Thursday 19 October 2017

Why are more tongue ties being diagnosed in babies in Ireland?

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Geraldine Gittens

Geraldine Gittens

Poor latch, mastitis, blisters, blocked ducts... If you're a breastfeeding mother, or if you have been, the chances are you'll have heard of these.

Tongue tie is another problem encountered by breastfeeding mothers. Once lampooned as a trendy fad, tongue tie is now being diagnosed more in babies, and the HSE now has a national clinical policy on it.

It occurs in babies when a piece of tissue attached to the baby's tongue is tight and/or unusually short, holding their tongue down and stopping it from moving freely.

It affects how the baby feeds and can cause physical problems for both mother and baby.

Desperate with lack of sleep, first time mothers often feel they have nowhere to turn, and they often don't know that tongue tie is a fixable problem.

"As there are more babies breastfeeding now, there are now more tongue ties being detected," Dr Alan O'Reilly, a GP and certified lactation consultant, who specialises in tongue tie, advises.

"There are a growing number of pediatricians and GPs that are developing an interest in breastfeeding and tongue tie as the public's concern and interest have risen."

"Most children with tongue tie will breastfeed successfully with expert lactation support and without any surgical intervention (to have the tongue tie cut)."

More mothers are breastfeeding their babies today in Ireland than they were forty years ago.

Throughout the 1970s and 1980s, the majority of babies in Ireland were fed formula. In 1974, for example, the breastfeeding initiation rate in the Rotunda hospital was 11pc. 

Fast forward to earlier this year, when it was found that some 55.4pc of babies were being breastfed at the time of the public health nurse's first visit. 

Breastfeeding rates in Ireland are climbing (albeit that Ireland still has the lowest rate for breastfeeding in Europe.) And as the rates increase, the challenges that can come with breastfeeding, are being talked about more. 

In 2014 the journal Maternal and Child Health published a study looking at breastfeeding and maternal depression. It found that mothers who planned to breastfeed and went on to do so were around 50pc less likely to become depressed than mothers who had not planned to, and who did not, breastfeed.

"When people choose to come in to get a frenotomy (have the tongue tie cut) done for their baby, it's a decision that they don't make lightly. They're doing it because they're passionate about breastfeeding," Dr O'Reilly said.

"The babies that I see at my frenotomy clinic would continue to have breastfeeding difficulties despite maximum lactation support."

Breastfeeding your baby can offer protection against gastrointestinal infections and diarrhea, middle-ear infections, Type 1 and Type 2 diabetes, lymphoma, leukaemia, and Hodgkin's disease. It also reduces the likelihood of childhood obesity.

Mothers who are struggling with breastfeeding challenges can often continue to breastfeed successfully if they are given the right help.

"It is vital that mothers and babies are assessed by healthcare professionals with experience in breastfeeding and tongue tie. In Ireland this expertise usually lies with lactation consultants and public health nurses. Doctors in general have very limited teaching and training in breastfeeding," Dr O'Reilly said.

"With tongue tie, it's important that people get assessed by people qualified in the area and that they get the maximum amount of lactation support without jumping straight to a frenotomy (where the tongue tie is cut)." 

"Bottle-fed babies with tongue tie generally do not have a problem with feeding. The peristaltic wave-like motion that is required for efficient breastfeeding is not required for bottle-feeding." 

Dr O’Reilly cautions that tongue tie could be over-diagnosed, though.

"It is true that the growing awareness of tongue tie has brought its own problems. There is a growing over-diagnosis of tongue tie in babies with completely normal tongue anatomy and function. It is important that mothers and babies see healthcare professionals with adequate experience and training."

"Parents are now more informed about breastfeeding as people research their symptoms online and they discuss their symptoms with other mothers and health professionals on online forums."

"Mothers of children with restrictive tongue ties and breastfeeding problems are sharing their positive and sometimes negative experiences with each other."

Often the mother will be advised to push through the challenges and continue breastfeeding because babies will only become established at breastfeeding after the first two or three weeks.

"It is important that babies get the chance to establish breastfeeding on their own and with lactation support if required before considering tongue tie release. There are very restrictive tongues which may not allow a baby to form a sustainable latch from birth. I feel that these babies should be seen as soon as possible by a lactation expert with experience in diagnosing tongue tie. There are also mild tongue ties that will allow for established, sustainable and pain free breastfeeding after lactation support for 2-4 weeks,” Dr O'Reilly said.

"It is vital that all babies with difficulty breastfeeding are also assessed by a doctor to exclude medical conditions such as infection, neurological disorders and congenital abnormalities that may be associated with breastfeeding problems for baby."

Dermot Murnane is an oral surgeon who releases tongue and lip ties in infants, children and adult.

"Tongue tie runs in families. It's a family trait. If you find one baby has it, a cousin has had it, for example,” he said.

 "It's a simple one-minute procedure and the result is instant. If the baby feeds straight away, it will feel different to mum straight away. The baby might be sore for a day or two, but after day three there's generally a turn around, and the baby has a firmer latch and more rhythm to their feeding. Much happier baby, baby goes to sleep, and much happier mum then.”

Dr Murnane says the amount of frenotomies he’s performing has increased in the last few years.

“The lack of provision of services is amazing. It's mind boggling how difficult it is to get such a procedure done. Maternity hospitals don't even check if there is a tongue tie. It's poo-pooed as a non-event. A lot of it is changing but people thought that was just quackery and they'd discourage you from having it released."

"It's a very small tiny little procedure, and there's practically noone in the  country doing it. People have to travel horrendous distances to have it done It's a 30 second procedure.”

"It should be a standard procedure provided in any maternity hospital. Legend has it that midwives would keep one sharp finger nail and they would do it. That of course has changed now," he said.

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