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.

So you’ve got yourself a gym membership or bought a set of home weights. Now what? With the sheer amount of confusing exercise advice out there, it can be hard to decide what to include in a weights routine.

It can help to know there are broadly two types of movements in resistance training (lifting weights): compound exercises and isolation exercises.

So what’s the difference? And what’s all this got to do with strength, speed and healthy ageing?

What’s the difference?

Compound exercises involve multiple joints and muscle groups working together.

In a push up, for example, your shoulder and elbow joints are moving together. This targets the muscles in the chest, shoulder and triceps.

When you do a squat, you’re using your thigh and butt muscles, your back, and even the muscles in your core.

It can help to think about compound movements by grouping them by primary movement patterns.

For example, some lower body compound exercises follow a “squat pattern”. Examples include bodyweight squats, weighted squats, lunges and split squats.

We also have “hinge patterns”, where you hinge from a point on your body (such as the hips). Examples include deadlifts, hip thrusts and kettle bell swings.

Upper body compounded exercises can be grouped into “push patterns” (such as vertical barbell lifts) or “pull patterns” (such as weighted rows, chin ups or lat pull downs, which is where you use a pulley system machine to lift weights by pulling a bar downwards).

In contrast, isolation exercises are movements that occur at a single joint.

For instance, bicep curls only require movement at the elbow joint and work your bicep muscles. Tricep extensions and lateral raises are other examples of isolation exercises.

Compound exercises can make daily life easier

Many compound exercises mimic movements we do every day.

Hinge patterns mimic picking something off the floor. A vertical press mimics putting a heavy box on a high shelf. A squat mimics standing up from the couch or getting on and off the toilet.

That might sound ridiculous to a young, fit person (“why would I need to practise getting on and off a toilet?”).

Unfortunately, we lose strength and muscle mass as we age. Men lose about 5% of their muscle mass per decade, while for women the figure is about 4% per decade.

When this decline begins can vary widely. However, approximately 30% of an adult’s peak muscle mass is lost by the time they are 80.

The good news is resistance training can counteract these age-related changes in muscle size and strength.

So building strength through compound exercise movements may help make daily life feel a bit easier. In fact, our ability to perform compound movements are a good indicator how well we can function as we age.

What about strength and athletic ability?

Compound exercises use multiple joints, so you can generally lift heavier weights than you could with isolation exercises. Lifting a heavier weight means you can build muscle strength more efficiently.

One study divided a group of 36 people into two. Three times a week, one group performed isolation exercises, while the other group did compound exercises.

After eight weeks, both groups had lost fat. But the compound exercises group saw much better results on measures of cardiovascular fitness, bench press strength, knee extension strength, and squat strength.

If you play a sport, compound movements can also help boost athletic ability.

Squat patterns require your hip, knee, and ankle to extend at the same time (also known as triple extension).

Our bodies use this triple extension trick when we run, sprint, jump or change direction quickly. In fact, research has found squat strength is strongly linked to being able to sprint faster and jump higher.

Isolation exercises are still good

What if you’re unable to do compound movements, or you just don’t want to?

Don’t worry, you’ll still build strength and muscle with isolation exercises.

Isolation exercises are also typically easier to learn as there is no skill required. They are an easy and low risk way to add extra exercise at the end of the workout, where you might otherwise be too tired to do more compound exercises safely and with correct form.

In fact, both isolation and compound exercises seem to be equally effective in helping us lose body fat and increase fat-free muscle mass when total intensity and volume of exercises are otherwise equal.

Some people also do isolation exercises when they want to build up a particular muscle group for a certain sport or for a bodybuilding competition, for example.

I just want a time efficient workout

Considering the above factors, you could consider prioritising compound exercises if you’re:

• time poor
• keen to lift heavier weights
• looking for an efficient way to train many muscles in the one workout
• interested in healthy ageing.

That said, most well designed workout programs will include both compound and isolation movements.

Correction: This article has been amended to reflect the fact a weighted row is a pull pattern, not a push pattern.

Mandy Hagstrom, Senior Lecturer, Exercise Physiology. School of Health Sciences, UNSW Sydney and Anurag Pandit, PhD Candidate in Exercise Physiology, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.