Debate over tongue tie procedures in babies continues. Here’s why it can be beneficial for some infants
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There is increasing media interest about surgical procedures on new babies for tongue tie. Some hail it as a miracle cure, others view it as barbaric treatment, though adverse outcomes are rare.
Tongue tie occurs when the tissue under the tongue is attached to the lower gum or floor of the mouth in a way that can restrict the movement or range of the tongue. This can impact early breastfeeding in babies. It affects an estimated 8% of children under one year of age.
While there has been an increase in tongue tie releases (also called division or frenotomy), it’s important to keep this in perspective relative to the increase in breastfeeding rates.
The World Health Organization recommends exclusive breastfeeding for the first six months of life, with breastfeeding recommended into the second year of life and beyond for the health of mother and baby as well as optimal growth. Global rates of breastfeeding infants for the first six months have increased from 38% to 48% over the past decade. So, it is not surprising there is also an increase in the number of babies being referred globally with breastfeeding challenges and potential tongue tie.
An Australian study published in 2023 showed that despite a 25% increase in referrals for tongue tie division between 2014 and 2018, there was no increase in the number of tongue tie divisions performed. Tongue tie surgery rates increased in Australia in the decade from 2006 to 2016 (from 1.22 per 1,000 population to 6.35) for 0 to 4 year olds. There is no data on surgery rates in Australia over the last eight years.
Tongue tie division isn’t always appropriate but it can make a big difference to the babies who need it. More referrals doesn’t necessarily mean more procedures are performed.
How tongue tie can affect babies
When tongue tie (ankyloglossia) restricts the movement of the tongue, it can make it more difficult for a baby to latch onto the mother’s breast and painlessly breastfeed.
Earlier this month, the International Consortium of oral Ankylofrenula Professionals released a tongue tie position statement and practice guideline. Written by a range of health professionals, the guidelines define tongue tie as a functional diagnosis that can impact breastfeeding, eating, drinking and speech. The guidelines provide health professionals and families with information on the assessment and management of tongue tie.
Tongue tie release has been shown to improve latch during breastfeeding, reduce nipple pain and improve breast and bottle feeding. Early assessment and treatment are important to help mothers breastfeed for longer and address any potential functional problems.
Where to get advice
If feeding isn’t going well, it may cause pain for the mother or there may be signs the baby isn’t attaching properly to the breast or not getting enough milk. Parents can seek skilled help and assessment from a certified lactation consultant or International Board-Certified Lactation Consultant who can be found via online registry.
Alternatively, a health professional with training and skills in tongue tie assessment and division can assist families. This may include a doctor, midwife, speech pathologist or dentist with extended skills, training and experience in treating babies with tongue tie.
When access to advice or treatment is delayed, it can lead to unnecessary supplementation with bottle feeds, early weaning from breastfeeding and increased parental anxiety.
Getting a tongue tie assessment
During assessment, a qualified health professional will collect a thorough case history, including pregnancy and birth details, do a structural and functional assessment, and conduct a comprehensive breastfeeding or feeding assessment.
They will view and thoroughly examine the mouth, including the tongue’s movement and lift. The appearance of where the tissue attaches to the underside of the tongue, the ability of the tongue to move and how the baby can suck also needs to be properly assessed.
Treatment decisions should focus on the concerns of the mother and baby and the impact of current feeding issues. Tongue tie division as a baby is not recommended for the sole purpose of avoiding speech problems in later life if there are no feeding concerns for the baby.
Treatment options
The Australian Dental Association’s 2020 guidelines provide a management pathway for babies diagnosed with tongue tie.
Once feeding issues are identified and if a tongue tie is diagnosed, non-surgical management to optimise positioning, latch and education for parents should be the first-line approach.
If feeding issues persist during follow-up assessment after non-surgical management, a tongue tie division may be considered. Tongue tie release may be one option to address functional challenges associated with breastfeeding problems in babies.
There are risks associated with any procedure, including tongue tie release, such as bleeding. These risks should be discussed with the treating practitioner before conducting any laser, scissor or scalpel tongue tie procedure.
Post-release support by a certified lactation consultant or feeding specialist is necessary after a tongue tie division. A post-release treatment plan should be developed by a team of health professionals including advice and support for breastfeeding to address both the mother and baby’s individual needs.
We would like to acknowledge the contribution of Raymond J. Tseng, DDS, PhD, (Paediatric Dentist) to the writing of this article.
Sharon Smart, Lecturer and Researcher (Speech Pathology) – School of Allied Health, Curtin University; David Todd, Associate Professor, Neonatology, ANU Medical School, Australian National University, and Monica J. Hogan, PhD student, ANU School of Medicine and Psychology, Australian National University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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This Week In Brain News
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While reading this week’s health news, we’ve singled out three brain-related articles to feature here:
Bad breath now, bad brain later?
Researchers found links between oral microbiome populations, and changes in brain function with aging. The short version is indeed “bad breath now = bad brain later”, but more specifically:
- People who had large numbers of the bacteria groups Neisseria and Haemophilus had better memory, attention and ability to do complex tasks
- People who had higher levels of Porphyromonas had more memory problems later
- People with a lot of Prevotella tended to predict poorer brain health and was more common in people who carry the Alzheimer’s Disease risk gene, APOE4.
If you’ve never heard of half of those, don’t worry: mostly your oral microbiome can take care of itself, provide you consistently do the things that create a “good” oral microbiome. So, see our “related” link below:
Read in full: Mouth bacteria may hold insight into your future brain function
Related: Improve Your Oral Microbiome
Weeding out a major cause of cognitive decline
Cannabis may be great for relaxation, but regular use is not great for mental sharpness, and recent use (even if not regular, and even if currently sober) shows a similar dip in cognitive abilities, especially working memory. In other words, cannabis use for relaxation should be at most an occasional thing, rather than an everyday thing.
While the results of the study are probably not shocking, something that we found interesting was their classification system:
❝Heavy users are considered young adults who’ve used cannabis more than 1000 times over their lifetime. Whereas, using 10 to 999 times was considered a moderate user, and fewer than 10 times was considered a non-user.❞
Which—while being descriptive rather than prescriptive in nature—suggests that, to be on the healthy end of the bell curve, an occasional cannabis-user might want to consider “if you have 999 uses before you hit the “heavy user” category, project those 999 uses against your life expectancy, and moderate your use accordingly”. In other words, a person just now starting use, who expects to live another 40 years, would calculate: 999/40 = 24.9 uses per year, so call it 2 per month. A person who only expects to live another 20 years, would do the same math and arrive at 4 per month.
Disclaimer: the above is intended as an interesting reframe, and a way of looking at long-term cannabis use while being mindful of the risks. It is not intended as advice. This health-conscious writer personally has no intention of using at all, unless perhaps in some bad future scenario in which I have bad chronic pain, I might consider that pain relief effects may be worth the downsides. Or I might not; I hope not to be in the situation to find out!
Read in full: Largest study ever done on cannabis and brain function finds impact on working memory
Related: Cannabis Myths vs Reality
Mind-reading technology improves again
We’ve come quite a way from simple 1/0 reads, and basic cursor control! Now, researchers have created a brain decode that can translate a person’s thoughts into continuous text, without requiring the person to focus on words—in other words, it verbalizes the ideas directly. Most recently, the latest upgrade means that while previously, the device had to be trained on an individual brain for many hours, now the training/calibration process takes only an hour:
Read in full: Improved brain decoder holds promise for communication in people with aphasia
Related: Are Brain Chips Safe?
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Apricot vs Banana – Which is Healthier?
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Our Verdict
When comparing apricot to banana, we picked the banana.
Why?
Both are great, and it was close!
In terms of macros, apricot has more protein, while banana has more carbs and fiber; both are low glycemic index foods, and we’ll call this category a tie.
In the category of vitamins, apricot has more of vitamins A, C, E, and K, while banana has more of vitamins B1, B2, B3, B5, B6, B7, B9, and choline, giving banana the win by strength of numbers. It’s worth noting though that apricots are one of the best fruits for vitamin A in particular.
When it comes to minerals, apricot has slightly more calcium, iron, and zinc, while banana has a lot more magnesium, manganese, potassium, and selenium, meaning a moderate win for banana here.
Adding up the sections makes for an overall win for banana—but of course, by all means enjoy either or both!
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← we argue for apricots as bonus number 9 on the list
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Which gut drugs might end up in a lawsuit? Are there really links with cancer and kidney disease? Should I stop taking them?
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Common medicines used to treat conditions including heartburn, reflux, indigestion and stomach ulcers may be the subject of a class action lawsuit in Australia.
Lawyers are exploring whether long-term use of these over-the-counter and prescription drugs are linked to stomach cancer or kidney disease.
The potential class action follows the settlement of a related multi-million dollar lawsuit in the United States. Last year, international pharmaceutical company AstraZeneca settled for US$425 million (A$637 million) after patients made the case that two of its drugs caused significant and potentially life-threatening side effects.
Specifically, patients claimed the company’s drugs Nexium (esomeprazole) and Prilosec (omeprazole) increased the risk of kidney damage.
Doucefleur/Shutterstock Which drugs are involved in Australia?
The class of drugs we’re talking about are “proton pump inhibitors” (sometimes called PPIs). In the case of the Australian potential class action, lawyers are investigating:
- Nexium (esomeprazole)
- Losec, Asimax (omeprazole)
- Somac (pantoprazole)
- Pariet (rabeprazole)
- Zoton (lansoprazole).
Depending on their strength and quantity, these medicines are available over-the-counter in pharmacies or by prescription.
They have been available in Australia for more than 20 years and are in the top ten medicines dispensed through the Pharmaceutical Benefits Scheme.
They are used to treat conditions exacerbated by stomach acid. These include heartburn, gastric reflux and indigestion. They work by blocking the protein responsible for pumping acid into the stomach.
These drugs are also prescribed with antibiotics to treat the bacterium Helicobacter pylori, which causes stomach ulcers and stomach cancer.
This class of drugs is also used with antibiotics to treat Helicobacter pylori infections. nobeastsofierce/Shutterstock What do we know about the risks?
Appropriate use of proton pump inhibitors plays an important role in treating several serious digestive problems. Like all medicines, there are risks associated with their use depending on how much and how long they are used.
When proton pump inhibitors are used appropriately for the short-term treatment of stomach problems, they are generally well tolerated, safe and effective.
Their risks are mostly associated with long-term use (using them for more than a year) due to the negative effects from having reduced levels of stomach acid. In elderly people, these include an increased risk of gut and respiratory tract infections, nutrient deficiencies and fractures. Long-term use of these drugs in elderly people has also been associated with an increased risk of dementia.
In children, there is an increased risk of serious infection associated with using these drugs, regardless of how long they are used.
How about the cancer and kidney risk?
Currently, the Australian consumer medicine information sheets that come with the medicines, like this one for esomeprazole, do not list stomach cancer or kidney injury as a risk associated with using proton pump inhibitors.
So what does the evidence say about the risk?
Over the past few years, there have been large studies based on observing people in the general population who have used proton pump inhibitors. These studies have found people who take them are almost two times more likely to develop stomach cancer and 1.7 times more likely to develop chronic kidney disease when compared with people who are not taking them.
In particular, these studies report that users of the drugs lansoprazole and pantoprazole have about a three to four times higher risk than non-users of developing chronic kidney disease.
While these observational studies show a link between using the drugs and these outcomes, we cannot say from this evidence that one causes the other.
Researchers have not yet shown these drugs cause kidney disease. crystal light/Shutterstock What can I do if I’m worried?
Several digestive conditions, especially reflux and heartburn, may benefit from simple dietary and lifestyle changes. But the overall evidence for these is not strong and how well they work varies between individuals.
But it may help to avoid large meals within two to three hours before bed, and reduce your intake of fatty food, alcohol and coffee. Eating slowly and getting your weight down if you are overweight may also help your symptoms.
There are also medications other than proton pump inhibitors that can be used for heartburn, reflux and stomach ulcers.
These include over-the-counter antacids (such as Gaviscon and Mylanta), which work by neutralising the acidic environment of the stomach.
Alternatives for prescription drugs include nizatidine and famotidine. These work by blocking histamine receptors in the stomach, which decreases stomach acid production.
If you are concerned about your use of proton pump inhibitors it is important to speak with your doctor or pharmacist before you stop using them. That’s because when you have been using them for a while, stopping them may result in increased or “rebound” acid production.
Nial Wheate, Professor and Director – Academic Excellence, Macquarie University; Joanna Harnett, Senior Lecturer – Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, and Wai-Jo Jocelin Chan, Pharmacist and Associate Lecturer, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Lyme Disease At-A-Glance
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Good info as always…was wondering if you have any recommendations for fighting Lyme disease naturally along wDr advice? Dr’s aren’t real keen on alternatives so always interested. Thanks❞
That depends on whether we’re looking at prevention or cure!
Prevention:
- Try not to get bitten by Lyme-disease-carrying ticks. Boots and long socks are your friends. As are long-gauntletted gloves for gardening.
- If you are in a high-risk area and/or engage in high-risk activities, check your body daily.
- This is because it usually takes 36–48 hours of being attached for a tick to cause an infection
- Obviously best if you can get a partner or close friend to help you with this, unless you have mastered some advanced pretzel positions of yoga.
- Contrary to many folk remedies, the safest way to remove a tick is with tweezers (carefully!).
- If you find and remove a tick, or otherwise suspect you have developed symptoms, go to your doctor immediately (not next week; today; time really counts for this).
Cure:
- No. Sorry. Regretfully, antibiotics are the only known effective treatment.
However! As with almost any kind of recovery, getting good rest, including good quality sleep, will hasten things. Also sensible is reducing stress if possible, and anything that could worsen inflammation.
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Make Time – by Jake Knapp and John Zeratzky
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We live in an information-saturated world, and we have done for so long now that it’s easy to forget: we did not evolve for this!
It’s easy to say “unplug”, but the reality is:
We also have to actually function in this fast-paced info-dense world whether we want to or not, and we are expected to be able to handle it.
So… How?
Appropriately enough, authors Knapp and Zeratsky present the answer in a skimmer-friendly fashion, with summaries and bullet points and diagrams and emboldened text forease of speed-reading. Who uses such tricks?!
In short, less living life in “default mode scramble” and more about making an impact in the ways you actually want to, for you.
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Get Well, Stay Well – by Dr. Gemma Newman
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Dr. Gemma Newman is a GP (British equivalent of what in America is called a “family doctor”) who realized she was functioning great as a diagnostic flowchart interpreter and pill dispensary, but not actually doing much of what she got into the job to do: helping people.
Her patients were getting plenty of treatments, but not getting better. Often, they were getting worse. And she knew why: they come in for treatment for one medical problem, when they have six and a half medical problems probably a stack of non-medical problems that contributed to them,
So, this book sets out to do what she tries to do in her office, but often doesn’t have the time: treat the whole person.
In it, she details what areas of life to look at, what things are most likely to contribute to wellness/unwellness (be those things completely in your power or not), and how to—bit by bit—make all the parts better, and keep them that way.
The writing style is conversational, and while it’s heavily informed by her professional competence, there’s no arcane science here; it’s more about the system of bringing everything together harmoniously.
Bottom line: if you think there’s more to wellness than can be represented on an annual physicals chart, then this is the book to help you get/keep on top of things.
Click here to check out Get Well, Stay Well, and do just that!
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