Tongue and Lip Tie FAQ - Page 8

[gabbyraja]

laerhk - is it Amanda Kaufman in Ann Arbor? I was thinking about seeing her as well, as she accepts our insurance. However, I emailed her and she said this:

I do perform frenotomy (tongue tie) clipping on infants. I do not practice lip frenulum clipping.

I use a sterile scissor, I clip all forms of tongue tie, both the obvious anterior and more difficult posterior ties. I like this resource for information.

http://www.suite101.com/content/diagnosing-tonguetie-in-a-breastfed-baby-a78730#ixzz17dyhe4rr

The book recommended to give doctors in that reference is fantastic and they can read a considerable amount for free through google books just by clicking on the reference.

I have never needed to find out about labial frenotomies because they are often diagnosed after teeth are coming in, noticed when people have a large gap between the front teeth (like David Letterman).

I only have experience in infants, with the latest I've done is 5 months old. I assume older kids will have more bleeding and be harder to hold down, making it more likely I would injury the mouth. My little sister had her tongue clipped by our dentist when she was a 4 year old with a lisp (30 years ago).

There is a lot of controversy among specialists mostly because they don't beleive it causes breastfeeding problems. I think they are all looking to "first do no harm" and don't realize it is a problem. If you present them good information and resources, I hope anyone would help you out. We may need to develop a consortium across Michigan of the providers who will do this to help each other out.

So, she can help my infant with one procedure. But I think 4 of my kids have lip and/or tongue ties. Apparently the oral surgery clinic at U of M is able to do all of the surgeries, but 1. they didn't sound particularly knowledgable about any of it and 2. our insurance won't cover any of the procedures, so there's no point in driving all the way there. So, we're seeing Oral Surgery of Lansing next week. They confirmed for me that they are knowledgable  on the subject of type IV tongue tie and do lip ties w/laser. I'll report back on what they say after the consult of $90/child (Gasp!). Will you do so for your doc visit also? And share who they are if it goes well?

[treekidsandadog]

Where are you in Michigan??  UP or LP??  I only ask because we are persuing a dentist in Sault, Ontario to clip my son's lip and tongue...It is an option if you are close enough.  I haven't actually met with the dentist yet, but am working on it.  It is not too expensive either (if your insurance doesn't cover it over there) as their socialized health care keeps costs down.  HTH

[gabbyraja]

I'm a troll. :) We live in Lansing. There's apparently a doc in OH that's only a 5 hour drive or so away, but I'd REALLY rather find someone closer. I never thought about heading across the border, though. Thanks for the idea!

I've emailed Dr Kaufman to ask her to at least evaluate my 2 little guys. They are exceptional at cooperating at dr's offices and such. Fingers crossed.

[treekidsandadog]

Good luck!!

[treekidsandadog]

Just talked to the dentist office in Sault, ONT and they are going to charge me $35 for a consult and can get us in next Friday!!  That's less than my dental co-pays with my regular dentist!

[danipoppins]

Looks like this is the spot for me. My two week old had his posterior TT clipped last week by a local ENT. I'm sorry to say I hadn't done a ton of research prior to getting it clipped and only after did I realize his was probably type 4. My 10yo was/is TT as well and I couldn't find anyone to clip it so we struggle through it and managed okay. His was a very different TT (type 1 probably) and tore a bit at one point and stretched over the many yrs of our nursing relationship. This baby's never would have stretched on his own I don't think.

Anyway, the clipping really doesn't seem to have helped much. I'm still in pain at the beginning of every feed and he can barely get his tongue over his bottom lip. He's still clicking during let downs. The ENT was touted as the go to guy for clipping tight frenulums, but I found him to be rather aloof and he didn't give us any exercises to do post frenotomy. It wasn't until 3 days later when I went to the LC specifically for that purpose that I got some to do. Though now I'm worried his tongue may have reattached in the meantime and/or will need to be clipped again. He also didn't evaluate him for a lip tie, which I've since discovered he also has (though he flares fine and it doesn't appear to be having much of an impact if any).

He's getting plenty of milk (a bit of over supply?) and is gaining well. It's just my poor nipples. I've been putting the lanolin on regularly, but it looks like it's giving me an odd rash on my areolas. My nipples are pink, but not cracked or bleeding (one had started to by day 2 and the lanolin cleared it right up).

I'm trying to do some sucking exercises, but he won't suck on my finger or a paci. So far all I've been able to do is rub his gums to get him to stretch it side to side and put my fingers under and manually stretch it up (which makes him gag). Any other ideas for us? Are some pacifiers better than others?

Interestingly, my sister, my mom and myself are all TT and my mom and I both have labial frenula that cause/d a space between the two front teeth. My mom was able to BF me, but not my younger sister and never knew why until my oldest was born and we realized she's TT.

There are a couple of other local docs the LCs gave me names for who are frenotomy friendly. How long might it take to retrain his suck (he was 9 days old when he was clipped)? When should I consider a second clipping/second opinion? How would I know if the labial frenulum is a factor?

(sorry for any typos/auto correct weirdness, I'm typing from my phone)

[CelinerD]

@danipoppins:

After getting tt released, its very helpful to elevate babies tongue as much as possible to keep it from adhering again. I have been told that one can do it even a week after tt release. Sometimes if babies have trouble latching after tt release and it is very painful still, nipple shields can be very helpful for transitioning (yes, they do have a use!). Dr. Evelyn Jain's recommendations for a mom I know was:

I usually try a shield AS YOUNG AS POSSIBLE to retrain and strengthen tongue and orofacial muscles. Usu. try a 24 and if he cannot do 24 then go to a 20 mm  shield and graduate to 24 when he is stronger A six weeker may need some persuading by dripping milk onto the shield or popping a feeding tube under the shield to give flow.

great web site with excellent links:

http://kiddsteeth.com/articles/breastfeedingdrkotlowtx.pdf  (shows exercises to elevate the tongue)..Worth it to do the exercises as much as possible.

http://www.tonguetie.net/index.php?option=com_content&task=view&id=8&Itemid=7

And sometimes the TT is not released enough. Maybe there is someone else in your community who is more comfortable with this procedure..there is a post on the first or second page of this thread with practitioners all over the country who are experienced in frenotomy. But my experience is that it takes many babies a couple of weeks to get breastfeeding to the place where its no longer uncomfortable after tt release just as it can take a few weeks to get breastfeeding well established without any glitches along the way.

Like you, it seems that I had a very tight lip tie - I remember it tearing when I was younger and how painful it was and it seems I was TT'd as well. Eldest daughter has lip tie and was tt'd mildly, I had cracked bleeding nipples for 3 weeks - it was 1980 and we knew nothing then..and my 2nd and 3rd daughters had lip ties, though breastfeeding was not uncomfortable. The older 3 all have spaces between their front teeth as .did I until I was in my 30's

Good luck!

[gruntlings]

I just wanted to thank the person that recommended Dr. Dahl. She clipped my son's tongue today and I've seen an immediate drastic improvement in his latch. 

It was a regular tongue tie "to the tip" and so it was not a posterior clipping (although he might need that as well at some point). But she did it in her office with a topical numbing agent only. She said that she usually doesn't do older infants in her office as they can move a lot more and so she usually uses nitrous oxide at the hospital. I asked if she could do it if we were able to make sure he didn't move, and she was comfortable with that as long as we were sure we could restrain him. I swaddled him in my stretchy wrap (sort of like a Moby) so that he couldn't move his arms, and his dad held his head still. The whole thing from swaddling through numbing, snipping, nursing, and him popping off to smile and babble at us after it was all over was 10 minutes.

We opted for no injection because the pain of a simple tongue tie release is compared to having one's ears pierced. Local anesthesia hurts more than that!

There was minimal bleeding- she pressed a piece of gauze under his tongue and pressed the tongue back once it was snipped, and then had him go right to the breast.

She's fast, gentle, very good, and communicative/accommodating.

[gabbyraja]

Turned out that Dr Kauffman couldn't participate with my insurance. So, we just paid out of pocket to a local oral surgeon. Oral Surgery of Lansing, in case any future mamas come her elooking for the info. He didn't really see much of a problem with my little ones, but the 8 yr old he agreed we might want to get her maxillary frenulum done. He didn't argue with me about my 4 yr old; would do it if I wanted him to. So, we got both of them done. $475 ea. That was our entire budget for this year. We'll reevaluate the little ones next year. Also, they tried to pull some crap that they don't allow the parents back, but I threw a huge fit, cancelling the appt for my 4 yr old, and they actually went and asked the dr. He said it was fine, and I was back with both kids for their surgeries. Laser took about 1 minute with both of them.