07/25/2018
If you’ve tried everything and are still having trouble breastfeeding, find an IBCLC and find a provider that TRULY examines your babies latch and mouth to be sure this isn’t something that could be affecting your breastfeeding. It is not a FAD. There are more women breastfeeding now than previously, so we are noting this problem more often than previously. Unless someone has taken it upon themselves to receive further education on Lactation, it’s likely they aren’t properly trained in how to help with breastfeeding problems. Don’t give up, find help!
Doctors have forgotten how to examine babies
One of the basic tenets of modern medicine is the fact that doctors must first learn what is normal before we can decide what is abnormal. Can you imagine trying to sort out cardiac sounds through a stethoscope without knowing what the normal sounds even are? How could a doctor even hear a murmur in that instance? What about an orthopedic surgeon not understanding how the knee works? The examples are endless.
Now, let’s take a look at what happens with babies and breastfeeding. Part of the problem in our medical system is that in many instances, we have an OB/GYN taking care of the mom and a pediatrician taking care of the baby and the two parties don’t talk to one other so when the mother-baby unit has a problem, balls get dropped (yes, I know there are exceptions like family practitioners and midwives, etc). Who is supposed to take the helm when breastfeeding goes awry? My answer is very simple: the IBCLC *must* be the one that directs traffic. The problem is that IBCLCs are forbidden from diagnosing tongue tie, and often, doctors dismiss or don’t even read the recommendations of the IBCLC.
Why is this happening? Why aren’t doctors practicing good medicine when it comes to tongue tie’s impact on breastfeeding? Here are some answers:
1) they don’t care about the importance of breastfeeding and see formula as an equivalent option (this is especially prevalent in the ENT community)
2) They look at the upswing in the number of tongue tie procedures and get very suspicious and therefore refuse to learn about it
3) They don’t know anything about breastfeeding so don’t actually know how to work up problems and then just send them to the IBCLC, who is powerless
4) They don’t understand what the tongue is supposed to do during breastfeeding and therefore are not able to diagnosis tongue pathology.
For this post, we’re going to focus on #4. Tongue tie is not taught in any residency program. As a resident, I was involved in over 2800 surgeries over 4 years of training. I did 1 frenotomy on a 7 year old boy that went under general anesthesia for a 5 second, inadequate (in retrospect) frenotomy. That’s it. In medical school, I got 1 lecture on breastfeeding. So what happened all of the sudden? Well, in 2008, Donna Geddes’ study from Australia showed us for the first time what the tongue is supposed to do during breastfeeding. Some of us listened and learned more, and those are the ones leading the pack.
Here’s the most important thing to realize: most pediatricians nowadays are not doing a history and physical examination on a baby’s mouth. Instead, they are doing a history and VISIBLE examination. Like most other doctors, a tongue tie is defined as a tongue tie ONLY if it involves the absolute tip of the tongue. Those kinds of ties are indeed visible. But because we now know that others, slightly deeper and harder to see ties exist, doctors will frequently tell parents, “I don’t see a tongue tie”. That is an accurate statement often. The problem is that a baby can have a tie without it being readily apparent by visible inspection.
If you went to the doctor with searing knee pain and the doctor only looked at the knee without physically checking the knee, you’d be angry. So when the doctor tells you that your baby isn’t tied but hasn’t tried to specifically lift the tongue, you should demand a referral to someone more experienced.
Frankly, doctors (and dentists and lactation consultants etc) have completely forgotten how to do their jobs. We need doctors to learn how to examine a baby properly and we need them to learn right now. Our children can’t wait for the current generation of doctors to retire before trying to tackle this issue.
