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From:
"K. Jean Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 3 May 2014 21:12:43 -0400
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<What doctors do agree on is that tongue-tie went out of fashion medically for several decades, effectively disappearing as a diagnosis.
Mrs Caulfield believes it stems back to the introduction of formula milk in the Fifties.  ‘All babies used to be breastfed. Then it was thought to be unhygienic and unreliable, so went out of fashion and most babies were bottle fed,’ she says.
Medical students were not taught about tongue-tie and it disappeared from text books because it was thought to be a cosmetic issue. 
‘In the past, checking for this condition was routine after birth — if tongue-tie was found, the midwife would divide it there and then.>

In a U.S. historical context: While commercial formula was not introduced in our hospital till 1953, the 'karo, Carnation or Pet brand canned milk, and water" recipe was mixed in our hospital formula kitchen, sterilized by autoclave and used in our hospital till 1954, and moms who formula fed, and even breastfed with the expectation of need for supplementation, had to be ready at home with a sterilizer and supplies to make and sterilize, home-made formula. This happened to my mom in 1930. This 'recipe' and sterilization process was being prescribed for decades before the commercial stuff came on the market. Bottles and nipples were easily available for decades before commercial formula came on the market. Despite the fact that many mothers may or may not have started off breastfeeding, not many kept on for very long, and home-made formula was very common in the US long before commercial formula came on the market. 

In our hospital in the '50's during the post-WW 2 baby boom, all births were attended by family doctors (who of course cared for mother and baby both). Every circ set included a grooved tongue director, and nearly all baby boys were circed. While they were immobilized on the circ board and crying, while the doctor was waiting for the circ to stop active bleeding, the doc's often nonchalantly had a great opportunity to see the frenulum as the baby screamed, and used the time to clip it. With this much understanding, most of them of course, checked the frenulums of baby girls during the first physical by 24 hours, and if needed, had the baby girl restrained on the circ board and clipped the frenulum. I never heard of an upper lip frenulum way back then. (A whole lot of other non-natural rules stemming from the after effects of maternal twilight sleep and general anesthetics were in force, but because of this consistent clipping practice in the first 24 hours, I was never clinically aware of any newborn problems in either breastfed or bottle fed babies) from TT .) 

As perinatal medicine began to develop in the 1960's, and malpractice insurance for deliveries began to shoot through the roof, fewer and fewer deliveries were done by general practitioners. On July 1 for succeeding years, there were gradually new obstetricians and pediatricians coming on staff, and fewer new general practitioners even taking OB patients except for early OB care, and older doctors retiring, or limiting their practices with no more OB. 

It soon became apparent that the Pediatricians objected to Obstetricians doing surgery on "their" patients, and soon, the OB's stopped doing circs. Many pediatricians were against circumcision, and many seemed to have been taught that tongue-tie was a "non-issue". This gradual changeover in the different physician specialties providing maternal-child health care is when and how I saw the recognition of the need to clip tongue ties "die out" among medical providers in our locale. I have, however wondered, if the marketing ploys of the formula manufacturers and pushing the "ease" of bottle feeding were not somehow "connected" with the seemingly across-the-board training of the pediatricians of that era that TT was a non-issue. I never heard it mentioned in early LLL (1960) circles in our town either, and can look back on some baffling nipple damage cases after this time period that I now recognize were probably associated with TT. 

I have an old 1969 pediatric text, published in England, but used in U.S. as well: Craig WS, Care of the Newly Born Infant, 4th edition. "Apparent shortening of the frenulum attached to the underside of the tongue is not uncommon. Although associated with them, it is not the cause of feeding difficulties. With growth, the tongue and frenulum grow forwards.The tongue grows more rapidly than the frenulum and soon becomes freely mobile. True tongue-tie is extremely rare." Another paragraph describes sucking blisters on the upper lip, giving various explanations, but no mention of lip ties.

K. Jean Cotterman RNC-E, IBCLC

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