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Tongue-Tie

I got a call from an American lady, living in Xian (over 600 km from where we live). She had encountered quite a few breastfeeding problems and had no one in her vicinity to turn to. After taking a detailed history and listening to her story, I gave her advice to make sure that the baby would get the nutrition he needed (baby’s weight gain was poor), that her milk supply improved and eventually to work towards complete breastfeeding. However, things didn’t work out as we had hoped. When she planned a trip to Shanghai, I put her into contact with a LC there. This LC discovered that the baby had a tongue-tie. The LC in Shanghai didn’t know anyone who would do a frenotomy (a simple snip of this band of tissue), which often resolves the breastfeeding problems caused by the tongue-tie. Even in Thailand this mother couldn’t find anyone who would do this procedure.

At the end of December my Chinese friend called for advice. She struggled with frequent, long feeds. Since she lives far away, I put her in contact with a LLL leader, but the problem remained. Mid February I had a chance to visit the family. I observed a good latch, some effective sucking, but lots of non-nutritive sucking at the breast as well. No wonder the feedings were taking so long. And the cause? Yes, indeed: a tongue-tie. We started calling around hospitals in this big city to try and find a place where they would do a frenotomy. No success. I asked the doctors in our own Evergreen medical team. They wouldn’t do it because of liability. Then I talked to head of the maternity ward of our local hospital. “Why don’t you do a presentation on tongue-ties for the whole staff next week”, was the response of doctor Chen. That did sound promising. The lesson was an eye-opener for the medical staff. They had never heard about it and had never realised how it can affect breastfeeding. But soon enough I found out that the doctors weren’t willing to do a frenotomy. “It’s not within our scope. It’s not our responsibility. We’ll refer to the children’s hospital in the city.” I actually did find some hospitals that will do a frenotomy, but always under GA, regardless of the age of the infant.

One day dr Chen grabs me by the arm as I do my breastfeeding rounds on the ward. “My daughter-in-law had a son yesterday. You have to go and see her!” As we walk along the corridor to her room, she adds: “I think he has a tongue-tie”. And sure enough, the baby has a tongue-tie. We talk about the need for a frenotomy. Two days later she tells me enthusiastically that she has done a frenotomy on her grandson: “Such a simple procedure! Feedings are much shorter now! Huge difference!” “Yes!” That is exactly what we needed. This doctor has now experienced first hand how simple and effective the procedure is! “That is awesome… It would be great if you would do it for other babies too!”, I encouraged her. Exactly a week later, I am asked to see a baby with a tongue-tie and ineffective feedings at the breast. A tongue-tie indeed. I informed the parents, I talked about the different options, including frenotomy. But the nurse is already shaking her head, indicating that dr Chen would not be willing to do the procedure.

A month later, I sit in the doctor’s office. I ask dr. Chen how her grandson is doing. As we talk, the topic of the tongue-tie comes up. “Can be treated so effectively. I don’t get it why in the world doctors want to do a frenotomy under GA”, are some of the comments made. I take up the opportunity to ask her again why she is not willing to do it for other babies. “Is it because of liability?” I ask. “No, most parents don’t want it. If they want it done, I’m willing to do it,” is her response. Later I discover that she actually has a point: quite a few parents are rather apprehensive to get the procedure done.

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