The Boob Group
Tight Frenula And Breastfeeding

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

Dr. James Ochi: When a new mother begins to breastfeed her child, she spends much of her time focusing on getting the perfect latch and bringing in her milk supply. Sometimes, no matter how perfect her child’s latch maybe, a tight frenula or a tongue tie can greatly hinder this process. I’m Dr. James Ochi, a pediatric ear, nose and throat doctor and this is The Boob Group!

[Theme Music/Intro]

Robin Kaplan: Welcome to The Boob Group, broadcasting from the Birth Education Center of San Diego. I’m your host, Robin Kaplan. I’m also a certified lactation consultant and owner of The San Diego Breastfeeding Center. At The Boob Group, we’re your online support group for all things related to breastfeeding and don’t forget to stay updated on all of our upcoming shows and giveaways by following us on Facebook, Twitter, Google+ and Pinterest. Today, I’m joined by three fantastic panelists in the studio. Ladies, will you please introduce yourself?

Carole Potter: I’m Carole Potter. I’m 32 years old. I’m a registered nurse and I have one daughter. Her name is Mallory and she’s three months old.

Erin Esteves: My name is Erin Esteves. I’m an international business operations manager. I won’t say my age. [Laughs] I have one child who is nine months old and his name is Cash.

Megan Weber: I’m Megan Weber. I’m 26 years old and a billing clerk and I have two children, a three-year-old girl and a four-month-old son.

Robin Kaplan: Well ladies, welcome to the show.

[Theme Music]
[Featured Segment: The Best Online Breastfeeding Resources]

Robin Kaplan: Before we get started with today’s topic, here’s Amber McCann talking about the best online breastfeeding resources.

Amber McCann: Hello Boob Group Listeners, I’m Amber McCann, an international board-certified lactation consultant and owner of Nourish Breastfeeding Support just outside of Washington DC. I’m here to answer some of your most common questions when it comes to finding quality breastfeeding resources online. Such as, oh my goodness! What is going on with my breasts? Here’s a little secret. All certified lactation consultants, the experts of breastfeeding, check in at https://www.kellymom.com from time to time. For your information, when I type the letter K into my Google search box, kellymom.com is the first site that pops up. Google, it knows me better than I know myself. Kelly Mom is an online resource for evidence-based information about breastfeeding. It has articles about 100s of breastfeeding questions and concerns and interprets research in a way that it’s understandable for the mothers that need the information. Have a question about plugged ducts? Kelly Mom’s got a page for that. Wondering about how to add in solid foods in the baby’s diet? Kelly Mom has gathered information at one place. Have an unexplainable red patch on your breast? Kelly Mom can give you some guidance. So Kelly Mom should never replace the medical and lactation care you would receive from your doctor or a board-certified lactation consultant. It can calm your fears until you can connect to the professional. In addition to the site, Kelly Mom also has excellent forms for connecting with others interested in breastfeeding and a great Facebook page that highlights articles and blog posts you might be interested in. Check out https://www.kellymom.com. Thank you for listening. I’m Amber McCann and I would love for you to check out my website at https://www.nourishbreastfeeding.com for information on my business and a little bit more about where to get connected with great online breastfeeding support or join me on my Facebook page. It’s https://www.facebook.com/nourishbreastfeedingsupport. And, if you have a great online breastfeeding resource you’d like us to know about, please send an email to amber@nourishbreastfeeding.com or share it on The Boob Group Facebook page. Be sure to listen to The Boob Group each week for more fantastic conversations about breastfeeding and how to find a great breastfeeding support.

[Theme Music]

Robin Kaplan: Today on The Boob Group, we’re talking about tight frenula or tongue ties and their effects on breastfeeding. Our expert, Dr. James Ochi is an ear, nose and throat doctor with Children’s ENT of San Diego and one of our best tongue tie experts in San Diego. Dr. Ochi, it’s a pleasure to have you on our show today.

Dr. James Ochi: Thank you.

Robin Kaplan: So Dr. Ochi, can you explain what a tight frenulum is and what it looks like?

Dr. James Ochi: Yes, the frenulum is the structure right below the tongue that anchors the base of the tongue to the floor of the mouth and if it’s unusually tied, it can cause difficulties with latching and breastfeeding. Interestingly enough though, in recent years, we’ve recognized there is a posterior version which is essentially, almost, it’s so subtle, it’s extremely difficult to recognize on physical exam.

[00:05:09]
Robin Kaplan: Yeah so, the one that is the most easiest to see is the one that actually goes to the tip of the tongue which will actually pull it back but these posteriors are much more challenging to define.

Dr. James Ochi: That’s exactly right.

Robin Kaplan: Okay, and how would a mother know that her baby has a tight frenulum and what symptoms would she be looking for?
Dr. James Ochi: Well, that’s a great question too because what I’ve realized over the years is that because the physical exam finding this subtle to nonexistent, going by what the mother tells me is extremely important. So, really the symptoms revolve obviously around breastfeeding for mothers such as painful breastfeeding or frustration, nipple damage in terms of cracking or bleeding, pinching of the nipple after nursing, the mother often can get so upset obviously, she cries and does so frequently and because of these difficulties, her milk supply can go down. As for the child, the baby ends up taking forever seemingly to feed because they’re getting so little milk. They often fall asleep at the breast from fatigue. They gulp lots of air so they have gas which has to come out one or two ways obviously. And they often make clicking sounds because they’re breaking the seal often.

Robin Kaplan: Okay panelists, you’ve all had babies who have had tongue ties and so, Carole, if you don’t mind starting, when did you first find out that your baby had a tight frenulum and what were the symptoms that she was showing?
Carole Potter: She was found four weeks old and her symptoms were she would take forever to feed. She was very gassy. She often didn’t seem to be satisfied by a feed. She would pop on and off the breast. She was totally not happy with breastfeeding and she wasn’t getting nutrition or food and she was constantly hungry so feeds were taking really long time and I think that’s all. I just want you to know it was very difficult emotionally for myself and for Mallory.

Robin Kaplan: Okay, how about you Erin?

Erin Esteves: Well, I learned very shortly after giving birth. The very first time he latched, it was excruciatingly painful even with the drugs and the euphoria and everyone kept telling me that it was normal to feel such discomfort. So, I passed it off and continued to try and nurse him exclusively and it was literally toe-curling, excruciating pain. So, I requested a lactation consultant immediately. One came in the very next day. I asked for another because no change had been made because the latch was perfect. They were looking at me and everything seemed prima facially excellent. However, it was horribly painful. And Cash just cried constantly. He wasn’t satiated. He wasn’t satisfied. Another lactation consultant came in and she’s the one who pointed, inserting her finger into his mouth realized that he had the tongue-tied and two days later, he had the procedure done.

Robin Kaplan: Okay, how about you Megan?

Megan Weber: Actually, both my children had this and with my daughter, when we were in the hospital, she was never able to latch and when a lactation consultant came in, you know, they gave me all the paperwork about it saying she’s probably gonna have to have her tongue clipped and when we went into the pediatrician’s office a few days after we left the hospital, the pediatrician said, “No, no, no, it’s fine.” So hers never got taken care of. With my son, he nursed right away after giving birth and even when we went home, for two days it was fine and then all of a sudden, nothing. He wouldn’t latch at all and it was horrible. It was painful when we could get him to latch and he would latch just a few seconds. And then, we went back to the hospital and spoke with a lactation consultant and that’s when she said, you know, he really does need to get his tongue clipped. So, probably about a week after his birth, he got it done.

Robin Kaplan: And Megan brings up a really good point. Dr. Ochi, do you find that all type of frenula causes breastfeeding challenges or that some babies can breastfeed even by having a tight frenulum?

Dr.James Ochi: Yes, now that’s a very interesting and important point. I’ve been impressed over the years how a child can seemingly have all the physical findings of Ankyloglossia or Tongue Tie and when I asked the mother how it was for breastfeeding and they often say, “Oh! I went 16 months, no problem.” So again, I think that looking or paying attention to what the mother has to say is paramount because obviously, I’ve had plenty of mothers bring their babies with blatant tongue tie into the office asking me to clip them and if they have no symptoms and the baby is doing well, you know, as a surgeon, that’s exactly who you don’t wanna do surgery on because there’s no opportunity for improvement. Mother and baby are happy and the only thing I can do is to mess that up. [Laughs]

[00:10:14]
Robin Kaplan: Yeah, don’t fix with number essentially. You know, my son, both my sons are, have pretty obvious frenulum’s but my kids are 7 and almost 6 now and so, at that time, I don’t know if they were necessarily checking them as frequently as maybe we do now. And, we had challenges in the beginning but, maybe I just had a really good milk supply because it didn’t affect it in that way and so, they actually eventually, kind of overcame those challenges in those first couple weeks. And so, but the interesting thing though is and there might be lots of reasons why but, I’ve seen this with some of my other clients too that the milk supply didn’t stay as long and I think it was because they had such copious amounts of milk and then when we have these hormonal changes at about three months when our body is really kind of in supply and demand making sure we’re eating enough that may be their tongues weren’t functioning as well as maybe they could have. But, one of my sons definitely has a lisp and it’s something that and they both kind of have gastrointestinal issues which I know is sometimes connected with it. So, it’s something that my husband and I discussed and said, “maybe when they’re older, if it’s still presenting an issue, then making that choice that they actually wanted to have it clipped.” But at this point it’s not worth it.

Dr.James Ochi: I think that’s a good point.

Robin Kaplan: I know all the ladies here ended up having their children’s frenulum clipped and so, how did you decide to make that choice? Erin, do you mind?

Erin Esteves: No, not at all. Well, I’ve done extensive reading before I had my baby and so, I was aware that the possibility existed. I also knew that percentage-wise, it could make no difference at all. But, I had to give it a try because I had wanted to breastfeed. Also, I had seen another lactation specialist, Miss. Robin and she also gave me the support I needed to make the decision. My husband and I had it done and finally enough, it was when we were holding him, when they clipped him that my milk came in. [Laughs] It was like, “okay, now I can give it to you.” [Laughs]

Robin Kaplan: How about you Megan? I know your daughter didn’t end up having it clipped so, what about your son? How old was he?

Megan Weber: He was a week old when he had it clipped and, you know, I remember it was on a Friday when we were told that he was gonna need to have it clipped and so, obviously we weren’t gonna have it done over the weekend and so, that whole weekend we spent, you know, researching, deciding if this was the right choice, you know, like, “oh! Do we wanna put our son through pain just so he can nurse? How important is this?” and you know, my uncle is a dentist and he was actually saying that he does it through laser, with a water laser and that it’s absolutely painless and there’s no bleeding. So then in my mind I’m thinking, “well, which do I do? Do I do a clipping or do I do this water laser?” and, you know, in the end we decided to clip in. It was the best choice for us for sure.

Robin Kaplan: How about you Carole?

Carole Potter: So, around four weeks, around the time that I called this lactation consultant to come in and check Mallory because something just wasn’t right with her, I was losing my milk supply. I had a great milk supply to start so much so that it was flooding her every time and that’s the only way she was really getting weight was through this intense milk supply. And that started to go down and I kind of noticed something wasn’t right. So, she found her tongue tie on Thursday and we got it clipped the following week by the time we were able to arrange the insurances and all that information to go to the TNT. So, we decided in our case, there was no choice. She wasn’t, when my milk supply went down, I was trying to pump and give her milk through the bottle and she couldn’t even take milk from a bottle. So, we knew that, you know, both something in her oral structure was compromising her ability to eat and she was born pretty small. So, we were really worried about her weight gain. So, and the fact that she couldn’t take milk from a bottle and she would dribble it out and she would inhale a lot air.

Robin Kaplan: And so there wasn’t even another option.

Carole Potter: No, so we got it clipped around almost five weeks.

Robin Kaplan: Okay, Dr. Ochi, do you think that there’s a window of opportunity to clip it for babies to then kind of get back on the breastfeeding track?

Dr.James Ochi: Well, I would say that in general of course, the earlier the better because once the baby figures out that it’s easier to get milk out of a bottle sometimes, then they look at their mother and say, “why are you making me want the wrong way around the block?” you know, “cut that out.” You know, and that becomes a problem then because even if you clip that baby’s tongue, they’re still gonna want to have the bottle and if they develop nipple aversion that’s a problem.

[00:15:09]
Robin Kaplan: Okay, do you think that there’s a defining moment or is it baby to baby?

Dr.James Ochi: It is baby to baby. I’ve been impressed because I’ve done this sometimes in the office in children that are 5 or 6 months old and they can often, you know, go to the breast and have no problem. And then, I’ve done this for babies, you know, that are tiny, little babies, you know, just a few days old and they don’t go back to the breasts. So, it’s all over the place.

Robin Kaplan: Okay, and do you find that you’re seeing more tongue ties, now that you’ve been in this practice for so long. Do you think it’s just something that lactation consultants are catching earlier on or do we just hear about tongue ties all the time now?

Dr.James Ochi: Sure, I appreciate exactly what you’re saying because when I was in residency 23 years ago, I might have done may be, one or two of these in 5 years. But, it’s literally very common for me to do several a day and it’s amazing to me how frequent this entity shows up and it’s also amazing to me how many of these mothers come with post year tongue ties in their babies. So, the answer to all your questions is yes, I’m bowled over by how common it is now.

Robin Kaplan: Do you think that it’s over diagnosed?

Dr.James Ochi: Well, that’s an interesting question because how do you explain the sudden tsunami of tongue ties? Surely, you know, we didn’t just suddenly have an epidural of this. It’s not catching as far as I know and so, you know, I think that it is being recognized more often and things that used to be attributed to say, I think a lot of mothers are too readily, you know, I’ve had so many mothers say, “well, I have flat nipples, so that’s why I couldn’t nurse my children.” Well, maybe it was the baby’s tongue.

Robin Kaplan: Right, so maybe some of these other things that have popped up for reasons why we were not able to breastfeed could have been a tongue tie just we weren’t looking for.

Dr.James Ochi: Yes, that’s exactly right.

Robin Kaplan: Okay, well, when we come back, Dr. Ochi will prescribe the procedure for clipping a baby’s tight frenulum and ways to ensure that the procedure is successful. We’ll be right back.

[Theme Music]

Robin Kaplan: Okay and we’re back. So Dr. Ochi, what exactly is a Frenectomy and can you explain what happens during this procedure?

Dr.James Ochi: Well, Frenectomy simply means cutting the lingual frenulum. That’s all it means and I typically do this in the office on the same day as the office visit and simply what happens is the mother holds the baby in a position where the mouth is open and I can see inside the mouth. And then, I take what’s called a groove-seeking director which is simply a metal retractor that lifts the tongue and exposes the frenulum and you then take a clamp which basically just clamps the frenulum and makes it so that there’s less blood loss. And then you use a pair of scissors to divide the frenulum. And then, for me personally, what I do is I use silver nitrate to stop bleeding because I find it then just two things it does minimize blood loss so there is often less than a couple drops. And secondly, it makes the procedure shorter and thirdly, it’s been my contention although this is not proven obviously that it decreases the chance of it coming back.

Robin Kaplan: oh so, it’s scaring down. Okay, that’s good to know.

Dr.James Ochi: And then immediately afterwards, I ask the mother, once she settles the baby down to try to breastfeed in the office.

Robin Kaplan: Would you say that most of them feel a significant difference?

Dr.James Ochi: Yes, I mean, I’ve been amazed how immediate the improvement is.

Robin Kaplan: Okay fantastic. Ladies, what was it like to watch your baby go through this procedure? Megan, do you mind starting?

Megan Weber: Yeah, for me, I didn’t have to hold my baby down. There was an assistant in the room who did that and so, it obviously was not easy to watch. But, I will say that it was very quick, less than 30 seconds and I was holding my baby calming him down. So, I think that I stressed out a lot more about it than, you know, how painful or how hard the actual procedure was.

Robin Kaplan: Okay, how about you, Erin.

Erin Esteves: I just kept telling myself that there was nothing I could do to help him avoid this that it was a necessary evil and that it would all be better sooner than later.

Robin Kaplan: How about you Carole?

Carole Potter: I agree with the other two moms. There was no options. So, you just, you know, hold and comfort them afterward and tell him you’re sorry and they’ll get better.

Robin Kaplan: Carole and other ladies as well, did you find that there was a positive change immediately after the clipping and did it extend past that first feeding after the clipping?

[00:19:53]
Carole Potter: So, my daughter still hasn’t yet, yet to really return back to the breast. She just has a really hard time with the latch and she still has a lot of discomfort in her gut in terms of swallowing lot of air and so, she’s sort of an intense sparkle baby in various ways and so, her trying to get her return to the breast has been extremely challenging. So, in terms of getting her to be able to take the bottle after the procedure, it was about the same. We didn’t see improvement until about two weeks until the actual diamond-shaped incision that is made started to heal is when we started to see improvement in her bottle feeding. Up until then she just continued to dribble a lot out of her mouth and still could not get a proper latch. So, for her there wasn’t an immediate improvement.

Robin Kaplan: Yeah, how about you Erin?

Erin Esteves: Nor with Cash. No, it actually took several weeks and several daily exercises and things of that nature before he finally improved and now it’s just perfect.

Robin Kaplan: How about you Megan?

Megan Weber: Yeah, it took about, I would say a good week for my son to finally latch back on and then from that point it was just trying to convince him that the breast is better than the bottle. You know, it probably took another week before we were exclusively breastfeeding and no more bottles.

Robin Kaplan: Dr. Ochi, do you find that it’s common for after the baby has a Frenectomy that they might need some sort of extra treatment like, craniosacral therapy and if so, why would that be the case?

Dr.James Ochi: Well, that’s a very interesting question because again, this is a new area for all of us but I would say, I have no background or experience with craniosacral therapy. But I’ve been blown away about with how many mothers have a positive experience with Craniosacral therapy and I have no explanation for that. But, it appears to be to be a benefit in lot of cases. I’ve yet to see a single complication because of craniosacral therapy. And so, I think it’s a reasonable modality. It seems to me to be probably one of the few things that can be done after the frenectomy to help improve the chances of going back to the breast.

Robin Kaplan: Okay, and I know that in your practice, you actually acupuncture on the babies as well.

Dr.James Ochi: Yes and actually I’m happy to report that I just became board certified. I think it was last week for acupuncture.

Robin Kaplan: Congratulation.

Dr.James Ochi: So, I’m certified in both ENT now and acupuncture.

Robin Kaplan: That’s fantastic, and so why did you decide to start doing that on the babies after Frenectomy?

Dr.James Ochi: Well, as those of us in health care know, there is no safe dose for interacting lidocaine in little babies and so, obviously, the complications although, thankfully, extremely unusual would be severe and tragic and so, for many practitioners including myself before I learned acupuncture, we basically just go ahead and do it under no anesthesia and often the babes would scream for about 45 minutes to an hour and it’s just heartbreaking to sit in the next room listening to that go on. So, acupuncture in newborns, I’ve found is highly effective and it ends up being, you know, something that you probably, it’s hard to describe over the radio but essentially, what they look like are little round dot band-aids and underneath those little round dot band-aids which is just one on each hand are a tiny little acupuncture needle that is 0.6 millimeter. So, it’s about a little over half a millimeter. And one other thing that’s nice is those stay in place for the next few days because as we all know, it’s not just the procedure that needs to, you know, be dealt with, it’s the following 5 or 6 days or weeks until the baby gets with the program. So, what you’re trying to do is to do something not only to decrease the discomfort of the procedure but, help the baby for the reminder of their recovery which is days. Another thing that I recently added is Shonishin Techniques. Now, Shonishin is a Japanese interpretation of Chinese acupuncture and one of the reasons why I pursued this is because it does not involve needles and you end up doing rubbing techniques that help to basically stabilize the baby and calm him or her down on both before and after the procedure. And it works. It’s unbelievable. Now, obviously, as with everything in medicine, it’s not a 100% but, I’ve been very encouraged by that as well.

Robin Kaplan: Is it something that parents can do after, for days to come after the procedure as well?

Dr.James Ochi: Yes, in fact I show them not only how to do this, but also acupressure points that they can stimulate on their baby.

Robin Kaplan: To help with the pain.

Dr.James Ochi: Yes, and I don’t know if we’ve talked about this before but, I’ve also started to offer acupuncture to help mothers with their milk supplies.

[00:25:07]
Robin Kaplan: Ahh!!! Fantastic, that’s one of my favorite remedies.

All : [laughs]

Robin Kaplan: So, that’s wonderful. Ladies, did u try any additional therapies after your baby’s Frenectomy?

Erin Esteves : Other than some exercises on his movement of his tongue and placement, we do lot of finger feeding to help him keep his tongue down and to train it to move properly, some jaw exercises that sort of thing,But unfortunately, our insurance did not cover or physician was not on board for the craniosacral therapy. So we had to do kind of stuff on our own. But theexercises that our lactation specialist gave us were very, very helpful and we were pretty religious about doing them on a daily basis because I was determined to breastfeed that child successfully so…..

Robin Kaplan: How about you, Carole?

Carole Potter: Yes, so with the Posterior Tongue Tied clipping you have to do these stretching and sweeping exercises for about 2 weeks after the actual clipping and the stretching exercises with time get less painful for the baby but they are pretty hard for them initially so I used various homeopathic stuff that was given by my lactation consultant as well as, stuff that I can buy like, whole foods or sprouts and that helped Mallory a lot with the exercises because she is an intense baby and the stretching was hard on her. But I wanted to make sure that nothing grew back. So I was trying to do them as strong as I could and we also did Craniosacral therapy. We did about 8 sessions of it and we noticed the difference probably after about,we noticed the difference right away, the peak probably about 6 session but Mallory liked going so we just continued it.It doesn't hurt her at all and, you know, she always takes really good naps after it so, I figured that she is getting some benefit from it but I always noticed after a session her bottle feeding she dribbled a lot less. Her tongue was lot more coordinated and her suck. So, I could see the benefit in her.

Robin Kaplan: How about you, Megan?

Megan Weber: We just did this stretching and I remembered pushing my son's tongue up to make sure that, you know, that the tightness wouldn't come back. So that's all we did.

Robin Kaplan: Okay, Dr. Ochi do you recommend tongue and mouth exercises after the procedure?

Dr. James Ochi: That's a great question because I can understand the rationale behind it. One of the unfortunate consequences of putting your finger in your baby's mouth after the procedure is bedone is an obviously it hurts and I had so many parents call me up saying basically my baby, you know, cries every time I get off the gloves and I have to do this 3 or 4 times a day and in fact, just on my way over here I got a call by my answering service because, they said well, you know, one of your patient's was advised to do he exercises. Now the patient is bleeding and so obviously the choices are number 1, deal with it at the home. Number2, take the child to the emergency room. So I guess, I personally don't tell people to do those exercises because of these issues. I don't have a problem with the lactation consultants, advising that if they feel that's what they want for the clients. I thankfully have not had a baby ever had to have her procedure done or get hospitalized or, you know, undergo second you know cartelization or anything like that but I do think that there may be potential benefit in those exercises but we need to consider what we’re asking these people to do and the potential possible complications.

Robin Kaplan: Well, that makes a lot of sense, absolutely!

Carole Potter: There's a lot of I think discrepancy too with exactly how to do these stretches and exercises, so sometimes I think that can be confusing for a parent who is, you know, has this complicated situation and not sure if they are doing them right and so ..

Robin Kaplan: Absolutely, no thank you for adding that. Dr. Ochi are there any reasons why a mom would not, choose to not clip her baby's tongue, you would kind mentioned breast feeding is going okay,are there any other reasons why you would recommend just kind of leaving it alone?

Dr. James Ochi: Well, that too is a very prudent point because as a surgeon I find that it’s fairly easy to find people to do procedures on. It’s much harder to try to identify patients,who probably will not benefit from the procedure there ends. I advise them that before you do surgery on them. So for me,I think the things I think about are nipple aversion in another word if the baby is basically not going to the breasts and only wants the bottle, you know, doing a Frenectomy on that child may not be fruitful in the sense that the child is unlikely to wanna go back to the breast just because you clipped their tongue. Secondly,if a mother comes in and has real trouble with milk supply, as in it sounds unrealistic that the child is gonna be able to get meaningful nutrition directly from the breast,I think we need to talk about that and thirdly, often, unfortunately because lot of these mothers in my opinion wander around in the forest before they get identified. They show up and they havesevere nipple damage as in we also need to think about, is it realistic to think that baby is gonna be able to be put on those breasts and, you know, again these are all subjective various but those are things that I think about before proceeding with the procedure.

[00:31:08]
Robin Kaplan: Okay!

Carole Potter: If I could interject, I know that in my instance the damage was substantial and the pain even after the procedure was done continued for a very long period of times so much so that I spent one entire week only pumping because I had to give myself that break. I could not put in to my breast. But then, I continued to try again and it took about 6 weeks. But so yeah, definitely the damage psychologically, physically and emotionally to a woman is noticeable.

Dr. James Ochi: Yes, I think that’s an important point and some mothers obviously are up for that challenge and some will quite frankly say to me, thank you for telling me about this, because I can't go through, you know, because of work issues or what's going on at home and so again it is important for me to identify this and discuss these issues before doing a procedure because obviously once you do the procedure they are committed to recover, as in it is too late to talk about not doing it.

All: [laughs]

Robin Kaplan: Absolutely! And then just to kind of round this out,so can a Tight Frenulum causes challenges with everything other than breastfeeding that might be worth clipping, even if the mom has decided not to breastfeed.

Dr. James Ochi: Sure, the three big waves of kids that I see with tightFrenula are number one, obviously newborns with difficulty in breastfeeding. Secondly, around say 6 to 9 months when the babies being transitioned to solids, the mothers would come in and say something like hi, “this child chokes and I am so paranoid with every meal that I give her. I just feel like we are on the verge of doing a hymn like maneuver” and in fact some of those mothers have done hymn-like on their baby. and I remember one mother who came years ago, she said,“the few times we've had a baby sitter I've had to tell the baby sitter you must not give anything that is not contingent within this zip lock bag”, because in other words, she was that paranoid about her baby you know choking and thirdly, that the third big wave is children who are just about to enter kindergarten where the mother will says, “hi, no one outside of this family can really understand this child, I have to be his interpreter for most interactions” and obviously it’s because, you know, their physically unable to produce the sounds clearly, so those are the 3 big waves.

Robin Kaplan : Okay, well, thank you so much, Dr. Ochi for your expertise and insight into Tight Frenula and their facts on breastfeeding and on other things, other developmental milestones. Wow, we really appreciate it.

Dr. James Ochi: I very much appreciate this opportunity because Ithink all of us need to get the word out.

Robin Kaplan: Absolutely, thank you so much.

Dr. James Ochi: Oh! You're welcome.

[Theme Music]

[Featured Segment: Nursing Basics For the New Mom]
Robin Kaplan: Before we wrap things up, here is Denise Altman talkingabout nursing basics for the new mom.

Denise Altman: Hey there, boob group! My name is Denise Altman.I am a private practice IBCLC, otherwise known as a registered lactation consultant. Private practice means I have my own business, and I specialize in prenatal education and breastfeeding support. This session is about prenatal breastfeeding, something I definitely have to talk about. When we are thinking about prenatal preparation for breastfeeding it’s good to start with the birth. A great way to prepare for the birth is to educate yourself and where better than a pre natal birth class. There are lots of options out there for you, from hypnobirthing to private classes to Lamaze, Bradley Method, Cascade Birth, You name it, lots and lots of classes to help you prepare. Some are short, one-day classes offered through your local hospital or birth center. Others are series of a weekend or maybe even courses of several weeks. Type class or the brand of class is going to suggest the length of the duration as well asthe structure of content. When choosing a birth class, be sure to explore your options, find out what's in your community. Some classes are done privately through private instructors while lactation consultants or even doulas. As I said earlier other classes are done through your hospital or birth center.When you explore your options take time to go to the organization’sweb site such as Lamaze or ICEA or Bradley aswell as talk to the individual in charge of classes where you're attending or where you plan to attend. Find out the details, who is doing the teaching, what they are teaching, how is this going to better prepare you for the birth. I hope that the information in this session can help you get started on exploring your option. For additional tips on choosing breastfeeding class or birth class, please visit my website at https://www.feedyourbaby.com and keep listening to The Boob Group.

[Theme Music]

Robin Kaplan: So that will round out our show today, if you have any advice you'd like to share about your breastfeeding experience with baby with tight frenulum, we would absolutely love to hear about it. All you have to do is call The Boob Group hotline at 619-866-4775 and leave us message and we'll share your story in our upcoming episode. You can also add it to the comment section at the end of this episode on the Boob Group website which is https://www.theboobgroup.com.Coming up next week, we’ll be discussing breastfeeding criticism when its none of their business.Thanks for listening to the Boob Group, because mothers know breast.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. For such information in which areas are related to be accurate, it is not intended to replace or substitute for professional, medical or advisor care and should not be used for diagnosing or treating house care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified healthcare provider.

[00:37:22] End of Audio