Monday, June 16, 2014

The Newborn Hearing Screen and Upper Lip Tie

Last week I had a friend come out to do the newborn hearing screen for Audrey. (She is an apprentice midwife and has access to the machine). At the time of Audrey's birth some midwives were just starting to offer the screen to their homebirth clients and our midwife did not. (For more information on the newborn hearing screening program see here.) And it got swept by the wayside during her 6 week well child check up with the pediatrician and so here we are 18 months after her birth doing a hearing screen!

This has only become a concern since she is now officially diagnosed as "speech delayed." The pediatrician wrote a referral to the audiologist, whom we may still have to visit, but I always prefer erring on the less invasive and less traumatic approach first. (Kind of our general approach to everything; why go to a specialist if it's unnecessary? Another analogy: most American women see obstetricians for their normal pregnancies and births even though OBs are highly trained in abnormality and surgery whereas midwives are highly trained in normality. It's just overkill and those OBs are trained in and used to finding things wrong when it's usually just a variation of normal and not a high risk situation. Anyways....) So our birthy friend came over and administered the test, which was very easy and quick and not traumatic-yay! A soft rubber nodule was placed in each ear, one at a time, much like an ear plug, which delivered a sound made by the machine. It then measured the echo that happens when the ear functions normally. Depending on the echo measured the machine either gives the baby a PASS or REFER, which means to refer the baby to a audiologist for further testing. Well, Audrey passed, no surprise to us! It's pretty clear she can hear and understand us.

Today we went to see Dr. Darcy of St Croix Kidds Pediatric Dentistry in Hudson, WI about Audrey's suspected upper lip tie. I was pretty sure she had an upper lip tie but wasn't sure if she also had a tongue tie or lower lip tie. Here is what the St Croix Kidds website says about tongue and lip tie, which is better than I can explain it: "The muscles of the cheek and lips are attached to the gums and tissue of the mouth by a piece of soft tissue called a frenum. Sometimes a frenum can be attached too high on the gums causing recession or spaces between teeth. Also, there is another frenum under the tongue. If this frenum is attached too close to the end of the tongue it can adversely affect swallowing and speech. This is referred to as being “tongue-tied”. A frenectomy is a safe and simple procedure where either part or all of the frenum in question is removed in order to maintain a healthy balance to the mouth."

Tongue and lip ties can cause problems with nursing (painful, cracked, sore nipples for mom and insufficient milk intake for baby), speech problems, and dental problems. Although I now realize that we both would have greatly benefited if she had had a frenectomy as a newborn-well mostly me. She gained weight well but I had severely cracked and painful nipples for almost 6 weeks. Dr. Darcy said she will need the procedure before she gets her permanent teeth, around 6-8 years old, but since she has no cavities (yay!) there's no reason to do it now.

Here is an example of an upper lip tie (not Audrey)

Normal upper frenum with no tie

I was still very happy we had a consult with Dr. Darcy for two reasons. 1) She confirmed that night nursing will not cause cavities as long as we brush her teeth before bed, contrary to our pediatrician telling me I need to night wean her. (Yep, great idea! She still frequently nurses at night so let's take away a good number of her calories she's getting based on problems bottle-fed babies have! Because it's not like she's had trouble gaining weight or anything!) 2) Dr. Darcy told me how to brush around the delicate frenum tissues, which I've been doing wrong! Normally you would just brush right across the whole area but with all that tissue in the way you need to go in from each side with the top of the toothbrush not going across the tissues but just up to the space between the front teeth AND also do the back of the front teeth.

So two very good appointments! And now we're off on our first camping trip as a family with the Twin Cities Attachment Parenting Group! Four days with a toddler in a tent and cloth diapers, cooking over an open fire! Should be fun! :)

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