Dr. Alan O’Reilly MB BCH BAO DCH DRCOG IBCLC facilitated two workshops entitled “Tongue Tie: Lactation Support V Frenotomy” at the recent ALCI Conference.
Dr. Alan O’Reilly is a GP who works in Camden Street in Dublin. He qualified as a Doctor in Galway, In 2013 he trained in assessing and releasing tongue ties. He qualified as an International Board Certified Lactation Consultant (IBCLC) in 2017. Margaret O’Connor IBCLC works alongside him in his Gp surgery in Dublin.
Objections of the Workshop
- Normal tongue movement and function
- Symptoms of tongue tie
- Examination of tTongue tie
- Lactation Support
- Tongue Movement during breastfeeding
What is a Tongue Tie
This is a lingual frenulum that causes a restriction in tongue movement. Reduced tongue movement leads to impaired tongue function.
Examination of Tongue Movements
- Extension: rub chin just below the lower –lip.
- Lateralisation: run a finger along outside of lower gum from side to side.
- Elevation: may be noted when infant cries.
- Suction: allow infant to suck on the clean finger.
- Grooving: allow the infant to suck finger and assess how well the sides of the tongue holds on to the finger.
Examination of Tongue tie
- Insertion of Lingual frenulum on
1. Inferior surface of tongue
- Floor of mouth
- Elasticity of Frenulum on elevation
- Thickness and Fibrosity of Frenulum
Tongue tie and Frenotomy
- Everybody seems to have a tongue tie.
- Parents are leaving Lactation Consultations believing a Frenotomy is that sliver bullet that will solve all of their feeding problems.
- The Focus needs to always be on lactation support and Frenotomy if indicated should be just part of the plan.
Lactation Support: First few days
Baby not Latching on
- Hand express colostrum
- Avoid bottle – feeding
- Consider finger – feeding, spoon or cup feeding
- Syringe feeding is also a good option
- Suck training
- Electronic pump when milk comes in
“Single most Important factor in getting baby to latch is an abundant milk supply” (Jack Newman).
Dr. O’Reilly also stated that treating nipple pain is very important. He highlighted the importance of working on a deeper latch. Topical steroid may help reduce inflammation and take pain killers if needed. Feed expressed milk to allow nipples time to heal. Ensure to maintain an abundant milk supply.
Nipple shields are also useful if a baby is unable to sustain a latch or has a dysfunctional suck. Nipple shields may transfer more milk with a nipple shield that without. Useful for flat or inverted nipples. The shield is a barrier for inflamed or ulcerated nipples.
A mother protects her milk supply by pumping intermittently. Monitor weight gain. Supplement if required with feeding tools. Use for a short period if possible. Wean slowly if used for an extended period (over 7 – 10 days).
- If a baby is not gaining weight, look at history of mother: Breast surgery, PCOS and Hypothyroidism.
- Improve latch.
- Ensure mum recognizes effective feeding and swallowing
- Breast Compression towards end of feed.
- Consider galactogogues.
- Consider additional feeds by feeding – tube: further stimulates supply.
There should be a Weight Gain of 155 grams per week. Fluid requirements: 160 mls per Kilo e.g 4 kg baby requires 640 mls per 24 hours, which equates to 80mls per feed.
Useful Handout here.
Barbara Noonan Sexton October 2019.
Barbara received a bursary of €50 from ALCI to attend the 2019 ALCI Conference.