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.

More than 7 million people in Australia were born overseas. Some 5.8 million people report speaking a language other than English at home.

But how well are we looking after culturally and linguistically diverse (CALD) Australians?

In countries around the world, evidence suggests people from CALD backgrounds are at increased risk of harm as a result of the health care they receive when compared to the general population. Common problems include a higher risk of contracting a hospital-acquired infection or medication errors.

People receiving cancer care are at particularly high risk of harm associated with their health care.

In a recent study, we found CALD cancer patients in Australia had roughly a one-in-three risk of something going wrong during their cancer care. This is unacceptably high.

We reviewed medical records

We worked with four cancer services (two in New South Wales and two in Victoria) that provide care to high proportions of people from CALD backgrounds. These four cancer services offer a combination of care to patients in hospitals, clinics and in their homes.

We analysed de-identified medical records of people from CALD backgrounds who received care at any of the four cancer services during 2018. To identify CALD patients, we used information from their medical records including “country of birth”, “preferred language”, “language spoken at home” and “interpreter required”.

We reviewed a total of 628 medical records of CALD cancer patients. We found roughly one in three medical records (212 out of 628) had at least one patient safety event recorded. We defined a patient safety event as any event that could have or did result in harm to the patient as a result of the health care they receive. We also found 44 patient records had three or more safety events recorded over a 12-month period.

Medication-related safety events were common, such as the wrong medication type or dose being given to a patient. Sometimes the patients themselves took the wrong type or dose of a medication or stopped medication all together. We also observed a variety of other patient safety events such as falls, pressure ulcers and infections after surgery.

The number of incidents could even be higher than what we observed. We know from other research that not all patient safety events are documented.

We didn’t have a control group, which is the main limitation of our study. In other words, we didn’t examine medical records of patients from non-CALD backgrounds to compare how common patient safety events were between groups.

But looking at other data suggests the rate of incidents is much higher in CALD patients.

Studies over many years indicate around one in ten patients admitted to hospital experience a safety event.

One study from Norway found cancer patients have a 39% greater risk of experiencing adverse events in hospital when compared to other patients (24.2% compared to 17.4%).

Why is the risk of incidents so high for CALD patients?

We identified miscommunication as a key factor that put cancer patients from CALD backgrounds at risk.

For example, we observed from one patient’s notes that the patient didn’t take their medication because they were confused by the instructions given by different clinicians. This confusion might have stemmed from language barriers or health literacy issues.

In some medical records, we also saw interpreter requirements were unmet. For example, at the time of admission, assessment for language needs noted an interpreter was not required. However, later notes mentioned the patient had poor English or needed an interpreter.

Also, with the limited availability of interpreters, they’re often reserved for specialist appointments, and not used for “routine” tasks, such as during chemotherapy treatment. This may result in side effects from cancer medications not being properly identified and responded to, potentially leading to patient harm.

What can we do to improve things?

To make care safer, patients, their families and the clinicians who care for them should come together so that any solutions developed are practical, relevant, and informed by their combined experiences.

As an example, we developed a tool with consumers from CALD backgrounds and their clinicians that seeks to ensure that when patient medications are changed, there is common understanding between the clinician and the patient of their medication and care instructions. This includes recognising the side effects of the medications and who to contact if they have concerns.

This tool uses images and simple language to support common understanding of medication and care instructions. It takes into account specific cultural expectations and is available in different languages. It’s currently being evaluated in two cancer clinics.

To make cancer care safer for patients from CALD backgrounds, health systems and services will need to support and invest in strategies that are specifically targeted towards people from these backgrounds. This will ensure more equitable health solutions that improve the health of all Australians.

Ashfaq Chauhan, Research Fellow, Australian Institute of Health Innovation, Macquarie University; Melvin Chin, Senior Lecturer, School of Clinical Medicine, UNSW Sydney; Meron Pitcher, Honorary, Medicine, Dentistry and Health Sciences, The University of Melbourne, and Reema Harrison, Professor, Australian Institute of Health Innovation, Macquarie University

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