I have been away and read with interest all the mail on tongue tie. This is an area where I think we will see many
changes in the next ten years or so and I can commend LC's on leading the way in raising interest in this area because
it is in the field of breastfeeding where mounting evidence is emerging and certainly nowhere else.

It has been my experience as an SLT/IBCLC that somehow whenever breastfeeding comes into the picture
you have to work so much harder to get people to listen.  It has certainly been my experience in working
with our LC's to get a service for tongue tie release in our hospital. So wherever you are do not despair change
is never easy and there is much work to be done.

The review on ankyloglossia published on the Cochrane database, also here:
 http://www.cfp.ca/content/53/6/1027.full 

concludes: 


" The authors stated that frenotomy should be viewed as a safe, effective and practical treatment for breastfeeding problems in infants with ankyloglossia where a proper assessment of alternative explanations for poor feeding and failure to thrive has been carried out."



"Our study has shown clearly that there is no accepted, widely used method for diagnosing ankyloglossia. The 1 standardized tool, the assessment tool for lingual frenulum function (ATLFF) developed by Hazelbaker,17 is too lengthy and complex for use in a busy clinic, and in 1 study, could not be used to evaluate more than 60% of infants being tested."

"Development of a concise, practical, standardized, validated tool for diagnosing ankyloglossia and a decision rule for frenotomy are important for further research. They would allow researchers to conduct further randomized controlled trials and also permit integrated analysis of data from these trials. "


The onus is on us to work towards standardised assessment with accurate description and routine exclusion of other causes. 

Possibly this is the area where the current focus needs to be. Correct me if I am wrong but we do not have a solid tool to assess posterior tongue tie and submucous tongue tie. If a tongue cannot protrude beyond the gum, cannot elevate and cannot lateralise I can motivate tongue tie release, if it can protrude and lateralise I currently have a hard time convincing ENT's. 

My thinking (currently) is that we need to move away from focussing primarily on the tongue of the baby , we need to look at this tongue in relation to this nipple. There is such a range when it comes to normal tongue movement. Also
some mothers will deal better with a degree of discomfort than others; some mothers will deal better with frequent feeding, etc. It is very individual for the mother baby pair and proving to health care professionals like ENT's, Paediatricians and Dentists on the basis of our subjective assessment that the tongue is abnormal in order for them to act will be difficult, not impossible, but always very difficult.

Ultrasound is really the only objective tool that can show how the tongue impacts on the nipple and how it's function is atypical in comparison to the norm. Is this where we have to look anew for a diagnostic tool? 

I will rest my case for now. 

Loraine Hamm
SLT/IBCLC 
New Zealand


 

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome