I have seen a lot of tongue-tied babies with feeding problems. The
literature (Ballard, 2002) suggests that approx. 25% of infants with this
condition will have breastfeeding problems. As Jeanette (and others) have
pointed out, there are repurcussions with other issues such as speech,
dentition, and appearance. When I see infants with the condition, I often
show the parents photos to help educate them about the condition. I use the
ones in The Breastfeeding Atlas that show normal range-of-motion and
comparison photos showing inhibited range of motion. Because there are
photos in there of older children and adults with the condition, parents see
for themselves the effect on appearance and function.
I never state that the baby should or should not be clipped, but I
describe what I see and typically refer the baby to a person who can clip it
to get their opinion. These referral sources are (unlike me) medical
professionals. Their opinion will hold greater weight to counter-balance
the lack of information of the original pediatrician.
I share my observations during the consult and in my report to the
pediatrician. These might include: the presence ofchoppy, jerky jaw
excursions during breastfeeding, inability of the baby to sustain a feeding
of normal duration, lots of breaks in suction, many short feeds with low
intake and a baby who doesn't ever seem satiated in spite of constant
nursing. Mother may have chronically pinched, bruised or traumatized
nipples typical when a baby compensates for suction creation deficits by
clamping. During my exam of the baby, I point out the degree to which baby
can (or can't) lift tongue off the floor of the mouth, or extend it over the
lower lip. I might flip to the ref. page in the Atlas to show the parents
the list of articles on the subject. In lieu of the book, LCs can obtain
and carry a copies of some of the articles in the pediatric literature on
the subject. The Ballard 2002 Pediatrics article is on-line.
I wouldn't get into a position of appearing to argue with the other
physician. Parents can read the info for themselves, and this is a powerful
way to emphasize the point that you aren't making all this up. I feel
fortunate that there are dentists, doctors, and ENT specialists in Austin to
whom I can refer parents for another opinion. I see my role as
identification of the problem, acting as a resource for education, and
sharing references. If the parents decide not to pursue remediation, my
management suggestions would include assymetric latch with more head
extension to shorten the distance the baby has to reach the tongue. I might
advise shoring up the milk supply and harvesting for supplementation the
postfeed pumped cream. Babies often fall during teething and cut the
frenulum themselves, and the forward growth of the mandible during the first
4 months postpartum mitigates the issue of the frenulum somewhat over time.
I would share this information with the parents so they can see that the
occasional apparant resolution of the problem is not the work of the
frenulum fairy.
Disclaimer: I wrote and have an obvious financial interest in the
Breastfeeding Atlas. My defence for mentioning it specifically is that Kay
Hoover and I selfishly put in it all the stuff that helps us practice, and
educating parents with photos is incredibly useful
Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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