to wish babies were checked for tongue tie routinely before leaving hospital?

[MixedBerries]

Now I don't want this to descend into a slinging match about feeding choices (which usually happens whenever bf or ff are mentioned) but is it really unreasonable to expect that this is something that should be checked for by the paediatrician before leaving hospital? It would take about 1 minute.
According to NICE and UNICEF (who I assume know a thing or two) it affects 3 to 10 per cent of all babies yet at least 5 midwives, one health visitor and one paediatrician failed to check or notice it in my DS. It's not even a "hidden" posterior tongue tie. Once it was diagnosed (at 2 weeks following bleeding nipples, weight loss and failure to latch), we had to wait a further 2 weeks to see the lactation specialist as she was on holiday and is the only one in the area qualified to clip it. They we waited a further week to have it clipped. That didn't work so we had to travel half way across the country to see another specialist who clipped it again at 7 weeks. By this time DS had lost interest in boob feeding so I've been trying to get him back on and expressing in the meantime.
Now at 13 weeks, he completely refuses the breast and I don't have the time to express every 3 hours so essentially, once my freezer stash has run out, it's the end of bf. IF anyone had checked, I've been told it could have been sorted the day he was born and all this could have been avoided.
So in the light of "breast is best" being repeated over and over by the health profession, don't you think it's something fairly fundamental that could be checked for by people who are supposedly here for the best interests of our children? I'm so bloody angry. (Yes, I KNOW ff won't kill him but we really wanted to bf, particularly since asthma and allergies run in the family on both sides. And my point is that this could have been avoided so easily).

Edless - there is a TT Clinic at East Surrey that runs twice a week (Tues & Thursday IIRC) I don't know about PRH or Worthing though.

My ds is 4 and we were told his toungue would only be snipped if it interferred with feeding or speech, it never really did either and i bf for a year. Although i sometimes wonder if he would want it snipped when he is older and then blame me for not having it done when he was little...

Such a shame that it takes so long to get sorted and yes i really think they should check at birth.

Monkey - a friend of mine had really bad problems bfing for weeks and her DC was finally diagnosed with TT, they said there was nowhere to do it locally and told her the closest clinic doing TT snips was Newcastle but it was a 3w wait (we're in West Sussex). Funnily enough she stopped bfing then.

DS had a posterior tongue tie that was missed by everyone, despite me having the typical symptoms and specifically asking for it to be checked for. The only 'help' I was offered was my GP telling me that if it was that painful I should switch to formula and that by 6 weeks DS had had all the benefit of breastmilk.

As a last ditch attempt I paid for a private lactation consultant (a cost that I could ill-afford), who diagnosed him almost immediately. It still took another couple of weeks, and 2 trains each way, to get it snipped (nowhere in my county does it). I am so angry that I spent the first 11 weeks of DS's life in agony, and that instead of enjoying my new baby I dreaded him waking up and wanting to be fed - huge amount of guilt about those feelings. The snip would have been easier for DS had he been younger, but it made it possible for me to continue feeding him. He is now 22 months, and still breastfed.

It was also my first concern when I found myself pregnant again. I had to fight and push so hard to get DS's TT snipped and I just dread the thought of going through it all again. I have already spoken to the hospital where I will probably give birth. They have told me that they check for tongue ties as part of the first day check but do not perform tongue tie divisions, so even if one is spotted (they missed DS's) I will still have to wait a few weeks for a referal. I feel tearful at the possibility that DC2 will have a TT (the odds are higher as DS has one) and that I will have to go through the pain again. A new baby is hard enough without chucking a tongue tie into the mix!

Not able to read all the replies to this post but I think YESYESYESYES please.

Even though the midwife checked, she did not pick up on my DD's posterior/mild tongue-tie, which affected her feeding a fair bit and took 3 months before anyone else stuck their finger in her mouth to diagnose. Now its sorted, its made such a difference! I think education about the signs etc may be a good way forward too.

Apologies if someone has already posted along these lines!

Oh god, wish I hadn't seen this thread as now I'm worried that DS has tongue tie.
He's 7 weeks tomorrow and I asked 2 midwives in hospital to check for it - they both said no tt.
He latched on great but wouldn't suck hard enough to get sufficient milk and we ended up back in hospital when he lost a serious amount of weight and had no wet nappies. He then became 'afraid' of the breast as he must have been so hungry, so we ended up topping him up with formula and now at 7 weeks he has been mixed fed by bottle, with the % of ebm in the bottle getting lower and lower.
I had come to terms with not bf as we had a very traumatic delivery and I had done everything I could to bf, including getting bf councillors to the house to watch me etc and no one could help - I was doing everything right, he simply would not suck.

Now I am afraid that perhaps he has tongue tie that was not picked up. His tongue does not look heart shaped but does have a tiny indentation - would this cause him not to suck? When I was observed, the latch was good. If it is tt and it could have been sorted, I will be so upset.

I'm going to branch out on my own and say that I don't think babies should be checked for TT routinely at birth.

1. A visual check does not show you if the tongue tie interferes with feeding, a thorough assessment of feeding difficulties needs to be made to effectively diagnose it. Paediatricians and Midwives doing routine post natal checks are not usually experienced in solving breastfeeding problems.

2. A tongue tie which causes problems with latching in the first few days can rectify itself with a few days, so early diagnoses would mean these babies may be treated for something that does not require treatment. They may also be treated for tongue tie without correcting any other breastfeeding problems thus not solving the actual problem.

3. Mothers who are experiencing breastfeeding difficulties whose babies are diagnosed with tongue tie may lay the blame for all breastfeeding issues with the tongue tie and not try to correct poor positioning and attachment. When these babies have the tongue tie snipped, the problems are still there.

4. Although it is a minor procedure, it is not without risks and can be very stressful for mothers and babies.

5. Cost. If all babies were routinely checked and tongue tie separation offered there would be an increase cost to the health service. It is not simply a case of the person diagnosing it grabbing a pair of sterile scissors. More people would be demanding tongue tie separation at birth for the prevention of possible future speech problems and feeding problems which need better assessment.

I am not opposed to checking for tongue ties but feel it needs to be done in newborns as part of a feeding assessment if breastfeeding problems present and only after thorough checking of all other aspects such as positioning and attachment. It would be fantastic if all Midwives and Paediatricians were experience in breastfeeding an assessed breastfeeding thoroughly as part of routine newborn checks.

YANBU - totally feel your pain. my DD was diagnosed, again too late, I gave up BF due to failure to thrive and lack of milk.. :-(

saddens me something so simple can be missed and relatively easy to recognise

I totally agree that all babies should be assessed by a midwife/dr before discharge from hospital. I had my first baby 5 months ago & found bf really painful, lengthy & difficult. It was only going to a bf support group afterwards, that the bf support worker spotted he might have a posterior tt. We had it snipped soon after (at about 6 weeks) & gradually his technique improved & I healed up. Glad I persevered, but if he hadn't have had some treatment, there's no way I could have gone on much longer, as we were both in tears some feed times. Really recommend finding post-natal bf support via midwife/nct/La Leche League etc. Definitely worth getting someone skilled to look if bf is painful & takes ages.

Warning: GP's seem to be taught that tt is of no consequence & may therefore be reluctant to refer you/baby for snipping. I had 2 GP's poo-pooing the skilled advice I'd received. One even told me (afterwards) that she thought it was 'barbaric' that I'd taken DS to have tt division! I told her he cried less than when he had his imms!

Because there would be a great deal of expensive legal action if anything went wrong and it was done by someone not qualified or insured to do it. The fingernail thing is a great idea but doesn't really fit in with the whole sterile instrument hospital procedure thingy!

I have no idea about TT and tooth decay, I'll put my hand up to that. As for speech problems, not all TTs interfere with speech and whether or not it will interfere with speech can only be assessed once a child is verbal.

It does cost money to do it. I don't know all the details but know it is quite costly to run a clinic for this but also it would actually not be as costly as risking breastfeeding failure...

It would be fantastic if TT diagnoses and treatment was easier to come by without ridiculous waiting times.

fanny as with all things, a check would be routine yet with parental agreement ..treatment would be parental choice.

if you knew your baby had TT and then experienced problems, knowing you could get a quick treatment at the hospital you gave birth in rather than waiting weeks for referral would make a huge difference...

complications are very, very rare....and less than having the same thing done under GA in later life...

I wish MN had been around when my DD1 was a baby as I struggled on with very painful BF until she grew out of her tougue tie at about 13 weeks. Looking back i really don't know how I carried on with constantly bleeding nipples and very poor support.
In the long term she has not been affected in any way by her tongue tie, but I agree with you OP an initial check and treatment would have really helped
YANBU

@lukewarm

Mnhq have passed on to their campaigns team to consider...

Hi there Someone who knows more than me will pop in and update you Thanks M Towers

Hello OliviaMumsnet. Thanks for the update. It would be great if this became a campaign and turned into something that could actually make a difference. I'm so angry and sad about my completely avoidable experience and even sadder and angrier to read how common an experience it is.

FannyBazaar whilst I do understand your points, I think treating any tongue tie is the decision of the parent and not an automatic consequence of diagnosis. Almost nobody would have it snipped without a long hard think- we had so many problems yet I still had massive reservations about interfering with my newborn's tongue.

On balance, we decided to go for it because it was so obvious that the tt was the cause. It was very stressful but not half as stressful as having a starving baby screaming at your breast while it vomits up blood from your nipples on the 20th feed of the morning.

In short, identifying a tt at birth wouldn't necessarily lead to more snipping procedures. It would be possible to adopt a "wait and see" approach but if problems occurred, it would be high on the list of suspects.

Plus anyone with any specialist knowledge of breastfeeding would be able to tell if bf problems are the result of tt or just poor latch etc. Frustratingly, we were watched by scores of HCPs who kept saying how the latch was perfect. The next thing they said was that bleeding nipples aren't normal so we must be doing something wrong but no-one could tell me what. All this when you're trying to look after a newborn is too much.

As for cost, like you say, it would be far less costly to carry out this minor procedure at such an early age than have to carry it out under GA later on. Also, it would save endless visits to bf clinics, GP visits etc and the cost to the NHS of health any problems resulting from not breastfeeding.

Too tired to think now.! Thanks everyone for sharing experiences and I hope those of you who had to stop bf know it wasn't your fault in the slightest.

NewYearEverything Mon 23-Jan-12 21:15:00
"It is not simply a case of the person diagnosing it grabbing a pair of sterile scissors" Why not though? Midwives used to keep a sharp fingernail especially for this purpose! It is a very low risk procedure in a healthy term infant.

Exactly - I remember my midwife telling me this, and that the practice had only died off as bottle feeding became more prevalent so the general medical knowledge that existed about TT declined to almost nothing (in theory a TT baby can feed more easily from a bottle, although no-one told my bottle refusing DD2 this). This is the only reason is isn't a standard snip at birth now. If we, as a society, want to support BF, then we really should look at the way TT is diagnosed and treated (although obviously not via a sharp fingernail these days!).

IMO it should be something akin to the Vit K injection (yes, I know that can be controversial too). i.e. parents can read up on it beforehand, and make a decision as to whether they would give permission for a TT snip or not ahead of time. It really does only take 1-2 mins, so no reason it couldn't be done whilst the newborn is still in hospital, so no need for any other appointments etc. Really nothing more expensive or complicated than a newborn jab.

In our case, the TT wasn't (fortunately) causing hideous problems, but it was causing some problems (and in hindsight, through reading threads like this, I now realise that some other issues like choking were probably attributable to the TT as well). I was concerned that as my supply regulated (ie became less like a hose), the TT problems would get worse as DD2 wouldn't be able to suck harder/better to compensate. After reading up on potential future problems - speech, feeding solids, loss of simple pleasures like not being able to lick an ice cream - and how simple the procedure was at 6 weeks, versus later on as GA procedure, I really couldn't see why you wouldn't do it, rather than leave it to chance as to whether it would separate naturally or not later.

Under the 'potential complications' part of the consent form, our consultant listed 'none'. Enough said, no brainer.

Fingers crossed for a campaign. I really believe this could give many women the option of breastfeeding comfortably.

And save a lot of children speech problems. Great idea.

Do most babies who have tongue tie have trouble BFing? I only ask because all 4 of mine had tongue ties and none had trouble feeding. I fed them from 7 months to 12 months. No one told me it might cause a problem, and it didn't.
They had all broken their ties themselves by the time they were three. DS has a severe speech delay but it's been confirmed it's nothing to do with his tongue tie, and his sisters's speech was fine.
Surely it wouldn't be a good thing to snip them routinely if they were causing no problems?

Fivehourssleep, I'm not advocating snipping them routinely, I'm wishing they were CHECKED FOR routinely. Treatment would be the decision of the parent, depending on the effects of the TT and weighing up the pros and cons. Not all TTs do cause problems but when they do, we need to know that they're there in order to rectify the problem.

Mixedberries I know you are not.
And it does seem odd that no one checks, they check palates as a rule I think. I'm just wondering if people reading this thread might start looking around for someone to snip their children's ties just because they were there.
I know nothing about having them snipped. Do they ask any questions before they do it? Or do they just regard a tied tongue as abnormal, regardless of whether there are problems and go ahead anyhow?