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!