Tongue tie / ankyloglossia evaluation

[Flavio Martins]

Hi guys, good afternoon!

Today, at Twitter, Nick Embleton brought a discussion about tongue-tie (TT) and breastfeeding (BF). I've been thinking about it for some time now, since I'm very worried about overdiagnose of Ankyloglossia here, in Brazil. I'd like to know what's the tongue tie policie at your facilitys.

1) do you evaluate every baby for TT or just those who have dificult in BF?

A: in Brazil, TT evaluation is one of the mandatory triage before discharge from the "well baby nursery"

2) who performes the evaluation?

A: in my hospital, both the pediatrician and the speech therapist (ST). Usually, ST's evaluation finds higher incidence of Ankyloglossia.

3) in those babys with Ankyloglossia, at what age they undergo frenulotomy?

A: before 48 hours of life.

Thank you for your time!

[Stefan Johansson]

 

Thanks Flavio for bringing this up!

In Stockholm, it is practically only midwifes or parents that brings this up, because of breast feeding difficulties or family history. So, prevalence of the problems depends on where and whom you work with. In my previous hospital, tongue ties were less often seen as a problem, compared to my current work place where it is a rather common issue brought up.

The previous procedure was that the attending neonatologist did the frenulotomy (with glucose pain management only), but now cases are referred to an ENT doc.

But I agree with a comment in the Tw thread - evidence... not too much of that IMHO, but the procedure is simple and quick and can be done under good spray analgesia.

 

[satyen75]

Hi Flavio.

We are not doing routine evaluation for all babies but if there is breastfeeding and latch problems then that baby is evaluated by a pediatrician only for the tongue tie. Very rarely frenulotomy is advised if it is very sever and that too is done by Pediatric Surgeon. Not sure what are the benefits of this . We do not tend to do the procedure as early as 48 hours.

Regards

Dr Satyen K Hemrajani

Neonatologist, Jaipur, Rajasthan, INDIA

 

[Abdul kasim jaleel ahmed]

We don’t do evaluations for tongue tie as a part of feeding issues 

Don’t recommend for the procedure that too in early life

many centers commercializing the procedure 

needs strong EBM support 

 

[Flavio Martins]

On 2/16/2022 at 3:39 PM, Stefan Johansson said:

 

Thanks Flavio for bringing this up!

In Stockholm, it is practically only midwifes or parents that brings this up, because of breast feeding difficulties or family history. So, prevalence of the problems depends on where and whom you work with. In my previous hospital, tongue ties were less often seen as a problem, compared to my current work place where it is a rather common issue brought up.

The previous procedure was that the attending neonatologist did the frenulotomy (with glucose pain management only), but now cases are referred to an ENT doc.

But I agree with a comment in the Tw thread - evidence... not too much of that IMHO, but the procedure is simple and quick and can be done under good spray analgesia.

 

Thank you for your answer.

I agree, it's a simple and quick procedure. I've done It, literally, dozens of times. I recall one case of secundary infeccion and one bad bleeding.

But, I keep thinking: is It really necessary? And If so, are we doing It at the right time? Am I doing harm?

I know It's a difficult subject for RCT, but, still, It bugs me.

On 2/23/2022 at 9:22 AM, Abdul kasim jaleel ahmed said:

We don’t do evaluations for tongue tie as a part of feeding issues 

Don’t recommend for the procedure that too in early life

many centers commercializing the procedure 

needs strong EBM support 

 

Thank Abdul.

I work in 2 public hospitals, so It's not about money, but lt may be about some kind of confirmation bias from the speech therapists. I think, maybe, the children that go to speech therapist's clinic are those who are having problems in breastfeeding. Some of them have tongue-tie. Than, the speech therapist makes the assumption that every child with tongue-tie Will have problems in breastfeeding. 

There is a Clinical protocol for tongue-tie evaluation, Martinelli's (2013), that find out 23% of tongue-tie. I mean, is It even possible? By a evolucionary perspective, are 1/4 of babys not able to breastfeeding without frenulotomy?