the mother and that the baby is is a good position to properly milk the breast. When the baby can effectively nurse, the demand-supply cycle can function as it ought to with an abundant milk supply and a healthy, happy baby. Bodywork also gives full body benefits to a baby.  The stresses of life in utero and the birth process can cause a baby's muscles and fascia to contract, or be flaccid and cause not only feeding difficulties, but restricted movement in tummy time, rolling, crawling and walking. Gentle therapy restores full movement for all of these areas, not just the mouth. When positioning and bodywork only help a little. When these two are not relieving all breastfeeding difficulties, and there seems to be inadequate tongue movement, then I refer to a pediatric dentist for a detailed evaluation and diagnoses of mouth structure. A frenulum under the tongue, between the cheeks and gum or under the lips can cause a multitude of problems and breastfeeding is one area where they commonly show up. Other signs of oral tethering include reflux, airway constriction, snoring and mouth breathing, speech restrictions, teeth problems, and sleep difficulties. By having an exam, parents can make an informed choice whether they want treatment or not, and when the treatment would be most effective.  Here's what to expect before you go for a consultation and exam for possible tongue, lip or buccal ties with a pediatric dentist. The exam is very brief. "Shouldn't there be more to it," you will ask yourself.  It can be disconcerting, because in many cases you have been mystified, and in pain, with all of your symptoms for some time. Now, all of a sudden, someone is offering to treat them with what seems like an improbable, and expensive solution.  If you were referred by another professional, most likely they suspect a tie and the dentist is going to confirm a restriction and recommend a tongue tie revision, in most cases, immediately. You are under no obligation to do so, if you are not prepared, or need time to consider your options. You should not have the procedure done if you have any doubts about its efficacy, or doubts about the provider.  You should also seriously consider having the procedure scheduled in the future if you are heading into a stressful or busy time in your life, because after-care requires a time commitment and patience as your baby re-learns how to use their mouth muscles and tongue. You should also consider the problems with not revising a restriction. To help you feel more comfortable going forward with the revision during the initial exam, know that it is a minor procedure with very few complications. It is nowhere near as complicated as circumcision, for instance. More than 90% of my clients are happy that they did it. About 75% of my clients notice an immediate improvement in breastfeeding right after the revision. About 20% notice little, or no improvement at that time of the revision, but see improvement and resolution of breastfeeding problems over the next 2-6 weeks. About 5% of my clients regret having the procedure done because it was disruptive to their nursing relationship for a period of 1-2 weeks and they saw no improvement in breastfeeding. What happens during the procedure? The revision takes 5-7 minutes, even if the baby needs both tongue and lip ties done. Most providers bring the baby to a treatment room while the parents wait in the exam room. Parents usually watch a video about the procedure and after-care while waiting. The baby is swaddled and given eye protection with tiny goggles. An assistant holds and reassures the baby while the dentist lifts their tongue with a tool and uses a laser to evaporate the frenulum. The laser cauterizes the wound and there is no bleeding. While some babies are very upset, some babies remain calm throughout. You and your baby are reunited immediately after and you will be asked to breastfeed (if you are breastfeeding) and cuddle your baby. Under their tongue you will see a yellow-white diamond-shaped wound. The dentist will instruct you on "stretches" or "exercises" that will keep the wound from healing back on itself. After the procedure. The wound is numb for a few hours after, so head home immediately and settle in for cuddling and nursing. Your dentist may give you a remedy to help with pain and you can use it alongside breastfeeding, which is a natural pain reliever in itself. Several times a day you will put on a glove and stretch the wound open again. Take your time and ease your baby into it with some light stroking around and in their mouth. This keeps them calm and allows a more pleasant experience for both of you. During the first 24-48 hours after the revision, your baby may be fussy. Some babies go on a nursing strike for a few hours or overnight. Keep offering your breast and use skin-to-skin contact to calm both of you, ease their pain and remind them about breastfeeding. It is perfectly fine for them to go 12 hours without nursing or eating anything if they are a healthy term infant. If a strike continues, spoon feed milk or bottle feed until they return to nursing. If it's more than 12 hours, please contact me for help. I like aftercare as explained by Dr. Bobby Ghaheri, an ENT who does tongue tie revisions in Oregon. https://www.drghaheri.com/aftercare Hudson Valley Dentists  The following dentists are all located within an hour of New Paltz, NY. They are trusted and recommended by my clients. Dr. Geri-Lynn Waldman, DDS Hudson Valley Pediatric Dentistry 75 Crystal Run Rd Suite 235 Middletown, NY 10941 (845) 363-4177 https://www.hvkidsmiles.com Dr. Benjamin Dancygier, DDS Valley Pediatric Dentistry 3630 Hill Blvd, Suite 101 Jefferson Valley, NY 10535 1557 Route 82, Suite 2 Hopewell Junction, NY 12533 845-226-8577 https://www.valleypediatricdentistry.com Dr. Katherine Bracy and Dr. Cindy Chay Le Petite Dent  25 Smith St, Suite 103 Nanuet, NY 10954 845-624-0011 https://lapetitedent.com *Dr. Lawrence A Kotlow, DDS PC 340 Fuller Road Albany, NY 12203 518-489-2571 https://www.kiddsteeth.com *Dr. Kotlow is a highly regarded Pediatric Dentist. Some find his bedside manner abrupt, but he is also kind and professional.  REFERENCES Breastfeeding Info: Tongue and Lip Ties   https://www.llli.org/breastfeeding-info/tongue-lip-ties/ Mohrbacher, N. Breastfeeding Answers Made Simple. Amarillo Tx: Hale Publishing, 2010. What to Expect After Tongue Tie Release (Frenulotomy) http://milkmatters.org.uk/2016/10/11/expect-tongue-tie-release/ PROFESSIONAL REFERENCES Alona Bin-Nun et al. Dramatic Increase in Tongue Tie-Related Articles: A 67 Years Systematic Review, Breastfeeding Medicine. Sep 2017: 410-414. Baeza, Carmela et al. Assessment and Classification of Tongue-Tie, Clinical Lactation, Volume 8, Number 3, 2017, pp. 93-98(6). Geddes, DT. et al. Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008; 12(1):e188–94. Genna, Catherine Watson et al. Treating Tongue-Tie, Clinical Lactation, Volume 8, Number 3, 2017, pp. 99-103(5). Genna, C. Watson. Supporting Sucking Skills in Breastfeeding Infants. Burlington, MA. Jones & Bartlett, 2012. Hogan, M. Westcott, C. and Griffiths, M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005; 41:246–50. Kendall-Tackett, Kathleen, The  Tongue-Tie Controversy, Clinical Lactation, Volume 8, Number 3, 2017, pp. 87-88. Knox, I. Tongue tie and frenotomy in the breastfeeding newborn. Neoreviews 11 (9) Sept 2010. Shaul Dollberg,1 Ronella Marom,1 and Eyal Botzer, Lingual Frenotomy for Breastfeeding Difficulties: A Prospective Follow-Up Study, Breastfeeding Medicine, Volume 9, Number 6, 2014. DOI: 10.1089/bfm.2014.0010. Smillie,Christina et al. Post-Revision Instructions and Pain Relief, Clinical Lactation, Volume 8, Number 3, 2017, pp. 107-109(3).
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Donna Bruschi, IBCLC
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