Tongue Tie Talk · Maternal and Infant Challenges ... General Practitioner (GP) or HV referral to...
Transcript of Tongue Tie Talk · Maternal and Infant Challenges ... General Practitioner (GP) or HV referral to...
Tongue Tie Talk
Ankyloglossia
By Claire Carter
October 2017
Tongue Tie
Lingual Frenulum
Definition
• Ankyloglossia Greek for “crooked tongue”
• Lingual frenulum, membrane attached
underneath the tongue restricting range of
movement
• Tongue maybe restricted in forward protrusion,
lateral movement and elevation affecting feeding
• May result in feeding speech and oral/dental
hygiene problems Watson Genna(2002)
Incidence
• Messener et al (2000)……4.8%
• Griffiths (2000)……………10%
• Male to female ratio of 2.6:1.0
• (Messner et al, 2000)
• Family history in 50% of cases
• (LCGB, 2001)
Does it really matter?
• In Messner’s study (2000) of 1041 neonates,
4.8% (50 babies) were defined as having
tongue-tie. Of these, 25% were described by
their mothers as having breastfeeding problems
as opposed to 3% in the control group.
• In Fernando’s study (1998) of 200 babies with
tongue-tie, 20% of mothers had difficulty
breastfeeding and “nipple problems that
occurred were often serious enough to stop
them breastfeeding.”
Breastfeeding does matter • Breast feeding very important to wellbeing of
infant and mothers (WHO/Unicef 2003)
• Reduces the risk of hospital admissions for GI
and Respiratory infection (Quigley et al 2007)
• Reduces ear infection (Fewtrell 2004) and urinary
infection (Marild et al 1990)
• Long term reduction blood pressure, diabetes
cholesterol and cognitive development (Horta et al 2007)
• Women give up due to painful nipples, unable to
latch properly and insufficient milk (Bolling et al IFS 2005)
Maternal and Infant Challenges
MOTHER BABY
Sore or damaged nipples Difficulty in latching or maintaining the latch
Nipple pain while feeding Clicking noises while feeding
Mastitis/breast infections (from poor
drainage)
Fussiness at the breast
Diminished milk supply Frequent or prolonged feeding
Exhaustion from frequent feeding Prolonged physiological jaundice
Psychological effects from Failure to
establish breastfeeding
Colic due to poor attachment
Excessive early weight loss/failure to gain weight
Reproduced courtesy of LCGB from leaflet
“Breastfeeding and Tongue-tie”(2001)
Ros Escott, with permission Trisha Whisker, with permission
Hazlebaker’s assessment tool for lingual frenulum function
Appearance Items Function Items Appearance of tongue when lifted Lateralization
Round or square – 2 Complete – 2
Slight cleft in tip - 1 Body of tongue but not tongue-tip – 1
Heart or v shaped - 0 None - 0
Elasticity of frenulum Lift of tongue
Very elastic – 2 Tip to mid-mouth – 2
Moderately elastic – 1 Only edges to mid-mouth – 1
Little or no elasticity – 0 Tip stays at lower alveolar ridge or rises to
mid-mouth only with jaw closure – 0
Length of lingual frenulum when
tongue lifted
Extension of tongue
> 1cm – 2 Tip over lower lip – 2
1cm – 1 Tip over lower gum only – 1
<1cm – 0 Neither of the above or anterior or mid-
tongue humps – 0
Attachment of lingual frenulum to
tongue
Spread of anterior tongue
Posterior to tip – 2 Complete – 2
At tip – 1 Moderate or partial – 1
Notched tip – 0 Little or none – 0
Attachment of lingual frenulum to
alveolar ridge
Cupping
Attachment to floor of mouth or well below
ridge – 2
Entire edge, firm cup –
Attached just below ridge – 1 2 Side edges only, moderate cup – 1
Attached at ridge – 0 Poor or no cup – 0
Peristalsis
Complete anterior to posterior – 2
Partial, originating posterior to tip – 1
None or reverse motion – 0
Snapback
None – 2
Periodic – 1
Frequent or with each suck - 0
BTAT Scoring system
Ingram J, et al. Arch Dis Child Fetal Neonatal Ed 2015;100:F344–F348.
doi:10.1136/archdischild-2014-307503
Bristol Tongue
Assessment Tool
(BTAT)
0 1 2 Score
Tongue tip
appearance
Heart shaped Slight cleft/notched Rounded
Attachment of
frenulum to lower
gum ridge
Attached at top of
gum ridge
Attached to inner
aspect of gum
Attached to floor
of mouth
Lift of tongue with
mouth wide
(crying)
Minimal tongue lift Edges only to mid-
mouth
Full tongue lift to
mid-mouth
Protrusion of
tongue
Tip stays behind
gum
Tip over gum Tip can extend
over lower lip
What can you do ?
• If concerned about any baby’s feeding
• Refer locally BfN list found in the PCHR
• If frenulum suspected refer to RBH BFC
0118322 7295 OR email [email protected]
• Meantime encourage expressing to safeguard
the supply
Referral procedure
Feeding problem with Tongue Tie identified
Royal Berkshire Hospital (RBH)
Midwife/Health Visitor (HV) support with positioning and attachment & signpost to peer support at local drop
in group. Encourage mother to safeguard her milk supply by expressing milk as necessary.Many West Berkshire, Wokingham and Reading mothers can access the Breastfeeding Network Peer Support Project by phoning 0750 146 6818
or email: [email protected] (for all areas mentioned above)
Baby over 6 weeksGeneral Practitioner (GP) or HV referral to Mr W
Flannery Paediatric Surgeon, RBH for assessment
and probable tongue tie release.
Fax 0118 322 7147 or phone 0118 322 3051
OR email [email protected] subject heading
Tongue Tie PatientsGP ensure 6/52 check completed prior to procedure
Baby under 6 weeksParent self-refer to Royal Berkshire Hospital
Breast Feeding Clinic (BFC) for assessment.
If Frenulotomy is needed an appointment will
then be made for the procedure.
Ring 0118 322 7295
For more advice contact RBH Infant feeding team: 0118 322 8314 [email protected]
Other centres offering assessment and treatment of Tongue Tie listed at www.babyfriendly.org.uk
Local HV & /or continued peer support as necessary. Record in Personal Child Health Record and electronic record
.
Patient Information Leaflet
•
RBH audit results
• 1430 snipped since 2008 - March 2017
• 3% averages 200/year snipped by midwives
• Average 60% still BF at 3M
• Recent parent surveys reported that they wanted it
done as soon a possible
• Now weekly clinics
• Now cover in Mr Flannery’s absences
Take Home Messages
• Feeding assessment on all babies
• Support Feeding
• Safeguard supply
• Refer to BFC/Mr Flannery for further
assessment
• Decision to snip is based on feeding
assessment in presence of tongue tie
• Continued Support
• Ballard J, Auer C, Khoury J (2002) Ankyloglossia: Assessment Incidence and Effect of Frenuloplasty on the
Breastfeeding Dyad. Available from: http://www.paediatrics.ofg/cgi/content/abstract/110/5/e63; (last accessed Mar 10)
BTAT Scoring system
Ingram J, et al. Arch Dis Child Fetal Neonatal Ed 2015;100:F344–F348. doi:10.1136/archdischild-2014-307503
• Bolling K, Grant C, Hamlyn B (2007) Infant Feeding Survey 2005 London: Information Centre
• DH Infant Feeding Survey 2010 London: Information Centre
• Fernando C (1998) Tongue-tie from confusion to clarity. A guide to the diagnosis and treatment of ankyloglossia.
Sydney: Tandem Publications
• Fewtrell MS (2004) The Long-term benefits of having been breastfeed. Current Paediatrics 14:97-103
• Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartman PE, Simmer K. (2008) Frenulotomy for Breastfeeding Infants
with Ankyloglossia: Effect on Milk Removal and Sucking Mechanism as Imaged by Ultrasound .Paediatrics 122;e188-
e194
• Griffiths DM. (2004) Do tongue ties affect breastfeeding? Journal Human Lactation 20(4):409-414
• Hazelbaker AK (1993) The Assessment Tool for Lingual Frenulum Function (ATLFF): Use in a Lactation Consultant
Private Practice. CA: Pacific Oaks College Thesis
• Horta BL, Bahl R, Martines JC,(2007) Evidence on the long-term effects of breastfeeding: systemic review and meta-
analysis. Geneva:WHO
• Lactation consultants of Great Britain (2001) Breastfeeding and Tongue-tie. www.lcgb.org/.uk
• Marild S, Jodal U, Hanson LA. (1990) Breastfeeding and urinary tract infection. Lancet 336(8720):942
• Messner AH, Lalakea M, Aby J, Macmahon J, Blair E. (2000) Ankyloglossia: incidence and associated feeding
difficulties. Archives of Otolaryngology-Head Neck Surgery 126(1):36-39
• Newcomb PA, Storer BE, Longneck MP. (1994) Lactation and a reduced risk of premenopausal breast cancer. New
England Journal of Medicine 330(2):81-7
• NICE (2006) Routine Postnatal care of women and their babies. London NICE
• Paton LM, Alexander JL, Nowson CA (2003) Pregnancy and lactation have no long-term deleterious effects on
measures of bone mineral in healthy women: a twin study. American Journal of Clinical Nutrition 77(3):707-14
• Quigley MA, Kelly YJ, Sacker A. (2007) Breastfeeding and hospitalisation for diarrheal and respiratory infection in the UK
Millenium Cohort Study. Paediatrics 119(4):e 837-42
• Rosenblatt KA, Thomas DB. (193) Lactation and risk of epithelial ovarian cancer: The WHO Collaborative Study of
Neoplasia and Steroids Contraceptives. International Journal of Epidemiology 22(2):192-7
• Watson-Genna C (2002) Tongue Tie and Breastfeeding Available
at:http://.illi.org/llleaderweb/LV/LVAAprMay02p27.html(accessed Mar 10)
• Wooldridge MW. (1986) The anatomy of infant sucking. Midwifery 2(4):164-171
• WHO/UNICEF (2003) Global Strategy for infant and young child feeding Geneva: WHO
References