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Lactation Consults/Tongue-tie

Not every lactation visit is a tongue-tie, but I do see a lot of posterior tongue-ties.

More and more first-line providers recognize anterior tongue-tie, now. It's not to hard to get the thin membrane clipped. It is the norm for your local Pediatrician to not recognize a posterior tongue-tie and perhaps deny that tongue-tie is affecting breastfeeding.

Many times the feeding problems of the newborn: failure to gain weight, low milk supply, and sore nipples are a result of tongue-tie. We have a strong LLL community in South Florida, numerous midwives and excellent birth centers, and many experienced IBCLC's. They are all excellent resources for breastfeeding help. Most problems are resolved before you need me. If your leader, IBCLC, or midwife couldn't help fix your these problems with position and other non-medical intervention, I want you to at least be familiar with "the possibility" of tongue-tie before you come to see me. If you already know your baby is tongue-tied or you are not sure, it will be of benefit to look over these references.

Since most new moms are too overwhelmed to begin a search for tongue-tie, if you look over these pages, I can help you to plan for your office visit and expedite your breastfeeding situation getting back on track.

I am inspired to add this page to my blog after visiting the office of Lawrence Kotlow DDS in Albany NY on June 1, 20102. I wanted face-to-face training beyond all the distance-learning mothering and professional forums I participate on. His patient's breastfeeding situation get better fast with all the preparation that goes into an office visit. I can offer the procedure, but you need to be prepared to get the quickest gains.

Dr. Kotlow uses laser and nearly every baby he sees for tongue-tie gets the lower and the upper frenulum revised by laser, separated from parents, in  a dental procedure room.  I went up to see how this compared to how I am  using a simple curved scissor with the parents present in my quaint and comfortable exam room for "lower" tongue-tie. I am reassured that my approach to tongue-tie is right-on. I can get the cut as deep ( and preserve breastfeeding), but not cosmetically flush to the gum line.

If you been to my office, you know I have tried to keep the lactation room comfy. It would be a huge step to get a laser, ceiling light source, suction, safety goggles for me, staff, and different sizes of babies. My situation is right for me right now with my resources, and his is right for him as a dentist. Still, my clinical skills and simple clipping approach have benefited from observing Dr. Kotlow in person. I learned to do frenotomies by  Internet 15 years ago, and stay current through professional forums, but I have never have seen another dentist or MD approach a tongue-tie with the exception of the ENT who took my own son to the operating room to clip his.

I am a Family Physician and IBCLC with over 15 years of tongue-tie experience. I've been doing posterior ties about 6-7 years. Actually, I've been doing them all along, but I didn't know it had a name. I just new that snipping the obvious restriction, uncovered banding deeper and I snipped again. 

I am still old fashion using the scissor. I am extremely happy with the results. Most babies are latching before they leave my office and I address other breastfeeding issues at the same time: low or increased milk, spasm, infection, open wound, abscess, post-partum depression.... While feeding, I run through the importance of skin-to-skin (co-sleep, babywearing, co-bathing), our community resources, and not feeling guilty for not doing everything your pediatrician says (if I am not the PCP). Often I have plenty of time to talk to you about diapering, massage, vitamins, fluoride, and nutrition if you are interested. Many of my patients have chiropractors and alternative healers on board. I feel very rewarded being able to help the mothers. There is nothing more relaxing to me than seeing a happy mother/baby breastfeed.

I will say this: I am here for breastfeeding help. I have done upper-ties on 4 year olds. Yet, I prefer to help you with breastfeeding. I am not a dentist. If you are past a realistic chance of breastfeeding, if you are looking for cosmetic results (not functional-breastfeeding), or have other reasons to get the upper-tie done, you may want to consider the dentist right from the start.

Right now, I do the simple procedure in my exam room and I have been getting excellent latch results especially with babies under 3 months. I sit with you and give your baby time after the frenotomy to allow ample time to latch on, if you wish. I will discuss with you non-invasive post-procedure exercises to reduce the bad habits and compensation from other muscles.

To prepare for a visit, you can read through the links listed below.
If there is time, you may want to read about my philosophies or book (available by kindle).
An office visit will be for the mother and baby. The sooner the better as to prevent bad sucking habits and a reduction in your milk supply.
I do posterior tongue-ties and upper-lip ties. If your LLL, IBCLC, midwife or pediatrician told you its a tongue-tie, they are most likely correct. If someone told you, it's not a tongue-tie but you have sore nipples, intense unsatisfied baby, slow weight gain, it might be tongue-tie.
Bring a blanket.
My goal is to get your baby to latch without shield or supplements, but bring along whatever you are using to feed the baby because I like a comfortable baby.

I am also happy to be contacted for consult by phone/videos/ or photos before you make a decision. If you go to the dentist for revision, I am happy to offer phone support before and after from an MD IBCLC perspective.

If at the current time, you know you need a laser procedure, call Dr, Kotlow.

References and Previous Blog Posts

Identifying Posterior Tongue-Tie
My Son's Tongue-tie
Tongue-tie Case 1
Tongue-tie Case 2

Classification of Tongue-tie
Another way to Classify Tongue-ties

I just wanted to thank you so much for all the time you spent with my sister on Friday afternoon. Her little one is now nursing SO WELL, and she said his weight is already up significantly after just a couple of days. No more pain during feedings, and he is finally able to really fill up his little belly. You are awesome!~ MM

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