Slide 1 ___________________________________ ___________________________________ Tongue and Lip Tie – what do we know? ___________________________________ KANSAS BREASTFEEDING COALITION – 2018 BREASTFEEDING CONFERENCE KATHY LEEPER, MD, FAAP, IBCLC, FABM ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 ___________________________________ Disclosures: None •I have no relevant financial relationships with the manufacturer(s) of ___________________________________ any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity •I do not intend to discuss an unapproved/investigative use of a ___________________________________ commercial product/device in my presentation ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 FAAP- 1992 ___________________________________ IBCLC- 2000 FABM- 2008 Communities Supporting Breastfeeding Project 501c3 Lincoln, NE 2001-2014, 2018 ___________________________________ (IABLE) Institute for the Advancement of Breastfeeding & Lactation Education Board member Curriculum development, Trainer ___________________________________ Kansas Breastfeeding Friendly Practice Designation Board member 2014-17 ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 4 ___________________________________ Objectives •Identify 3 symptoms that can be associated with tongue-tie in ___________________________________ a breastfeeding infant •Identify 2 tools available for assessing the clinical significance of a lingual frenulum ___________________________________ •List 3 indications for clipping a tongue-tie ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 ___________________________________ Terminology •Frenulum = Frenum: a small fold or ridge of tissue that ___________________________________ supports or checks the motion of the part to which it is attached, in particular a fold of skin beneath the tongue, or between the lip and the gum. •Frenula = Frena (plural) ___________________________________ •Frenulotomy = Frenotomy (dividing tissue) •Frenectomy (removing tissue) ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 ___________________________________ “Founded in 2009, our group is comprised of Medical Doctors, Dentists, ___________________________________ Chiropractors, Osteopaths, IBCLCs (International Board Certified Lactation Consultants), Speech-Language Pathologists, Myofunctional Therapists and others.” ___________________________________ Mission Statement The International Affiliation of Tongue and Lip Tie Professionals (IATP) is a not- for-profit, multi-disciplinary group of healthcare professionals who advocate for research, education, and integrated clinical practice to improve the lives of all people affected by oral restrictions. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 7 ___________________________________ Definition: (from IATP) Q: What is Tongue Tie? ___________________________________ A: The lingual frenulum (or frenum), is a remnant of tissue in the mid-line between the under-surface of the tongue and the floor of the mouth. …Tongue-tie can thereby adversely affect breastfeeding. Research is urgently needed to elucidate possible implications that tongue-tie and ___________________________________ other oral restrictions have on chewing, swallowing, regurgitation, digestion, speech and breathing disorders. ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 ___________________________________ Incidence? ___________________________________ ✓From 2.5% to >10% reported ✓POOR definitions limit usefulness ✓ This is a problem for ALL studies ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 ___________________________________ How do we classify? Griffiths (2005- English surgeon) ◦ Characteristic of frenulum – diaphonus, medium, or thick ___________________________________ ◦ Shape of the tip of the tongue – dimpled, heart-shaped, or pointed ◦ Percentage of the tongue anchored by the frenulum – 100, 75, 50 and 25 Kotlow (2004-American dentist) ___________________________________ ◦ Class 1 12 -16 mm “mild” ◦ Class 2 8 -12 mm “moderate” ◦ Class 3 4 - 8 mm “severe” ◦ Class 4 0 - 4 mm “complete” ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 10 ___________________________________ Coryllos 2004-American surgeon ___________________________________ • Type 1: from tip of tongue to alveolar ridge • Type 2: 4 mm b/h tip to just b/h alveolar ridge • Type 3: Mid tongue to mid floor of mouth • Type 4 against the base of the tongue; shiny inelastic ___________________________________ characteristic, usually unable to see unless passively elevate tongue Type 1 & 2 or “classic”= “Anterior” Type 3 & 4 = “Posterior” ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 ___________________________________ Coryllos Type 1 ___________________________________ Leeper ___________________________________ Yvonne Lafort, MD ___________________________________ Leeper ___________________________________ ___________________________________ ___________________________________ Slide 12 ___________________________________ Coryllos Type 2 ___________________________________ Leeper ___________________________________ Leeper ___________________________________ Leeper ___________________________________ ___________________________________ ___________________________________ Slide 13 ___________________________________ Coryllos Type 3 ___________________________________ ___________________________________ ___________________________________ Leeper Leeper ___________________________________ ___________________________________ ___________________________________ Slide 14 ___________________________________ Coryllos Type 4 ___________________________________ ___________________________________ Leeper ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 ___________________________________ “Hour-glass” insertion ___________________________________ ___________________________________ James Murphy, MD ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 16 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 ___________________________________ IATP: What kinds of problems are caused by tongue-tie? “In infants, tongue-tie can impair their sucking, especially at the ___________________________________ breast. Babies can have minor to severe difficulty coordinating their sucking, swallowing, and breathing. Symptoms can run a wide gamut and may include latch difficulties, nipple pain or damage (although there may also be no pain whatsoever), poor milk transfer, ___________________________________ compromised milk supply, inadequate weight gain and failure to thrive, among others.” ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 AAP Section on Breastfeeding ___________________________________ Summer 2004 :CONGENTIAL TONGUE-TIE AND ITS IMPACT ON BREASTFEEDING By Elizabeth Coryllos, MD, MSs, FAAP, FACS, FRCSc, IBCLC, Catherine Watson Genna, BS, IBCLC, Salloum, MD, MA ___________________________________ Maternal presentation: · nipple damage / pain Infant symptoms and signs include: · painful breasts • ineffective milk transfer · poor milk removal • weight loss or inadequate gain · mastitis • fussiness at breast · low milk supply • breast refusal · plugged ducts • fatigue with breastfeeding ___________________________________ · frustration, disappointment, and discouragement • difficulty establishing suction to maintain a deep grasp · untimely weaning • poor latch • clicking sound while nursing • gradual sliding off of the breast • “chewing” on the nipple • making a mess ___________________________________ • messy with bottle • choking/coughing ___________________________________ ___________________________________ ___________________________________ Slide 19 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 ___________________________________ What else does the literature say?