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The confusions and controversies around the Tongue and Lip ties!

  • When we talk about babies with oral restrictions, what does it mean? 
  • My LC tells me my baby has a tie, my paediatrician says it’s nothing, I’m about what to do! confused
  • Why is there so much controversy in it?
  • Why is it that we are seeing so many cases these days? 
  • Is frenotomy a complete solution. I hear many times symptoms do not get better or can even worsen post frenotomy?

If you have any of these questions, Read on….

At the outset it is very important to understand a few facts:

  1. Feeding is an all-body function so just looking at the mouth will not give us the complete assessment of the situation. So even if your baby has obvious ties, there is much more that needs to be assessed and worked on.
  2. We need to look at the whole body.
  3. Breastfeeding is a complex interplay of many factors (Birth, earliest skin to skin contact, initial breastfeeding experiences, infant anatomy, maternal feelings, maternal knowledge, support to the mother, and many more)
  4. There are large knowledge gaps in the health care workers, in relation to skilled lactation support.
  5. Even among lactation Professionals, clinical skills are widely divergent, depending on their qualifications and experiences.

With the above facts in mind lets discuss further.

Oral restrictions in the baby are the Frenula (mucosal connections) that can be present under the upper lip(labial frenulum) and /or under the tongue (lingual frenulum) and or between the cheek and gum(buccal frenulum).They can cause problem if they restrict the normal functioning of tongue and other muscles during the process of breastfeeding / bottle feeding.

There is so much controversy around it because of many reasons.

  1. Mostly it’s something that we have started exploring recently and most of the health care providers have not had much knowledge and experience about these issues.
  2. As oral restrictions are not the ONLY reason to cause breastfeeding difficulties, If we just cut these restrictions, without addressing the other issues as well, the challenges do not settle (or at times worsen), thus making people feel that corrective procedures are useless.
  3. Similarly, if other factors are worked upon, in quite a lot of dyads, even in the presence of oral restrictions, the challenges settle, thus the hypothesis that we do not need to do any procedures!
  4. There are not much conclusive studies on these topics.

So, most of the clinicians/ providers see things based on their perspective and experiences only and give their opinion accordingly. What is needed is a comprehensive assessment of the whole mother baby dyad, so that an idea of all that’s going sub optimally can be assessed and thus corrected.

This needs a team of trained professionals working together and thus can mean more expenses.

In a country like ours, there is a scarcity of teamwork or rather appropriately trained professionals (except maybe in major metro cities) and also there is lots of skepticism and hesitancy in families against paying for breastfeeding support!

To understand it further let’s talk about a few factors that can have implications on breastfeeding.

1 Positioning of the baby inside the uterus

A baby in a vertex position, with ample amniotic fluid, no cord issues, Versus a baby who had positioning issues in utero (eg: Cord around neck, oblique lie, twin pregnancy, uterine myomas etc), both can behave differently while breastfeeding.

2 Type of birth:

A calm comfortable spontaneous vaginal birth, with baby being kept skin to skin with the parent, generally results in baby latching on his/ her own without any need of support..

(while we are at it, lets discuss birth here too! Contrary to popular belief, we ourselves are the people most responsible for our changing births and increasing rates of cesarean sections.For example,Our dietary habits, Our sedentary lifestyles, Lack of knowledge about pregnancy and child birth…..are a few factors)

Versus an augmented labor with lots of non-natural uterine contractions, Interventions like fundal pressure/ forceps / ventouse/cesarean…..resulting in possible physical and mental trauma, separation , delayed initiation of breastfeeding. Versus a Cesarean section….All have different impact on baby’s natural reflexes and thus on baby’s breastfeeding efficiency.

3 Early days after birth

The kind of breastfeeding knowledge and motivation the family has. If they have had Antenatal Breastfeeding education.

The kind of support / information they got post birth.

4 Later days how the baby is being kept, like if the baby is kept mostly swaddled on his or her back, or mostly on the parents’ body. If the baby held and soothed each time the baby is distressed. Is the baby kept lots in baby carriers / car seats etc

For a mother and baby to breastfeed well, we need a healthy and comfortable mom a healthy and comfortable baby and ample opportunities to breastfeed on demand.

Anything that interferes with it can cause breastfeeding challenges.

So if we just look at the frenulums and overlook the other issues, problems will remain.On the other hand if we sort out the other challenges and then if the challenges persist , we get the frenulums corrected, we get optimal benefits!

COVID-19 Taking Care of your family- Protection First

How to protect you​r family

These are  few measures one can take to protect your loved ones…

  • Wash  hands frequently with soap and water for at least 20 seconds. If soap and water are not available, use  any hand sanitizer which as at least  60% alcohol.
  • Limit your close contact with people other than family members  by practicing social distancing. This means staying home as much as possible.
  • Keep children and elderly away from others who are sick or keep them home if they themselves are ill.
  • Educate everyone at home, especially kids to cough and sneeze into  their arm or elbow, not their hands. And to immediately wash hands even if they have accidentally coughed or sneezed into hands.
  • Clean and disinfect your home as usual using regular household cleaning sprays or wipes. No special solutions are needed.
  • Wash stuffed toys in the warmest water possible and sun-dry them.
  • Avoid touching your face, nostrils, eyes, etc; teach your children to do the same.
  • Avoid travel to highly infected areas.
  • Follow  restrictions laid down by local government authorities with 100% compliance

If your child has been exposed to COVID-19, or you are concerned about your child’s symptoms, call your pediatrician immediately.​​​​

Matter inspired by guidelines issued by American Academy of Pediatrics(AAP), CLICK Here to view more info by AAP.

Head Injury

Immediately after a fall, most children cry excessively for next few minutes because of the sudden fall, even if they are not having so much pain. So firstly, they should all be consoled and cuddled and reassured that every thing is OK. At times small children vomit due to excess cry, which is OK and should not be confused with vomit due to a head injury.

If there is any external injury and a bleeding is seen, then a compress the bleeding area withany clean cloth for FULL 10 minutes by Watch and DO NOT repeatedly remove the pressure to look for any bleeding, before 10 minutes are over.

If there is no external Injury and you can pin-point the site of Injury, apply a cold pack(Cold Gel pack or Cold hand towel) over that area for 10-15 minutes and give a dose of Paracetamol for pain relief.

If the Height of Fall is more than 4 feet, then the child must be evaluated by a doctor or Neurosurgeon.

For next 24 hrs after any head injury, following points should be looked for..

  • Any Abnormal movements
  • Not moving any part
  • Repeated vomiting
  • Not sleeping or very irritable
  • Sleeping excessively… to check this, child has to be checked in middle of sleep after 2-3 hrs of sleep.
  • Any bleeding or discharge from nose or ear Headaches
  • Abnormal speech
  • Any Abnormal Behaviour.

If any of these signs are seen in next 24 hrs of a Head Injury, they may suggest an Internal Injury and parents should report to the doctor.

Powders which boost milk supply

Every monday during my rounds of postnatal mothers and babies I am saddened and angered by the massive amounts of formula tins and jars of the so called “Ayurvedic powders supposed to boost the milk supply” I see on each bedside…

Why mostly on mondays… because sunday is the only day I am not around in the wards to give anticipatory guidance to moms.

I am not as much against these powders as I am by the negative impact prescribing these have on a new mother’s psychology…….adding something to build up milk supply, implies that the lady wasn’t producing enough….. what the new mum’s brain perceives is that she is incapable of fulfilling the needs of her baby! Then when there is breast fullness on Day 3/4 the credit goes to the powder….

Other harmful aspect is that the actual cause of baby staying dissatisfied at breast…. Which most commonly is a suboptimal latch goes unaddressed …

As a result their take home message is that the powder helped in making sufficient milk. So they started their breastfeeding journeys underconfident and insecure .

And if the latch is not good enough mom keeps having complaints that baby is dissatisfied or takes very long feeds or causes pain etc etc

Is there a solution to this? Fortunately yes!!

If everyone knew the simple basic principle of milk production, how to latch on a baby effectively and how to assess good milk transfer, we will not even need these powders.

Add to it a little more knowledge about a newborn’s tummy size, behaviour, significance skin to skin contact and technique hand expression… And we have a winning formula.

So in a nutshell..

Get information on breastfeeding from a good/ reputed Antenatal class when you are pregnant where they tell you about all these things before you deliver your baby and incase you face challenges after birth of your baby, get help from a trained lactation professional / LC.

PS: Till date, no scientific study has actually concluded that these powders actually boost milk supply!!

When to worry about bed wetting or nocturnal enuresis

Boys usually are dry by night by the age of 6 yrs, while girls are faster and achieve night control by 5 yrs age. So, after these ages, it is a matter of concern if your child is not dry in night. It is of even more concern if the child had started remaining dry in night for more than a year and now again is bed wetting in night. Worms in tummy are very unlikely to result in bed wetting and there are other more common causes like excess water intake, constipation, urine infection, excess TV watching or video games.

So, First of all, one has to identify these causes  and remove them or treat them. If still child continues bed wetting then we have to do bladder training for 4-6 months Lastly, if everything fails, then special medications are given to get the results. It is important to note that these special medications will be of no help if other factors as mentioned above are not taken care of and bladder training has not been attempted religiously for 4-6 months

YES ! FORMULA IS ANIMAL MILK and it can be contaminated!!

I am amazed by the sheer number of people who get surprized when I tell them that formula milk is animal milk. So people please know that formula milk is dried -powdered animal milk. Also it is NOT  a sterile powder, Yes you read it right….It is NOT Sterile …..Many a times bacterial contaminants ( and others as well) have been found in Formula milk boxes of multiple formula companies. Read more about it (contamination).

The way formula is portrayed knowingly or unknowingly in our society, most families believe it to be a good thing  a saviour ! A very sad state of affairs indeed because our money and  resources are being wasted in formula feeding. An ideal state of affairs would be where the hospital budget allocated for Formula, fuel, cleanwater etc is deviated towards training their staff ( Doctors , Nurses)  in the art and skill of breastfeeding support.

Pregnancy Breastfeeding Classes

There is a very wise old saying….”Prevention is better than cure”, I can see various examples of this in my day to day dealings with new moms and families.

Most of the times new moms/ Families have not been to any antenatal Breastfeeding Education Classes and many a times they have not read / heard anything about breastfeeding ! By the time I see them, baby has received many doses of Formula ( Animal milk) and or other things like honey etc and Baby most of the time is being fed through a bottle and mother’s confidence has totally gone  !

I often feel like asking the family that will they do the same when travelling to an unknown place? i.e. just reach there without acquiring any knowledge about the place? So how come you enter parenthood without researching about how and what to feed your baby!!

Studies have shown that people who learn about breastfeeding during pregnancy have better breastfeeding rates compared to those who haven’t. Pregnancy is the best time to learn about breastfeeding. Antenatal classes taken by a Trained LC can prepare you best by guiding you about what’s normal, what’s expected, how to breastfeed incase of caesarean, how to ensure baby is getting colostrum in case of separation etc.

If you are in city/ area where you don’t have access to a good LC, look for online sessions. Prepare well for one of the most important phases of your life…..It results in a happy and healthy Mom, baby, family and society.

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