Post on 26-Mar-2020
Tongue tie & upper lip tieAnd it’s impact on breastfeeding in the early period
Maaike van Broekhoven SRN, IBCLC
Registered nurse 1985
20 years in maternity home care
Lactation consultant IBCLC since 2001
Recertified IBCLC in 2006, 2013 and 2017
Assisting at the Tongue Tie Clinic in Groningen, The Netherlands since 2015
Nursed two boys (14 and 16) 1,5 year with tt and ult
Program
How do we asses when mother calls for help
Importance of full tongue and lip mobiltiy
Impact tethered oral tissues on breastfeeding
Aerophagia and impact on whole family
More visual signs of ties
Supporting breastfeeding
Care after the release
How do we assesswhen mother calls for help
Patient history
Recording complaints mother
Complaints baby
Observing feeding
Check breast and nipple
Observing baby, asymmetry, tension, behaviour, pooh and pee, weight
Checking tongue and lip/cheeks for mobility and ties
Dr.Larry Kotlow paediatric dentist
Dr. James Murphy, peadiatrician
Has to feel smooth under tongue
No “speedbump”
“Fence”
“Guitarstring”
Dimpling tongue on pressure frenulum/ moving tongue
Clinical pearl for diagnosing tongue tie Association of Breastfeeding Medicine
Importance of full mobility of upper lip
Untreated ULT, lip tucked in, losing suction and grip on breast, baby needs to compensate to hold on.
Untreated, lip flanged manually, leaking milk, baby may “bite” to hold on.
After releasePictures Mieke van Rijn-Remans
Lip tie flexible
Importance of full mobility of midportion and posterior tongue.
Elad et al, biomechanical study breastfeeding, Tel Aviv, Israël.
Ultra sound study baby PTT type 3
Impact on breastfeeding
Tongue can’t go up and back +
upper lip outward
Nipple and breast not sucked in deep
Baby has to compensate to
hold on and draw out milk
Uses jaw & cheek muscles, clenching
nipple
Still not enough milk 7-10 % weightloss,
frustrated at breast/ sleepy
Poorly drained breasts,
engorgement, mastitis
Low milk supply after few weeks, FTT
Impact of aerophagia on well-being of baby and family
Low tongue doesn’t reach
palate, upper lip no seal
Low tongue doesn’t reach
palate, upper lip no seal
Tongue doesn’t close off throat, while moving up
and back
Tongue doesn’t close off throat, while moving up
and back
Baby swallows air with milk
Baby swallows air with milk
Air in stomach goes up or down
Air in stomach goes up or down
(Hidden) reflux, higgough, burping,
distended belly, colic, wind
(Hidden) reflux, higgough, burping,
distended belly, colic, wind
Very fussy and restless baby,
parents exhausted and insecure
Very fussy and restless baby,
parents exhausted and insecure
Hospital visits/ stays, carobel, reflux
medication
Hospital visits/ stays, carobel, reflux
medication
More visual signs and symptoms of tethered oral tissues
Friction blisters, fold philtrum
Poor seal and milk transfer
Two tone tongue
Papilla with debris
Doesn’t “clean” against palate
Suck blisters
Tongue low/ dent where tie is
High palate, narrow jawline
High and narrow palate
Complicates good seal
Tongue shapes the palate
Jawline follows tongue position
Thrush
ULT, after feeding
Trembling lower jaw
Mother thought he was cold
Shallow latch
Upper lip tucked in,
“cliffhanger”
Case study
Frenectomyby Kirsten
Tongue tie release midwife
5day
3mnth
6mnth
300 gr+
Nipple trauma from clenching
Nipple flattened/ lipstick shape Blocking blood flow
Poorly drained breasts; overproduction, blocked ducts, mastitis.
Supporting breastfeeding
Aid better latching• Shape breast and nipple, lower jaw deep in breast, support back• Laid back position cradle, clutch hold
Breastcompression, hand expressing milk or hands-on pumping• Less weightloss and engorgement• More milk production
Supplement at breast• To aid drinking at the breast• Extra tube/ syringe• Temporarily aid of nippleshield
Laidbackfeeding fordeeper latch
Supplement at the breast, toalso stimulateown milk
Nippleshield to keep thebaby at the breast
After release tongue and liptie
After procedure Soothing baby
Latching on/ feeding
Pain relief
Dimm lights
Checking wound
Before going home Informing parents
Woundhealing what to expect
24-48 hours unsettled baby
Alternatives for giving milk: bottle/ cup/ fingerfeeding
Mobile number for questions
Aftercare appointment within two weeks
Active wound management
4 times a day at least
No more than 6 hours in between
Rubbing wound(s) 5 times
Lifting upper lip 2/ 3 times
Lifting tongue 2/ 3 times
Not at night!
Practising active wound management
Dr. Kotlow Paediatric Dentistry Aftercare/ reattachment
Tongue Exercises
Preferably before every feed (not at night of course), when not to hungry
To activate the tongue to make more movements after tongue tie release
To stimulate stronger vacuum and stimulate high palate to come down
To stimulate more upward movement of the tongue, side ways, cupping
To decrease gag reflex
Playfull stuff first then wound care very shortly afterwards
Melissa Cole IBCLCLuna LactationRelaxing jaw tension
Exersicinggoodrestposturetongue, after release
ONLINE! Symposia (watch from your lazy chair ;)
http://www.astlit2018.org.au/
http://holisticibclc.blogspot.nl/2013/11/emerging-topics-in-breastfeeding.html
https://www.goldlearning.com/ce-library/all-lectures/accreditation/tongue-tie-symposium-2017-detail
Tongue tie professionals support and organisations.
ENT’s, IBCLC’s, Chiropractors, Cranio Sacral Therapist, Occupational therapists, Dentists, Paediatricians, Speech pathologists, Myofunctionaltherapists.
AITP https://tonguetieprofessionals.org/
ICAP https://www.facebook.com/groups/211928375852786/
https://www.facebook.com/groups/ttprofessional/
Sites
www.tonguetieclinic.com /aftercare (videos) / treatment (videos) /FAQ
Dr. James Murphy MD of the Academy of Breastfeeding Medicinhttps://bfmed.wordpress.com/2010/11/04/clinical-pearl-the-murphy-maneuver-for-diagnosing-tongue-tie/
Checklist signs and symptoms, FAQ’s aftercare http://tonguetieclinic.com/faq/checklist-of-signs-and-symptoms-of-tongue-tie-and-lip-tie/
Blogs, research, aftercare ENT Bobby Ghaheri www.drghaheri.com
Videos of aftercare Melissa Cole IBCLC
Courtesy of Melissa Cole IBCLC http://www.lunalactation.com/for-health-professionals/
Oral motor training
https://www.youtube.com/watch?v=iv3n41XdUAI
Videos of aftercare Dr.Kotlow M.D.
Courtesy of Dr. Lawrence A. KotlowDDS, PC
Pediatric Dentistry
https://www.kiddsteeth.com/breastfeeding.php
https://www.youtube.com/watch?v=AXiB8ODw45s
Assessment tool by Alison Hazelbaker
Youtube link:
https://www.youtube.com/watch?v=-4G-yV11iYA
International Organisations
INTERNATIONAL CONSORTIUM OF ORAL ANKYLOFRENULA PROFESSIONALS (ICAP) http://www.icapprofessionals.com
International Affiliation of Tongue Tie Professionals https://tonguetieprofessionals.org/
Thank you for your attention!