Tongue-tie - tell me what you think of the following two statements....

[ketchupkisses]

"significant tongue-tie is quite a difficult condition to diagnose during the neonatal period"

"research shows no difference in breastfeeding rates between infants, who have and have not had corrective surgery"

The quotes are from a letter I have just received from my NHS Primary Care Trust. The first is from a consultant neonatologist. The second is from the clinical director of the Trust.

So who am I to dispute them? In terms of diagnosis, I spotted my son's tongue-tie following a suggestion here on mumsnet. Perhaps I was just lucky?

On the second quote, all I can find on-line is a trial in Southampton where the "snip" was compared to extensive counselling. I can't find it now but I seem to remember the results supported division of the tongue-tie. Then there's the countless number of mumsnetters (me included) that have reported breastfeeding improving instantly following the treatment.

So, am I being fobbed off and should I reply asking them to reference the research? I'm not sure I have the energy.

My original letter to them asked them two questions. Why aren't all newborns routinely checked for tongue-tie before being discharged from hospital, and why isn't the "snip" offered anywhere in my area.

I've found the research here. 95% improved versus 3% in the control group. Is there other research that contradicts the findings?

I think that's bollocks quite honestly. Could it be that the 'research' shows no difference between babies because many of the mothers of babies with tongue-tie have given up breastfeeding early on, believing that their babies could not feed well from the breast and moved on to bottles? Those who have struggled on - would do so whether preoperly helped and supported or not.

I am not surprised that babies aren't routinely checked though. A significant number of babies are not born in hospital and it would not be reasonable or economic to arrange for the extra check for them. Plus - mothers like me who want as quick a discharge as possible wouldn't welcome hanging around for a doctor. BUT - tongue-tie should be checked for asap if there is any hint of a feeding/latch problem. I had a question about my dd3's latch - and my hv checked straight away for tonguet-tie which she didn't have.

sorry - their quotes are bollocks - not your findings - x post there

beig fobbed off. Kick off and get it done.

Psychomum5's DS2 had it done and feeding improved dramatically (he was her 5th b/f baby so she knew).

My DH has not had it done and he complains every so often of it feeling tight and achey.

I asked when both of mine were born for the m/w to check. A significant tongue tie can be felt by just running a finger under there, I don't see how it is so hard to diagnose

Ask them to provide references for their statements. Which study/studies "shows no difference in breastfeeding rates between infants, who have and have not had corrective surgery" etc...

One of the problems with the whole tongue tie thing is, sometimes it doesn't pose a problem. My DS2 was diagnosed with tongue tie by MWs, HVs and BFCs. But as he was breastfeeding beautifully, we left it be, and it caused no problems.

The correlation between how severe a tongue tie is (and his was severe, apparently!) and whether it causes a problem, seems a bit ... complicated.

thats bollocks!

Firstly, significant tongue-tie can be seen so if it can be seen, then surely running a finger under the tongue would diagnose it easily?! What a crock of shit!

Secondly, it makes a massive difference in whether a mum continues to breastfeed or not, because even if the baby is putting on weight well, the mum may be suffering from nipple trauma due to an inefficient latch, or even just exhausted from the sheer frequency of which a tongue-tied baby needs to feed!

Would love to see some evidence of what they're claiming ...

IMO you are definitley being fobbed off

Nothernlurker - i understand what you mean re an extra check for home-birth babies, but surely tongue-tie can be checked along with the basic 'ten fingers, ten toes' check when first born?

I feel their quotes are incorrect. My son had a tongue tie and it was a major factor in my decision to give up as I just couldn't seem to get a proper latch, plus had a c-section so difficult to try lots of positions for feeding.

I'd be really interested to know how they got their sample. I read somewhere that only 1 in 100 children have tongue tie so you would need a large sample size of at least several thousand to get a true indicitive picture, particularly when you take into account all the other factors that affect the decision to bf and keep on going with it.

Let us know how you get on.

There are NICE guidelines on TT.

Remind the clinical director of them - perhaps he has forgotten

www.nice.org.uk/guidance/index.jsp?action=byID&o=11180

that's a good point bluenose - I assume midwives are well able to recognise it as they deal with a lot of the early feeding problems?

If you go to Pubmed and type tongue tie breastfeeding into the search box, a number of studies come up, all of which showed improvement.

I couldn't see any negative results, and Pubmed searches the abstracts for all peer reviewed papers (ie the proper research).

I'd ask for the references they are quoting.

Just to add - 'significant' tongue tie, in the sense that some TTs make a diff to feeding and some do not, is difficult to diagnose. The condition itself is usually easy to spot, but some TT babies have no probs at all. So maybe the neo was right, if this is what he meant.

My third baby had tongue tie. It was diagnosed at one day old because I told the visiting midwife that her latch was wrong. I was a third time breastfeeding so I knew it was wrong. She couldn't open her mouth far enough and was basically chewing on my nipples and getting some (but not enough) milk. We had it cut at 9 days old and it made a huge difference to us. I still had a very painful letdown even after the bruising and bleeding healed, but breastfeeding became painfree at about one month.

DD was only checked because I said something to the midwife. I agree that babies should be routinely checked. I couldn't have carried on breastfeeding if it was as unpleasant as it was for the first 10 days. She also was slow in putting on weight because of it. At 4 weeks she was only 2 ounces over her birth weight, but is now fine.

Tiktok - "Just to add - 'significant' tongue tie, in the sense that some TTs make a diff to feeding and some do not, is difficult to diagnose. The condition itself is usually easy to spot, but some TT babies have no probs at all. So maybe the neo was right, if this is what he meant."

Yes, but the tongue-tie itself is soooooo easy to treat/divide - its such a simple procedure that can be done by a trained midwife (and used to be done routinely) that even if its hard to judge how it will impact feeding surely it must be easier just to divide it there and then in most cases?

Obviously this mean training more midwives to do it, which will have implications with cost, time etc, but i see no reason why this can't be added to become one of the things that mw's learn when they first do their training.

Just to put the debate in more context, the letter is actually from a complaints officer at the PCT who has compiled the comments from the other senior bods. So although tiktoks interpretation of the quotes sounds rather generous, she might be correct i.e. what they meant to say is that diagnosing a tongue-tie that will cause feeding problems is very difficult.

So then my next question is would it really be a disaster if a mother is told "your baby has tongue-tie. In the majority of cases it is nothing to worry about, but there is the possibility that it will effect breastfeeding. Don't think about it now, but we'll make a note in your records so that a midwife can check your latch when she visits.....etc, etc"

In my case, I did opt for a six hour discharge. I was discharged by a midwife who did the "has he got ten fingers and ten toes" check. I remember telling her he had been increasingly grizzly since birth, was latching on and off but falling asleep at the breast and then coming off hungry again - (classic symptons of tongue-tie I later discover) - was it possible he has wind?

Starlight - its because of stories like yours (and rookiemater's) that I wrote the letter in the first place. It breaks my heart to hear of what people go through!

well done ketchup for writing to your pct.

i think tiktok is right in that the paediatrician is saying 'significant' tt ie tt that will affect bf. tt is easy to diagnose by looking in the baby's mouth. however, i bet that paed thinks that tt almost never affects bf, hence use of 'significant'. most paediatricians and oral surgoens think the same. i am certain that paediatricians get no training in breast feeding.

i would dispute the 1 in 100 statistic, i thought it was much more common than that (3/8 babies in my nct grp for example). think i have read 20%??

i agree entirely with your idea of diagnosing tt early so should there be a problem it can be divided. although, i also think, it is such a simple thing to have it divided,with such a low complication rate, that why not do it anyway?

you could write back to your pct with the reference of the southampton study and any others and ask with what evidence the clinical director made that statement, this is your peer reviewed, published evidence.

good luck and well done for raising the issue with them.

When ds's tt was separated, all 3 of the mums there that day noticed a difference immediately (small sample and anecdotal, I know ) But if you search the UNICEF baby friendly website they have some links to proper studies.

Even routine checking wouldn't be enough, imo, without educating professionals about the results of correcting tt. In our case, both mw and hv diagnosed tt, but said it was not worth doing anything about bc ds was gaining weight (regardless that he was feeding constantly and I was in pain all the time).