GOLD Learning Speakers

Institutions:  Department of Nursing, Laniado Hospital, Netanya, Israel, Halav-EM Breastfeeding Clinic Background: As far as anterior tongue tie is concerned, there is a growing, vast body of knowledge that has been validated. As for posterior tongue tie, the scientific evidence is lacking and the assessment tools are not uniform among practitioners. Medical diagnoses are not part of the scope of practice of Lactation Consultants. Hence, there is a lot of confusion among professionals (both Drs and Lactation Consultants), resulting in over diagnosis and over treatment on the one hand, and also under treatment on the other. Aims: To present a unique perspective of an experienced Lactation Consultant who is also a dentist, experienced in diagnosing and treating various types of tongue ties. Narrative: The discussion will focus on the clinical dilemmas regarding releasing posterior tongue ties and their implications for breastfeeding in newborns as well as in older babies. Clinical cases of babies with posterior tongue ties will be shown to demonstrate how exclusive breastfeeding can be achieved in clinical cases with posterior tongue ties that were not released. Cases of anterior and posterior tongue ties that had been released although breastfeeding was going well will also be shown. In these cases, additional factors were taken into account, such as the palate structure and the additional consequences that Ankyloglossia may have later in life. Conclusions: In some cases of posterior tongue ties, good breastfeeding counseling can make the action of releasing the tongue redundant. However, then we are left to consider conservatively what other effects Ankyloglossia may have on our body.

Background As far as anterior tongue tie is concerned, there is a growing, vast body of knowledge that has been validated. As for posterior tongue tie, the scientific evidence is lacking, and the assessment tools are not uniform among practitioners. Medical diagnoses are not part of the scope of practice of Lactation Consultants. Hence, there is a lot of confusion among professionals (both Drs and Lactation Consultants), resulting in over diagnosis and over treatment on the one hand, and under treatment on the other. Purpose • To present a unique perspective of an experienced Lactation Consultant who is also a dentist, experienced in diagnosing and treating various types of tongue ties • To share a conservative clinical thinking process • To examine the effects of frenotomy on breastfeeding and nipple pain • To compare the effect of frenotomy on anterior verses posterior tongue ties. Approach The discussion will focus on the clinical dilemmas regarding releasing posterior tongue ties and their implications for breastfeeding. Clinical cases of babies with posterior tongue ties will be shown to demonstrate how exclusive breastfeeding can be achieved in clinical cases with posterior tongue ties that were not released. Cases of anterior and posterior tongue ties that had been released although breastfeeding was going well will also be shown. Conclusions Frenotomy is a predictable procedure for anterior tongue tie. However with posterior tongue ties, the outcome of nipple pain and breastfeeding latch are influenced also by different factors.