One factor working against us in Canada is the latest statement made by the
Canadian Pediatric Society on tongue-tie and breastfeeding. They are not in
favour of clipping. They also see length of time a baby is breastfed as the
only measure of successful bf'ing. They do not recognize the impact
breastfeeding difficulties have on mothers and infants.

Their web site isn't working this weekend but I was able to pull up the
HTML version for some charming quotes:

"little research has identified a causal relationship between tongue-tie,
lactation problems, speech dis-orders and other oral motor disorders (eg,
problems withswallowing or licking)"

"It is clear that restriction of the tongue movements must be quite extreme
to interfere with sucking and swallowing"

"Messner et al (10), in a prospective study, reported the incidence of
ankyloglossia ....... Thirty (83%) of the 36 infants with ankyloglossia
were successfully breastfed during the study period compared with 33 (92%)
of the 36 controlinfants (P=0.29). Mothers of infants with ankyloglossia
reported more breastfeeding difficulties than mothers of controls. However,
as stated above, the duration of breast-feeding was similar in both groups"

"Management of tongue-tie is usually conservative, requiring no
intervention beyond parental education and reassurance."

"Release of the tongue-tie appears to be aminor procedure, but may cause
complications such as bleed-ing, infection or injury to Wharton's duct
(21).A simple incision or `snipping' of a tongue-tie (frenecto-my) is the
most common procedure performed for partial ankyloglossia. However,
postoperative scarring may limit tongue movement even more (20,21).
Excision with lengthening of the ventral surface of the tongue or a Z-
plasty release is another procedure with less postoperative scarring, but
has the inherent risks of general anesthesia"

"CONCLUSION
Ankyloglossia is relatively uncommon in the newborn population. Most of the
time, it is an anatomical finding without significant consequences for the
newborn or infant affected by this condition. Current evidence seems to
demonstrate that despite ankyloglosssia, most newborns are able to
breastfeed succesfully (7,10).  Surgical intervention is not usually
warranted, but maybe necessary if the association between significant anky-
loglossia and major breastfeeding problems has been identified (20). More
definitive recommendations must await more precise criteria for diagnosis
along with the appropriately designed clinical trials."

Me again:
Anyone who sees nipple pain, slow weight gain, frustration and hours spent
feeding as NOT SIGNIFICANT CONSEQUENCES makes me a little crazy. But at
least it doesn't say never clip, it just invites us to convince the MD's
that our clients have MAJOR breastfeeding difficulties.

www.cps.ca/english/statements/CP/CP02-02.pdf

Janet Vandenberg RN, BScN, IBCLC
Ontario, Canada

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

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html