Many parents across Canada find it difficult to breastfeed, and in some cases, new mothers are told to use a laser procedure to resolve language issues in their infants – a treatment that experts say may be helpful. useless.
Six months ago, Shadi Toloui-Wallace became a new mother. And like many, she found breastfeeding difficult.
“He’s not eating, he’s losing weight,” Toloui-Wallace said. “And it’s quite painful, and he doesn’t take my breast.”
A lactation consultant said her son Ezra suffered from a condition called ankyloglossia or “tongue attachment”. Although everyone has a frenulum, which is a strip of skin connecting the tongue to the back of the mouth, sometimes infants are born with a frenulum that is too tight or too far forward in the mouth, restricting tongue movement and sometimes interfering. with breastfeeding.
Anterior – or classic – tongue ties are where this strip of skin near the front of the tongue is cut, often in a doctor’s office.
It is a simple procedure, but in recent years a more invasive laser treatment to treat what is called “posterior tongue attachments” has been recommended and promoted by some lactation consultants and dentists.
It is this procedure that the consultant recommended to Toloui-Wallace – a therapy that costs hundreds of dollars.
“You could hear it on the other side of the wall […] screaming, screaming and it’s pretty hard to hear your baby in pain, ”she said. “It was horrible.”
After the procedure, she was told to do exercises with her baby in order to exercise her tongue. But these turned out to be painful for him, which added stress to the parents.
“Basically there was […] massage techniques, kind of like pushing the tongue side to side, training them to use their tongue more because they’ve never used it like that before, ”she explained.
“I was pretty determined to breastfeed, as you can see, get through it all.”
She said they continued to do this for about three weeks until they saw another doctor, who recommended that they stop.
Women are strongly encouraged to breastfeed. The Canadian Pediatric Society website states that “breast milk is the best food you can give your newborn baby” and recommends “exclusive breastfeeding for the first six months of life”.
But many women struggle, and some lactation consultants conclude that the problem is a baby’s tongue attachment.
The problem with this increasingly popular laser procedure is that studies indicate that the definition of what constitutes a posterior tongue tie is nebulous.
Parents are also encouraged on social media to perform the laser procedure, with Facebook groups dedicated to supporting parents facing the language.
Increasingly, this rare procedure for cutting under the tongue is now becoming a big deal in Canada.
One study describes “runaway rates” of tongue tie procedures due to “the lack of standardized criteria for diagnosing ankyloglossia.”
And some experts warn that this is unnecessary in most cases, and carries risks when performed by practitioners without the necessary experience.
Verity Livingstone, Clinical Professor in the Department of Family Medicine at the University of British Columbia, is the founder of the Vancouver Breastfeeding Center.
She believes some consultants make diagnoses they don’t have the expertise to do, and exhausted parents just accept it.
“There are a lot of lay people in our communities who have some expertise in breastfeeding management, and they have established themselves as private practitioners and are making unusual diagnoses and making unusual recommendations, well outside of that scope. of expertise, ”Livingstone told CTV News.
Livingstone says she’s seen babies with wounds that take weeks to heal.
“If the cut is too big, the muscles and ligaments in the tongue are damaged, and they don’t always heal, the wound can become infected and bleed,” she said. “So the problems can be short term, which would be the bleeding and infection right away, [but] in the long run, it could damage the actual functioning of the language.
Fatima Ladha says she felt compelled by a breastfeeding specialist in British Columbia to perform the procedure on her son Mykhail when he was only nine days old.
She said within 10 minutes of meeting a lactation consultant with the parents and assessing the infant, she told the parents they needed to mend the baby’s tongue tie.
“She basically put her fingers in her mouth […] and asked us to bottle feed him and then try to get me to breastfeed him, and she basically said, ‘Oh, he’s got a tie on the tongue and on the lips from what I say. ‘ve seen, because the milk collects in his mouth, he cannot open his mouth wide. And so you will probably want to do a review as soon as possible in order to breastfeed successfully.
“It was very upsetting to hear all of this information, I mean, we are not getting enough sleep, we have a new baby, it’s a first baby,” Ladha said.
She hadn’t even started breastfeeding yet and wondered how a problem could be diagnosed so early when other solutions hadn’t even been tried.
“The lactation consultant had phone numbers ready to send immediately, within minutes of arriving with us,” Ladha said, adding that the consultant had given her specific oral surgeons and physiotherapists that she recommended that Ladha addresses himself.
Ladha declined, but said she saw a lot of new mothers in groups she was on social media in discussing the surgery.
She’s also a pharmacist, so she has some health expertise, which helped her in her decision, she says.
“It wasn’t even a doctor who [did the] diagnosis and so those are the thoughts that crossed my mind, ”she said.
Other studies suggest that the treatment helps babies eat better, with few complications, and some experts find them helpful.
Angela Grant Buechner is a Toronto-based registered nurse and breastfeeding expert who received treatment for her two children for a pinched tongue – her son when he was just 10 days old.
She said that although it was not an easy choice, it “made a huge difference” with her children.
“I think because I have this personal experience, it has been easier for me to see that sometimes it is necessary,” said Buechner.
She said it’s important not to jump on it just yet and see experts to see if there is anything that can be done to help the baby latch on and suck properly.
“But it’s really true that some babies have restrictions,” she said. “It really can be something that needs to go further and then we may have to consider a release of this attached tissue.”
She said some providers do not have the additional training needed to identify a posterior tongue link and properly assess tongue function, adding that this may lead some parents to be told all is well with their baby and then to be confused when they are still struggling weeks later.
“It’s often just that the training isn’t there to find out when a tie is actually causing eating or speech problems,” she said.
The Canadian Pediatric Society released a document dictating its position on the subject, written in 2015 and reaffirmed this summer, which suggests the issue is unclear.
“Based on the available evidence, frenotomy may not be recommended for all infants with ankyloglossia,” the document said.
Frenotomy is the term for surgery that cuts a tongue tie.
The paper added that while there is an association for some babies between ankyloglossia and difficulty breastfeeding, it is not true for all infants.
“If an association between a strong link with the tongue and major breastfeeding problems is identified and surgery is deemed necessary, the frenotomy should be performed by a clinician experienced with the procedure, using appropriate analgesia,” indicates the document.
“It is recommended to consult a health professional specializing in breastfeeding before referring a child for a frenotomy. “
Dr. Anne Rowan-Legg, author of the Canadian Pediatric Society position paper, is also a full-time pediatrician at CHEO, a pediatric health care and research center in Ottawa.
“I think one of the main issues is that the posterior tongue link doesn’t have a clear or consistent definition,” Rowan-Legg told CTV News.
“And this is what makes it very difficult for parents and mothers and also for studies as well.”
Due to the lack of a clear and widely understood definition, “it leaves some interpretation,” Rowan-Legg said, causing problems for clinicians when counseling parents.
“We know that many children with language ties can breastfeed successfully. This decision to have your tongue cut should not be made in a hurry. “
Helping mothers learn to breastfeed properly – support that is sometimes lacking, some experts say is more important than jumping to a frenotomy.
Toloui-Wallace got help breastfeeding after attending the Livingston Breastfeeding Clinic in Vancouver, and baby Ezra finally latched on properly.
Today, Ezra is happy and healthy.
Toloui-Wallace said she didn’t regret having the laser procedure, but was unsure whether that was what helped or not.
But she stresses that what parents need most is early support and a connection with credible postpartum breastfeeding experts, explaining that Livingstone’s expertise was essential to her.
“I just wish that health care providers were better informed and knew all the resources available to help parents make an informed decision for their child and for themselves,” she said.
She and Ladha share their stories for parents who are in similar situations and to raise awareness of this controversial issue.
“I also think it’s my duty as a health care provider to educate people and let them know how to defend themselves and protect themselves against something like this,” Ladha said.
“Whatever you are told, ask the questions, don’t be afraid to ask the questions. You are doing all you can to protect yourself and your child.
Doctors admit they have no idea how many of these procedures are done in Canada, as most are done in private.
Many are urging more studies to be done to see if the procedure is a real solution, as well as for more oversight of people offering surgical solutions.