The IATP asked AHRQ to delay its findings until we could provide input, but they refused. The statement is extremely disturbing as it presumes no validity to clinical evidence and marginalizes the experiences of so many mothers.
And, as Judy said it will only serve to do more damage both through dismissal by peds and ENTs and especially insurance providers. Sadly, the IBLCE still requires no education on this topic either and IME the vast number of IBCLCs still do not know how to evaluate oral function, assess for TT, make appropriate referrals or support the dyad toward functional breastfeeding.
Jennifer Tow, IBCLC, USA & France
Intuitive Parenting Network, LLC
Date: Wed, 22 Jul 2015 09:08:26
-0400
From: "Judith L. Gutowski" <[log in to unmask]>
Subject: AAP
statement of Tongue Tie is AHRQ
Perhaps this is what he is referring to. It
is from the Agency for
Healthcare Research and Quality.
Treatments for
Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-
reports/?productid=2073
<http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and
-reports/?productid=2073&pageaction=displayproduct>
&pageaction=displayproduct
The conclusion of this study is:
"A small body of evidence suggests that
frenotomy may be associated with
improvements in breastfeeding as reported by
mothers, and potentially in
nipple pain. However, with small, inconsistently
conducted studies, strength
of evidence is low to insufficient, preventing us
from drawing firm
conclusions at this time. Research is lacking on nonsurgical
interventions,
as well as on outcomes other than breastfeeding, particularly
speech and
dental outcomes. In particular, there is a lack of evidence on
significant
long-term outcomes, such as exclusive breastfeeding at 6 months of
age or at
1 year of age, growth, and other measures of health outcomes. Harms
are
minimal and rare; the most commonly reported harm is self-limited
bleeding.
Future research is needed on a range of issues, including prevalence
and
incidence of ankyloglossia and problems with the condition. The field
is
currently challenged by a lack of standardized approaches to assessing
and
studying the problems of infants with ankyloglossia."
This study
DOES NOT say that treatment is not recommended for of tongue tie,
but that the
evidence for its effectiveness is lacking. The reason is that
in the U.S. we
don't bother measuring what we don't value!!! "GOOD" studies
have evaluating
the effectiveness of Frenotomy on infant feeding and
maternal pain versus not
treating it have not been done.
Typical primary care providers who
encounter this in mothers and infants
don't know enough tongue function or
breastfeeding management to assess
it, unless they have closely worked with an
IBCLC experienced in the area.
Many physicians, as cited in the study (90% of
pediatricians and 70% of
otolaryngologists), flatly don't "believe" feeding
problems in infants are
caused by tongue tie. It is not real to them. The
article actually cites
many studies finding improved outcomes for breastfeeding
infants and nipple
pain improved. They also found that the procedure hard
minimal risk of harm.
The REASON we don't have studies on this is because
breastfeeding is not
that important in healthcare.
This research was
done by a group from Vanderbilt University one quoted as
stating, ""This is a
call to action for people to think of this as an
opportunity to do research.
One purpose of the literature review is to point
out limitations in the
evidence base and encourage people to fill
those
gaps."
http://news.vanderbilt.edu/2015/05/surgery-for-tongue-tie-shows-some-benefit
s-more-research-needed/
The beginning of this report states...
"The information in this report
is intended to help health care decision
makers-patients and clinicians, health
system leaders, and policymakers,
among others-make well-informed decisions and
thereby improve the quality of
health care services. This report is not
intended to be a substitute for the
application of clinical judgment. Anyone
who makes decisions concerning the
provision of clinical care should consider
this report in the same way as
any medical reference and in conjunction with
all other pertinent
information, i.e., in the context of available resources
and circumstances
presented by individual patients."
Sadly, we have one
insurer in my area that has already used this to
discontinue payments for
infant Frenotomy. Colleagues, no what shall we
do??? As usual the good
intentions to investigate this issue have resulted
in unintended consequences.
Judith L. Gutowski, BA, IBCLC, RLC
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