London - As soon as Justine Sullivan’s son Conor was born, he had trouble breastfeeding. Midwives at the hospital gave him formula milk, much to his mother’s exasperation.
“Conor’s first feed was from a bottle,” says Justine, 42, a TV producer from London.
“I was desperate to breastfeed, but they advised I should top up with formula because it was unlikely he was getting enough from me. It was frustrating, but I took their advice.”
For the next six weeks, Justine struggled to get her son to breastfeed.
“It took hours because Conor couldn’t latch on properly and get enough milk,” says Justine.
“He became frustrated and would bang his head against my chest. He’d fall asleep during his lengthy feeds, but as soon as I put him down, he’d wake up and want feeding again. It was exhausting.”
To breastfeed, babies need to be able to stick their tongue forward to latch on. Instead, Conor would chomp with his gums, which is ineffective and incredibly painful for the mother.
As a result, Justine had three bouts of mastitis, where the breast tissue becomes painful and inflamed, as well as nipple thrush, which in turn gave Conor oral thrush.
However, a simple check carried out when Conor was six weeks old changed everything.
“I’d seen my GP at least four times and Conor was given treatment for colic and reflux, which causes stomach cramps and vomiting in babies — neither of which he had,” says Justine.
“After six weeks, I went to a breastfeeding counsellor and the first thing she did was put her finger in Conor’s mouth. She told me he was tongue-tied and this was the reason he was having trouble. I couldn’t believe no one had checked before.”
Like many people, Justine had never heard of the condition. In fact, tongue-tie is thought to affect one in five babies — it’s where the frenulum, the string-like skin under the tongue, is too short.
This restricts movement, making breastfeeding difficult or impossible. It can also lead to speech problems.
Tongue-tied children may be messy eaters and have dental problems because the tongue is unable to remove food debris from the teeth.
Many adults are tongue-tied without realising it. It is thought to be inherited from the father and is more common in boys.
The condition can be diagnosed easily by feeling for the tightness of the frenulum.
Babies with tongue-tie tend to have heart-shaped tongues because the middle is pulled in by the short frenulum, and they cannot stick out their tongue beyond their lower lip.
Signs of the condition in newborns include gulping and clicking while breastfeeding because they can’t latch on properly.
Most tongue-tied babies can bottle feed because the teat goes right into the mouth.
Breast-feeding is seen as preferable to bottle-feeding by many experts as it is known to protect babies from stomach upsets, chest infections, allergies, sudden infant death syndrome and obesity and may even boost IQ.
It has also been shown to reduce a woman’s risk of breast cancer and can help her bond with a newborn.
The Department of Health recommends giving babies only breast milk for the first six months of life — mothers are offered £200 in vouchers if they reach this milestone.
However, while 69 percent of women breastfeed their baby at birth, this falls to 23 percent by six weeks, with just 1 per cent reaching the six-month target.
According to Helen Caulfield, a consultant paediatric ear, nose and throat surgeon at the Royal Free Hospital, London, breastfeeding rates could be improved if tongue-tie was treated.
Indeed, research published in the Journal of Paediatrics and Child Health in 2005 found treating tongue-tie led to improved feeding in 95 percent of babies.
“The procedure to release the tongue is quick, cheap and can relieve distress for the mother and baby,” says Mrs Caulfield.
Tongue-tie can be cured easily with a snip of the stringy membrane to release the tongue — an operation called a frenulotomy. Cutting the frenulum takes just a minute. The procedure involves a tiny amount of blood loss and, in many cases, allows breastfeeding immediately.
Even if babies are diagnosed, there are only 16 NHS centres offering treatment and waiting lists can be lengthy. The National Childbirth Trust is campaigning for tongue-tie treatment in every maternity unit. Justine was told she would have to wait two months for an NHS appointment because the GP didn’t consider her case urgent as Conor could take a bottle, so she went private.
However, some argue that many babies with the condition will not need treatment.
“The vast majority of children with tongue-tie will have a mild to moderate form,” says Dr Simon Newell, a neonatal consultant at Leeds Teaching Hospitals NHS Trust and vice president of the Royal College of Paediatrics and Child Health.
“Half will be able to breastfeed and so surgery is not necessary. But if the mother is having difficulty breastfeeding and other interventions have not helped, a tongue-tie division is a possible course of action.”
While complications of tongue-tie surgery are rare, if the procedure were to be carried out on every child with the condition, “we will end up seeing complications in children who didn’t really need it”. What doctors do agree on is that tongue-tie went out of fashion medically for several decades, effectively disappearing as a diagnosis.
Mrs Caulfield believes it stems back to the introduction of formula milk in the Fifties.
“All babies used to be breastfed. Then it was thought to be unhygienic and unreliable, so went out of fashion and most babies were bottle fed,” she says.
Medical students were not taught about tongue-tie and it disappeared from text books because it was thought to be a cosmetic issue.
“In the past, checking for this condition was routine after birth — if tongue-tie was found, the midwife would divide it there and then.
“Now little importance is placed on it. When an edition of the British Medical Journal was dedicated to breastfeeding, there was no mention of tongue-tie.”
After Justine’s experience with Conor, now aged four, and discovering her partner Christopher Johnstone and his father were tongue-tied, too, she checked her second son Arlo as soon as he was born two years ago and diagnosed tongue-tie.
She decided to have his operation done privately — both sons’ treatment came to £170.
“Because Conor wasn’t checked for tongue-tie earlier, his first few weeks were traumatic,” she says.
“Parents are not taught about tongue-tie at ante-natal classes, yet an early diagnosis can make such a difference. We need to change that.” - Daily Mail
* For more information, go to tongue-tie.org.uk