I have been very interested in this thread, and cannot wait for Cathy Watson
Genna to jump in, particularly since her book, "Supporting Sucking Skills in
Breastfeeding Infants" has raised much more awareness of this topic on an
international level. However, I do have a couple of points to add to the
discussion.
First, there are other reasons, olfactory and gustatory, for clipping tongue
tie. The tongue actually shapes the mouth, and without getting too
complicated, tongue tie often triangulates the palate, creating a high or
bubble palate that affects the olfactory area. This can result in SIDS or
apnea, sleep issues. In addition, triangulated palates can affect speech
and development of teeth. Many of us are familiar with Brian Palmer's
website. If you are not, go to: http://www.brianpalmerdds.com/
Second, perhaps other regions do not have as many tongue tie cases because
they do not have as many professional IBCLCs or medical practitioners
providing the assessment? Or perhaps it is more like to occur with some
populations rather than others. I agree with the comments about Northern
European background. However, my population is a high number of people with
European ancestry. Increased assessment also has something to do with
increased awareness. We do have to be careful about inaccurate assessment,
but there are adequate assessment strategies for tongue tie. It is not
erroneous. I would not assess a tongue tie that does not exist, but I have
had problems with follow up on level 3 and 4 frenum because many docs will
not do a frenotomy unless it appears in the front of the tongue.
Third, I am not as concerned about the over diagnosis of tongue-tie or
ankyloglossia as much as I am concerned about it's UNDER diagnosis, and the
number of moms who give up because nursing is too painful. We also have a
huge number of ped ENTs/ ped dentists that will NOT clip level 3 and level 4
frenum. Recently, I had a level 4 case in FL that I assessed, and luckily
mom had nursed baby # 1 for 3 years, and baby #1 also had a level 2 frenum.
I assessed a level 4 with baby # 2 on day 5. She went to her ped and an ENT
-- both said NO. Then she went for a second opinion with a ped ENT-- and
still NO. We took multiple mouth shots and shipped them to Genna/Dr.
Coryllos in NY. They agreed with my assessment. We still tried to find a
ped ENT or dentist in FL that would do the procedure. Mom finally said, "I
don't want to be anyone's guinea pig in FL." She flew to NY to have Dr.
Coryllos do a labial and lingual frenectomy that took less than 2 minutes to
perform at one month postpartum. Within 48 hours there was notable
improvement. Mom and baby are much happier-but surgery was not a magic
bullet. We needed to work together. Prior to the procedure, she had to
take him off breast, pump and feed, put him back on until she got very sore,
and repeat the pump and feed procedure. Although some learning was required
after the procedure, mom never went back to the pump and feed breaks. In the
U.S., we need to either clone Dr. Coryllos or TRAIN more ped ENTs to help
us. Let's not be afraid of this. Let's help more dyads get it together,
and help babies get healthier breathing and mouth development.
Debbie Albert, RN, Ph.D., IBCLC
Advanced Lactation Care, Inc.
Tampa, FL
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