I hear the accusation that moms and professionals are jumping too quickly to recommending frenotomies for lip and tongue-ties.  I think it is EXTREMELY important that these mothers and babies are given all the proper assistance and information to eliminate all the basic issues with breastfeeding.  But there are more than breastfeeding issues at stake here.  Correcting tongue and lip-ties (that are properly diagnosed), contributes to dental health as well.  Keeping in touch with mothers and babies long-term (through adulthood) can change your impression of what is necessary and what is not.  



-----Original Message-----

From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Ruth Piatak

Sent: Thursday, November 20, 2014 1:35 PM

Subject: Tongue and lip tie epidemic?



Nancy Mohrbacher, thank you for writing about the "epidemic". You are right that seeking frenectomy/frenotomy is a "terrible place for mothers to start" in addressing breastfeeding problems.



The first step should be for mothers to grow up seeing many effectively breastfeeding dyads of all ages, learning what effective positioning and normal frequency look like. At the least, mothers should attend breastfeeding peer groups several times during pregnancy.



Another step should be the establishment of good prenatal nutrition, which includes consuming significant quantities of dark green leaves (source of reliably bioavailable folate and so many other nutrients) and having a fully functional biome -- the lack of which is a serious First World problem we are only beginning to assess.



Another step should be physiologic birth -- also a rare phenomenon in much of the First World.



From LACTNET participants and their colleagues, mothers should be able to

obtain:



   - prenatal education about what works in breastfeeding, wherever bottle

   feeding has been the cultural norm.

   - reliable breastfeeding assessment immediately postpartum.

   - if breastfeeding is difficult, reliable education and troubleshooting

   wherever mother and baby are located throughout the first week.

   - if compensations (such as pumping, supplementing, breast compression,

   or nipple shields) are necessary, prompt and thorough follow-up by an IBCLC.

   - if medical (frenectomy/frenotomy, prescription galactagogue, etc.)

   and/or therapeutic (CST, OMT, MFR, SLP, OT, chiropractic, etc.) help is

   needed, prompt, appropriate referral.



I don't know whether to call myself a "dissident", Pamela Morrison, since there are so many gaps in knowledge and care that it is hard to figure out what I disagree with. I do ponder, however, whether a clue is hidden in a very important detail of Nancy's helpful infographic on Milk Storage Capacity <http://www.nancymohrbacher.com/blog/2014/1/17/infographic-on-breast-storage-capacity.html>.

At

the lower left, where it states, "May change from one baby to the next.

Baby 1 does not equal Baby 2," an important factor might be milk *transfer* capacity, greatly affected by the volume afforded by baby's posterior tongue mobility. When I see a baby's chin doing double time rather than drawing down during the mother's let-down, I look to how close baby's tongue can get to the palate. If baby can't even draw in or form a seal on the breast though the mother has been trying all the laid-back techniques <http://www.nancymohrbacher.com/blog/tag/laid-back-breastfeeding> Nancy has reported on so effectively, oral restriction is a prime suspect. Somehow, a lot of these cases are showing up in my small practice.



How do we determine without 20/20 hindsight whether a dyad will wean prematurely because of the effort of dealing with limited storage or transfer capacity? Or because of the discomfort for the mother, or the lack of suckling stimulation for the baby that banish the pleasure of breastfeeding? How do we determine what oral and other functions will be affected later in life by oral restrictions, which may make the expense and disruption of frenectomy/frenotomy worthwhile? How do we determine what will be most helpful in improving breastfeeding, when oral restrictions may be only one factor making it difficult?



The missing links in knowledge persist. The International Affiliation of Tongue Tie Professionals has only had two conferences -- not a lot of time to sort, debate and disseminate what has been observed and investigated by professionals who are actively involved in serving breastfeeding families who deal with oral restrictions.



The missing links in care are even more intractable. In the U. S. and many other places, lack of funding and of communication among professionals leaves many families with nowhere to turn but Dr. Google. How do we get health care providers to provide, and health care payers to pay for what works, when we do figure it out?



We continue the quest for the Truth about oral restrictions and what to do about them. LACTNET will be important to at least tackle the communication gaps.



Ruth Piatak

--

Ruth Piatak, BA, MS, LLLL, IBCLC

Tulsa, Oklahoma

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