Breastfeeding: Mothers are repeatedly told breast is best – but what about the lack of support when babies have tongue-tie?
The Independent, Weds 18th March 2015
The Association of Tongue-tie Practitioners was delighted to see your report Breastfeeding: Mothers are repeatedly told breast is best – but what about the lack of support when babies have tongue-tie? Wed 18 March edition of The Independent highlighting the issues faced by parents with tongue-tied babies. We were very happy to see that there was a positive outcome for Kate, the mother featured in the case study. Her experience highlights the serious feeding issues that can result from a tongue-tie and the difficulty mothers often face in getting the problem recognised and treated. It is a story that is very familiar to those of us working in breastfeeding support.
Unfortunately for Kate and her son the tongue-tie reoccurred after the first procedure so a second procedure was carried out. Recurrence is a recognised complication of tongue-tie division. But it is believed to affect only a very small percentage of babies. The case study suggests that the thing that led to a positive outcome, after the second division, was the 6 weeks of wound management they followed which Kate refers to as ‘the Kings College Treatment’.
This kind of disruptive wound management (which involves massaging the wound repeatedly over a period of time following tongue tie division) has been promoted by practitioners, not just at Kings College Hospital, but in other parts of the world, particularly in the United States. However, there are some concerns about this approach. Despite the fact that this kind of wound management has been recommended for several years there have been no published controlled studies done to establish its safety or efficacy. There is no agreed consensus on what post procedure wound management should involve. In the case study twice daily for 6 weeks was recommended. Others recommending this approach suggest massaging at every feed for at least a month, whilst some say twice a day for 5 days is sufficient. So it is a confusing situation for practitioners, as well as parents.
In the case study baby Ethan is reported to have tolerated the massage. But there are lots of reports from parents which describe the process as distressing, difficult and traumatic. It can also cause the wound to bleed, which can be frightening for parents, and many parents feel that it is painful for their baby and do not continue with it. There are professional concerns about increased risk of oral aversion and infection. There have also been lots of reports of babies continuing to suffer repeated recurrence of the tongue tie, despite following these massage regimens.
Recurrence of tongue tie is an issue that most definitely needs further research. It still not fully understood why it recurs in some babies and not others, although there are plenty of theories. It remains our experience that most babies do well after tongue tie division without the need for further surgery. A recent informal audit from ATP members found that around 3% of babies were returning for second divisions.
Whilst we fully respect and understand the fact that some parents may feel they would like to follow something like the Kings College Treatment after their baby’s tongue tie is divided, many practitioners feel that until robust research is undertaken it is important that parents understand that, whilst some may believe these approaches are helpful, there is a some way to go before there is a consensus on how best to manage the issue of recurrence of tongue-tie. The importance of skilled breastfeeding support in achieving successful outcomes for mothers and babies should not be underestimated.
Parents and professionals can find more information about tongue-tie at www.tongue-tie.org.uk.
Suzanne Barber RM IBCLC and Lynn Timms RHV IBCLC
On behalf of the Association of Tongue-tie Practitioners