Tongue Ties and Breastfeeding: Exploring 3/25/2015 the Controversy
Objectives Tongue ties and breastfeeding: exploring the controversy Review definitions, etiology, presentations, treatment options, and outcomes March 25 2015 Review current literature Dr. Gillian MacLean NICU Fellow Discuss current experiences and local resources
Definition and Etiology Presentation
Congenital anomaly Mother: Infant: Pain when nursing Poor latch Decreased mobility of tongue Cracked, blistered, Colic from a short and thick lingual bleeding nipples Gassy frenulum Blocked milk ducts Poor weight gain Mastitis ‘Gum’ or chew nipple Genetic link Poor or decresed milk Choke or pop off when supply nursing to breath Drooling Clicking sound when nursing
Adapted from www.mommypotamus.com
1 Tongue Ties and Breastfeeding: Exploring 3/25/2015 the Controversy
Diagnostic Criteria
Tip of tongue not past lip Abnormal swallow
Lingual attachment Unable to lick lips creates gap between teeth Nursing or bottle feeding difficulties puts force on teeth mal- positioning them causes blanching of gums
Treatment Options
Observe
Medical management does not exist
Surgical management
Observe Surgical Management
Monitor feeding issues as Scissors, electrocautery or laser to detach frenulum = infant Frenotomy
Advise potential for dental, Simple and minor procedure speech and feeding issues as child ages Pain relief options
Performed by primary care physicians, dentists, ENT surgeons, APN
2 Tongue Ties and Breastfeeding: Exploring 3/25/2015 the Controversy
Laser Surgery Electrocautery Revision
No GA, local possible No GA local possible
2-3 mins long Option only if mild case with minimal involvement Patient must be still of blood vessels
No bleeding or infection Safe risk
Heal very fast
Physical therapy 2-3/day for 14 days post-op
Surgery
No GA With GA Current evidence
Minimal pain and bleeding ~4mins under GA
Feeding improved Stitches usual immediately 10 day healing period Fast Same day hospital stay
Canadian Pediatric Society American Academy of Pediatrics
“Current evidence seems to demonstrate that despite Neoreviews 2010 ankyloglossia, most newborns are able to breastfeed successfully” “Untreated tongue tie can lead to untimely weaning and its attendant health risks. Frenotomy is a safe and “Based on available evidence, frenotomy cannot be effective procedure to release tongue tie and improve recommended” tongue function and breastfeeding outcomes.”
“association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed necessary, frenotomy should be performed”
CPS Position statement Ankyloglossia and breastfeeding 2014
3 Tongue Ties and Breastfeeding: Exploring 3/25/2015 the Controversy
Randomized, controlled trial of Academy of Breastfeeding Medicine division of tongue-tie infants with feeding problems Currently in revision Very few RCT’s
2004 Small sample size
“Conservative mgx maybe sufficient, requiring no 27/28 mothers had improved breastfeeding compared intervention beyond breastfeeding assistance, parental to 1/29 mothers in conservative mgx group education, and reassurance” 56% of tongue tie infants were able to adequately feed
Hogan et al J Paediatric Child Health 2005:41:246-250
A double blind, randomized, controlled trial of tongue tie division Efficacy of Neonatal Release of and its immediate effect on Ankyloglossia: A Randomized Trial breastfeeding Improvement in nipple pain and ability to breastfeed after frenotomy or a ‘sham’ frenotomy Found no improvement in breastfeeding overall or nipple pain Both groups had improved pain but more so in frenotomy group More mothers self reported improvement in frenotomy group – possible bias Breastfeeding overall much improved in frenotomy group
Buryk et al. Pediatrics 2011: 128
Barry et al. Breastfeed Med 2012;7:189-193
Summary
Congenital anomaly with decreased mobility of tongue
Severity and presentation varies
Treatment options vary but majority opt for frenotomy
Current evidence getting stronger for frenotomy but still lacking in standard definitions, classifications, and ideal patient to treat and when Thank you
Questions and Comments
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