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There are three conditions I have found which warrant a Frenotomy in a newborn: 1) Failure to achieve a latch after much effort by a skilled LC, 2) a latch which remains painful despite the best effort to reposition the infant and use of the asymmetric latch, and 3) the infant latches and feeds briefly then comes off the breast with a click or cluck sound and must be repeatedly relatched to finish the feeding. The last problem is due to an elastic frenulum (much like a bungee cord) that can be stretched to the latch position but requires much effort by the infant to do so. When the infant tires, the tongue snaps back, the suction is broken, and the infant slides off the breast.
In the few studies on newborn ankyloglossia done to date, the incidence of any ankyloglossia is about 4% and about half of these interfere to some extent with breastfeeding. Few newborns with ankyloglossia have trouble with formula feeding. There are no studies following infants with and without ankyloglossia from birth to determine which, if any, lingual frenulum results in a speech defect of a degree that requires therapy. One ongoing study in Australia2 demonstrated that most of those children presenting to a speech therapist with a lingual frenulum and speech defect benefited from release of the frenulum. Thus there is no way currently to know if lysis of the lingual frenulum in the newborn might be protective of developing a speech defect.
In Summary, the lingual frenulum is noted to be a significant anatomic structure in about 4% of newborns of whom about half have difficulty with breastfeeding and are improved by Frenotomy or Frenulectomy. Those who will
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benefit from these procedures cannot be determined by anatomic appearance alone and functional assessment of the tongue is a complex undertaking. The best predictor of outcome from Frenotomy appears to be direct observation of the infant by a person skilled in breastfeeding assistance. Regardless of lingual frenulum appearance, the infant who latches well without pain to the mother and obtains good milk transfer in one continuous feeding session requires no intervention at this time. An in-depth study to determine the exact incidence of each type of lingual frenulum, the clinical significance of each for breastfeeding and speech is needed. I hope to be the principal investigator of such a study beginning within the next year. Further information about this problem and specific advice for performing a Frenotomy can be found in the summer 2004 Edition of the AAP Section on Breastfeeding Newsletter article by Elizabeth Coryllos, MD et al3 at www.aap.org.
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The WIC Program: Your Partner in Breastfeeding Promotion and Support The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition program for low to mid-income pregnant or postpartum women, infants, and children under the age of five. Applicants must meet income guidelines (a family of four can make up to $2907 monthly), reside within the county, and be determined to be at "nutritional risk" by a health professional. Since its beginning in 1974, the WIC Program has earned the reputation of being one of the most successful and cost-effective federally funded nutrition programs in the United States. Many people are aware of findings that demonstrate WIC's role in improving birth outcomes and containing health care costs; however, few may realize that WIC has been playing an important role in improved infant feeding practices as well.
Studies show that between 1992 and 2002, the percentage of WIC mothers breastfeeding in the hospital increased by 20.0 percent (from 38.8 to 58.8 percent), while the percentage for non-WIC mothers breastfeeding in the hospital increased by 12.8 percent (from 66.4 to 79.2 percent). The percentage of WIC infants breastfeeding at six months of age doubled during this time period (from 10.1 to 22.1 percent). Despite these increased breastfeeding rates, a substantial gap still exists between non-WIC and WIC recipients.
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The California WIC Breastfeeding Mission Statement states that WIC promotes, supports and protects exclusive breastfeeding for approximately the first six months of life, and continued breastfeeding for at least the first year. Even though the provision of formula is mandated by USDA for infants of mothers who cannot or choose not to breastfeed, WIC health professionals are committed to promoting breastfeeding as the norm for infant feeding. Local agencies offer a variety of breastfeeding support services, including classes, support groups, peer counselors, incentive gifts, pump loan programs, and helplines. Every agency has a Breastfeeding Promotion Coordinator and many WIC nutritionists are certified lactation educators as well.
In San Diego County, the WIC Program is administered through five local agencies. Although the specifics of their services may differ, all are committed to the promotion and support of breastfeeding. Electric breastpumps are in limited supply and are loaned to each program's participants according to agency procedure and prioritized need. To apply or refer to the WIC Program, or for more information about breastfeeding support services, call your local WIC office for details.
American Red Cross WIC Program (800) 500-6411 No. County Health Services WIC Program (888) 471-6333 Scripps Mercy WIC Program (619) 260-7054 SDSU Foundation WIC Program (888) 999-6897 San Ysidro Health Center WIC Program (619) 426-7966 | |
