Brisbane Tongue Tie Clinic - Dr Helen Fung
P.  07 3398 5886
412 Old Cleveland Rd,
Coorparoo QLD 4151
info@brisbanetonguetie.com.au
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Tongue Tie - Is It Just a Fad?
SEE ALSO:
Tongue Tie Explained - Causes, Symptoms, and Treatment
 
10th September, 2015
By Dr. Helen Fung
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Dr Helen Fung
10th February, 2016
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Recently, an article published in the Australian media warned against the release of tongue ties (frenotomy) in newborn infants. There are also a number of online articles by well-meaning healthcare professionals that advise against treating infant tongue ties. Whilst a tongue tie is only one potential cause for breastfeeding problems, these highly emotive and uninformed articles are not helping parents to make the best informed decision available, and sweeping statements that providers of frenotomies are not discussing alternatives with the parents are irresponsible and far from the truth.

Advising against seeking the advice from a profession whose sole purpose is to concentrate on assisting and nurturing a breastfeeding relationship between mother and child is a poor advice. Breastfeeding is not simply a matter of making sure the baby’s weight is increasing adequately. Monitoring a baby’s weight is the simplest method available for a health care provider to quickly assess if a baby is getting enough calories. As it happens, popping a baby on the scales is easy, quick, and cost effective. Working with a mother to find out why the baby is unable to attach, why a mother’s breasts are blistering or bleeding at each feed, why a mum is getting mastitis, or why a baby is always crying despite being at the breast for hours on end, is not what a GP is trained to do.

Lactation Consultants, on the other hand, have spent years learning the anatomy and physiology of breastfeeding, as well as thousands of practical hours under supervision as part of their training on breastfeeding and bottle feeding. It is their profession to monitor mothers breastfeeding, offer suggestions on how to better position themselves and their baby, explain the causes of each symptom, and offer solutions to each problem. It is this knowledge and dedication that makes a Lactation Consultant a wonderful ally for any mother struggling with breastfeeding.

The modern scientific history of tongue ties may be brief, but tongue tie and frenotomies have been mentioned in numerous written documents that precede the modern medical literature. For centuries, breastfeeding was the only way to feed a baby, and the presence of a tongue tie restricting the ability of a baby to extract milk from the breast, was a matter of survival. Releasing tongue ties was a routine procedure to enable the baby to feed and hence stay alive. It was only with the invention of rubber teats, and the development of commercially available formula, that the babies with tongue ties were able to have an alternative. This caused a dramatic reduction in frenotomies, along with the declining rate of breastfeeding. Where 90% of infants were breastfed in the 1900’s, it had decreased to 42% in the 21st century. At the same time, formula business has developed into enormous US$44.8 billion industry in 2014.

In recent years, the atmosphere has started to change again. In modern research, human milk has been recognised as the best source of infant nutrition, and the current medical research indicates that formula fed babies have an increased risk of developing atopy or hypersensitivity, diabetes mellitus, and childhood obesity. Similarly it has been discovered that breastfeeding protects nursing women against breast cancer, and may also protect against ovarian cancer and type 2 diabetes. It has been this new knowledge and the recovering rates of breastfeeding, that has caused the need for tongue tie releases to increase again.

Because of the relative recent change, the body of evidence in the scientific literature on the effect of tongue ties, as well as the effect of any of its treatment is still in its infancy. The literature is developing though, and tongue tie is now confirmed to be relatively common clinical diagnosis. Collecting evidence is time consuming and challenging however, as there are a number of issues to the researching bodies. For example, it is almost impossible to randomly assign a breastfeeding dyad for the purposes of a study. Which struggling parent would accept the diagnosis of a condition, and then allow someone else to decide whether to accept the symptoms and persevere, or proceed with a quick and simple treatment with very few side effects and minimal discomfort, for the sake of collecting data?

Helping mothers breastfeed their babies successfully is not about driving commerce or taking advantage of unsuspecting mothers. It's a collaborative effort by a number of health care professionals actively teaching and learning about the issues surrounding breastfeeding, conducting studies to formally document what was once accepted as common sense, about educating parents on what once was knowledge acquired as a part of growing up in a community, and normalising what has become unusual due to commercial marketing by formula companies. Ultimately, the common goal is to provide the means for mothers to comfortably feed their children in the most natural and healthy way possible.
 
 
 
References:
 
Ballard J, Auer C, Khoury J. Ankyloglossia: assessment, incidence and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110:e63

Centers for Disease Control and Prevention. Breastfeeding Among US Children Born 1999 –2006. CDC National Immunization Survey. 2010. Accessed June 2010 at: http://www.cdc.gov/ breastfeeding/data/NIS_data/index.htm

Dollberg S, Botzerb E, Gunisa E, Mimounia FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg. 2006;41:1598 –1600

Dunn PM. Bridled babies: a history of tongue tie. Proc Bristol Medico-Historical Soc. 1995–1999;3:15–23

Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE, Simmer K. Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics. 2008;122:e188 – e194

Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health. 2005;41:246 –250

Obladen M. Much ado about nothing: two millennia of controversy on tongue-tie. Neonatology. 2010;97:83– 89

Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG. The Lancet Breastfeeding Series Group The Lancet , Volume 387 , Issue 10017 , 491 - 504. Why invest, and what it will take to improve breastfeeding practices?

Victora CG, Bahl R, Barros AJD, França, GVA, Horton S, Krasevek J, Murch S, Walker N, Rollins NC. Volume 387, No. 10017, p475–490, 30 January 2016. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect
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