Frenotomy–Parent Perseverance Pays Off

 

20140828_095301Breastfeeding always hurt for first- time breastfeeder, Tina. She was given a nipple shield to help with the pain. And it did help. Even so, she knew a nipple shield was not a long-term solution. She kept trying to get rid of the shield. She hated the thing! But every time baby latched without it it, it resulted in intense nipple pain and wounds—her nipple was painfully creased after feedings as well. So, understandably,  she continued to nurse with the shield.

Meanwhile, baby Carolyn wasn’t gaining weight well. At every appointment she was gaining about ½ of expected weight gain. Baby was breastfeeding frequently—over 10x/day and still not gaining appropriately. She was having infrequent bowel movements, was gassy, and uncomfortable. Tina felt that something was very wrong. Continue reading

Guest Post: Two Big Reasons to Skip Rice Cereal

The following is a guest post from Beth Martin. Beth is a certified Nutritional Therapy Practitioner (NTP) and the owner of Small Bites Wellness in Seattle, Washington. She is passionate about whole food nutrition for the whole family and believes that ANY change you make in the pursuit of your health, or your child’s health, is worthy. Health is a journey, not a destination. Thank you Beth, for this great information!

I recently shared the most common reasons pediatricians recommend rice cereal as a first food for infants.

IMG_1091I advocate feeding children nutrient dense whole foods that naturally contain the macronutrients, vitamins, and minerals they need to grow and develop. Rice cereal does not fit into this paradigm as a first food, and here’s why. Continue reading

Guest Post: Why Pediatricians Recommend Rice Cereal (and Why I don’t Agree)

The following is a guest post from Beth Martin. Beth is a certified Nutritional Therapy Practitioner (NTP) in Seattle, and the owner of Small Bites Wellness. She is passionate about whole food nutrition for the whole family and believes that ANY change you make in the pursuit of your health, or your child’s health, is worthy. Health is a journey, not a destination. Please contact Beth for questions about your family’s nutrition.

IMG_0117For decades, rice cereal has been the recommended first food for infants, sometimes as early as two months of age. In recent years, some doctors, nutritionists and the American Academy of Pediatrics (AAP) have begun to change their stance on rice cereal. Continue reading

Frenotomy Aftercare: Effective and Respectful

Your baby has had a frenotomy/frenectomy (frenectomy is the term for laser frenulum release and frenotomy for scissors) and the last thing you want is for it to heal incorrectly–possibly requiring a second procedure.  You probably got a handout with instructions for aftercare. It sounded simple when your IBCLC was discussing it with you.  But now that you’re home with baby, it all seems so confusing. What are all these “stretches” and “exercises” people are talking about?

Your provider might call them “stretches,” or “sweeps” or “exercises”. Whatever they are called, there is one purpose–to ensure that the frenotomy site heals as open as possible; which, in turn, will give baby more mobility (movement) of his tongue. We want that beautiful diamond that was created with the frenotomy or frenectomy to stay a beautiful diamond. Just like the one below.

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This photo was taken just a few days after a laser frenectomy. The color of the diamond is normal. It will be white or yellowish for a few days before it fades to pink.

 

 

 

 

Doing effective aftercare means you have to get your fingers in your baby’s mouth.  You’re not used to it. It feels strange. And baby likely won’t be thrilled about it either. Keep in mind, however, that there are probably a lot of things that your baby objects to, but you do it anyway, right? You change her diapers, bathe her and put clothes on her–all with some degree of protest from baby.

A few pointers to make this easier for both you and baby. Ask permission–verbally or by gently tapping on mouth with your fingers. Be matter-of-fact about the process and let baby know what you’re doing. Keep it short. Lastly, no need to be rough–you can be gentle and still be effective.

Here’s a short video of a tongue tied baby who is graciously helping to demonstrate aftercare. Most babies–including this one–really dislike anything under the tongue. She lets us know that she is not happy about the “forklift” maneuver, but she is not in any pain. Note: This is before the frenectomy so the frenulum is still present.

 

 

The photo below shows the forklift maneuver from the perspective of the parent. Note that the IBCLC in the picture is approaching from the top of the baby’s head. This is the most effective way to get complete separation of tongue and the floor of the mouth. The middle fingers are holding the chin to get separation–not merely a lift of the tongue. If you only lift the tongue, the jaw will follow and separation will not occur.

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Gloves are not required if you are the baby’s parent! But some parents do use gloves to do the aftercare because of concerns about fingernails. It’s up to you. Do whatever works for you to ensure that these “exercises” happen at least 6 times per day.

Finally, whether laser or scissors, please schedule a follow up with your IBCLC and your frenotomy/frenectomy provider about 5-7 days post procedure. You and your baby will benefit most from the procedure with timely follow up.

See also: “My Baby is Tongue Tied?”, “Twenty Things You Don’t Know about Tongue Tie”

If you suspect that your baby is tongue tied, I’m happy to help! No matter where you are around the globe, virtual consultations are available. If you’re in the Seattle area, we can meet in your home or at Docere Center for Natural Medicine.

For frenotomies in the Seattle area I highly recommend Dr. Chenelle Roberts at Docere Center for Natural Medicine in the Greenlake neighborhood.

Virtual Lactation Consultations

Meeting with a terrific IBCLC in person can be a game-changing moment for a parent struggling with breastfeeding challenges. But what if there is no IBCLC in your area?Maybe you’ve had a less than helpful experience with your local lactation professional. Or, perhaps you’re looking for a very specialized type of expertise. In all of these situations, a video conference may be perfect for you! With the advent of video conferencing platforms similar to skype and facetime, I can now see my clients and their babies from 1000’s of miles away!

Here’s what Dani had to say after a recent remote consultation with her and her baby who was refusing the breast:

“Renee was able to help our family tremendously even through cyberspace! She was very professional and respectful, I felt very comfortable– almost like she was in the same room with us. She also had great follow-up and support with our family. We were able to start exclusively nursing again after a several month break and other barriers in just a few days!”

This parent was able to show me frenulum of baby from afar.

This parent was able to show me the baby’s frenulum from afar.

If you like the idea of a remote consultation, here’s what you need know:

  • Consultations need to be scheduled in advance. I can usually schedule w/in 24-48 hours of your request. Be sure to let me know your time zone when you request an appointment!
  • I use a HIPAA-compliant platform so you don’t have to worry about privacy. There are no recordings made during your session.
  • Once your consultation is scheduled you will receive an invitation via email. You’ll be asked to download a small file so you can use the platform and we can see each other. This process is simple and takes less than a minute.
  • You will need to have high-speed internet to participate in a virtual consultation. A laptop, tablet or phone can be used as your camera. A helper to aim the camera can make things go smoothly.
  • Good lighting is essential—especially if I need to look into the baby’s mouth. Have a flashlight handy just in case.
  • If you’d like to bill your insurance company, you will be provided with a superbill and instructions for how to complete it.
  • Consultations last about an hour. Follow ups can be scheduled as necessary.
  • Payment for your consultation is made in advance through paypal. If you don’t have a paypal account we can make other arrangements for credit card payment over the phone.
  • I will do my best to locate professionals in your area who can help support the plan we develop together.

If this sounds good to you, shoot me an email to schedule. I look forward to meeting you soon!