Why is treating tongue-tie in breastfed babies an underground movement in Ireland?, Mind The Baby Blog, www.mindthebaby.ie

Why is treating tongue-tie in breastfed babies an underground movement in Ireland?

It is not news to anyone I’m sure that Ireland has the lowest breastfeeding rates in Europe. Public health campaigns and two active Government policies to improve rates in recent years have failed to have any impact at all. A slight increase has been attributed directly to the increase of foreign nationals in the country and the fact that our population of older mothers is growing. Research indicates that older mothers are more likely to breastfeed their children.

So all that money and time on trying to improve our breastfeeding rates and we have nothing to show for it. There’s a very strong argument to be made that rather than waste it on PR and ineffective policy, it should all have been ploughed into post-natal support where new mothers have immediate and regular access to qualified experienced lactation consultants when they need it. Watch the rates soar then…

Why is treating tongue-tie in breastfed babies an underground movement in Ireland?, Mind The Baby Blog, www.mindthebaby.ie
photo credit: blinzelblinzel via photopin cc

A lack of breastfeeding knowledge in our professional healthcare providers is one of the significant barriers to improving breastfeeding rates here. A second barrier is not prioritising establishing breastfeeding as a matter of policy in our healthcare system. Take, for example, the issue of tongue-tie in newborn babies.

A tongue-tie is where the piece of tissue that attaches the tongue to the floor of the mouth – called the frenulum – is tight or restricted. Medically, it’s called ankyloglossia.  Lots of babies with a tongue-tie can successfully breastfeed without any problems for the mother or baby but in some cases it can cause problems with latching, an unsettled baby, poor weight gain, sore nipples, a poor milk supply and mastitis. These are all problems that can easily derail a mother’s plan to breastfeed if they aren’t addressed. Studies have demonstrated that treating a tongue-tie by dividing the frenulum, a procedure called a frenuloplasty, can have a positive affect on breastfeeding in the majority of cases. In fact, the NICE guidelines in the UK support it once the procedure is carried out by a trained professional and the carers understand the procedure. You can read more about it here.

Although the procedure sounds awful, if it is done when a baby is less than three months old, no anesthesia is necessary, in most cases there is very little bleeding and the baby can be fed straight away. After six months, a general anaesthetic is required and it becomes a serious operation.

Treating tongue-tie when it’s causing problems for breastfeeding does not happen in maternity hospitals in Ireland. Which makes no sense whatsoever when your baby is still under their care up to six weeks after their birth. Surely if a staff lactation consultant diagnoses that a frenuloplasty will likely improve existing breastfeeding problems then this simple procedure should be done as a matter of course in the same hospital? Instead, parents are told that it might be considered in a few years time if it presents speech development problems and often they are encouraged to switch to formula. Once again a woman’s breastfeeding journey stops much sooner than she planned.

So here’s what happens instead: a good lactation consultant, or a word-of-mouth recommendation from a friend or an online parenting forum sees you making an appointment with a doctor who performs frenuloplasties in his own surgery. It’s like an underground movement. I am constantly hearing of people travelling across the country to one of these doctors – of which there are very few (I know of only two but there may be others) – so that they can fix the problem and continue on to successfully breastfeed their newborn baby.

Why is this happening when it’s being performed routinely internationally? The HSE has an information page about tongue-tie on its website basically supporting it as a treatment for improving breastfeeding outcomes but providing no information whatsoever on where to go to get it done. Can any readers shed any light on this? I have a few specific questions – maybe they’re cynical, I don’t know:

  • Is it because a consultant will get paid more if they wait until a child is old enough to require a general anaesthetic?
  • Is it because the HSE and the medical community talk a lot about the importance of breastfeeding but really they don’t give a flying eff?
  • Is it because they don’t really believe it is an effective treatment to improve breastfeeding rates?

I have a feeling it’s questions one and two but I’d love to be proved wrong. Do you know?

DECEMBER 2013 UPDATE: I will continue to maintain and up to date list of practitioners offering tongue-tie treatments around the country. Please do let me know if you have any new information. Thanks a million!

Resources: 

Information on tongue tie:

From BreastfeedingSupport.ie

From Kellymom

Quick self help on tongue tie

Tongue tie procedures contact details:

Dr Justin Roche, paediatrician, South Tipperary General Hospital by referral only. Telephone: 052 617 7033

Dr Rachel Quigley, GP, Blackrock, Cork. Telephone: 021 4358031

Prof. John Fenton, Barrington’s Hospital, Dooradoyle, Co Limerick. Telephone: 061 307540

Prof. Prem Puri, Paediatric Surgeon, Beacon Hospital, Sandyford Industrial Estate, Dublin 16. Telephone: 01 292 0530

Inchicore Family Doctors, Primary Care Centre, St Michaels Estate, Dublin 8. Referral from a lactation consultant only. Tel: 4166011. 

Dr Siun Murphy, Consultant Plastic Surgeon, Blackrock Clinic is now dividing tongue ties in babies up to 1 year (breastfed and formula fed babies). Referrals accepted from IBCLCs, GPs, PHNs, Paediatricans. Nicola O’Byrne IBCLC is  working with Dr. Murphy in the clinic, so will be assisting breastfeeding mums and babies post procedure with latching, positioning and general breastfeeding concerns. Referrals should be sent to siun@drsiunmurphy.com.

Added July 2014:
Dr. Alan O’Reilly, a GP in the Meath Primary Care Centre in Dublin 8 is  providing a frenotomy tongue-tie division service to private and GMS patients. The service is provided for babies with breastfeeding problems up to 6 months old. Referrals are accepted from lactation consultants, public health nurses and GPs. For more information please contact the clinic at 01-4536636. Referrals can be emailed directly to dralanoreilly@gmail.com. Further information will be available shortly on the practice website.

Breastfeeding support:

Irish International Board Certified Lactation Consultants

La Leche League Ireland

Cuidiu

Related Posts:

My top tip for national breastfeeding week

An apology to the La Leche League

The children’s hospital responded to my letter

63 thoughts on “Why is treating tongue-tie in breastfed babies an underground movement in Ireland?”

  1. Ridiculous situation – great post on it. The word needs to be spread.

    (Though I have to say the thing that came to mind when I read “ankyloglossia” was “I wonder if that’s related to the word ‘Ankylosaurus’?” Too many dinosaurs in my life, evidently.)

    One thing: I think when you say “railroad”, you mean “derail”.

  2. Don’t know much about tounge ties sorry, but while my daughter was getting the 4month Jabs the nurse doing them ask did I not think it was about time to chaner to formula instead of breastfeeding her. I wouldn’t of be so pissed off if there was weight gain issues but there wasn’t she was in the 91st persentile from the start.so I think a lack if knowledge is partly to blame.

    1. It think you’re spot on Breege. You’re not the first person I’ve heard of that happening to. I had a public health nurse tell me that I had to stop BFing my son at night so that he’d eat more solids during the day and sleep through the night. He was just gone six months old! Education has a huge part to play.

  3. Justin Roche is an utter legend! He took care of my daughters’ posterior tongue tie when she was 11 weeks, and at 14 months now we’re happily going strong!

  4. Yep, scandalous the way it’s left undiagnosed in so many. It’s so ridiculously easy to treat early on and so many women give up because they think they can’t feed when it’s really TT. When it IS diagnosed trying to find someone to clip it is another story entirely. It’s a simple procedure that any GP should be able to do (at least with the main type, PTT can be another story) but most of them don’t even want to know. As far as I am aware there is a doctor in Tipperary who people are waiting for weeks to see and I think there’s another in Maynooth, one of the LC’s might be able to give more details, but these guys have essentially become experts on TT because no one else will go near it. Crazy! Hate to think how many babies are missing out because this is being missed. :(

    1. Completely agree Deborah, it should be as simple as diagnosis, then treatment. The contact details of the two doctors you mention are at the end of the post. Hopefully they’ll be helpful to people looking for information.

  5. My son has a tongue tie, diagnosed at six months. It makes so much sense as our bfing journey was very difficult and ultimately, ended quickly. We are waiting for consultant apt, but because he is over six months we will be looking at a general if the procedure goes ahead. It is very frustrating, and of course, distressing.

    1. I believe some dentists can / will divide after 6 months without general anaesthetic. it is a laser division, so not every dentist had the kit… Might be worth asking around before opting for surgery.

  6. My oldest son had a tongue tie and we got it treated by Dr O’Rourke when he was 7 days old. The procedure was so incredibly simple, no worse than the heel prick blood test. It shocked me that everyone was so cloak and dagger about it. The procedure made a world of difference for my son who hadn’t eaten properly in that first week of his life. Unfortunately our delay in getting it cut set us up for a real battle to breastfeed faltering weight gain that lasted until his was on solids.

    If you want to breastfeed your kid, you obviously can’t wait until they are 6 months old (or more) to do the procedure. I agree with you it is absolutely ridiculous that it is treated so bizarrely here. My aunt was a dental hygienist in the US and said she regularly performed the clip on babies. I read that midwives up until the 1950s always grew one finger nail long and sharp so they could slide it under a newborn’s tongue at birth. The general excuse I hear is that as bottle feeding became en vouge, knowledge of this condition dropped off. A lot of kids with it will never be affected (if bottle fed) because it stretches over time. If it doesn’t then they may have speech impediments and won’t be able to eat ice cream because the tongue doesn’t come out all the way (tragic!) I’ve talked to newly qualified doctors and have heard anecdotes about practising GPs that have never heard of this condition.

    I was lucky that I had a lot of support, but I still felt like we were doing something wrong at the time. The lactation consultant that gave us the number for Dr ORourke and said “don’t tell anyone I gave it to you.” Isn’t that insane! It is a lot of pressure to put on a new mother who is incredibly worried and sleep deprived because babies who haven’t eaten in 7 days cry A LOT.

    The good news is that during my 2nd pregnancy, a lot of the midwives and PHNs I encountered said they had become very interested in tongue ties after meeting us. There have been a few national conferences about it that were apparently well attended. So things might be getting better….maybe.

    Here’s a post I wrote a while back about Nate’s tongue tie http://thedar.es/241/

  7. I think the lack of treatment for tongue tie is symptomatic of the general attitude towards breastfeeding in Ireland. Plenty of pressure and guilt being doled out, but not much in the way of practical help and advice. At six weeks old, my son was still not latching properly, and when I went to the local breastfeeding support group and asked for help, and asked if it could possibly be a tongue tie because I had never seen him stick out his tongue, and he had all the classic symptoms (gulping, wind, poor latch, clicking noise when feeding, etc.), she just dismissed me and said “If he hasn’t latched properly at 6 weeks he never will.” I quote those words often in my discussions about breastfeeding, because they hurt me so much. Here I was looking for help, trying to do what I knew was best for my baby, and the “professional” dismissed me. I have a feeling that if we run into problems when this new baby arrives in March or April, I won’t be taking such dismissals so lightly this time around.

  8. There is a dentist in Douglas in Cork who lasers them.Shane Curtin is his name and also a doctor in Dalkey but not sure of her name.My son’s was clipped by Justin Roche but international experiences show that lasering them gives better results for posterior tongue ties and upper lip ties.

  9. Dr McShane in Sheehan Medical General Practice in Glasthule/Dunlaoghaire, Co.Dublin snips ties. I brought my daughter to him when she was 8 days old and he assessed her.

  10. all 3 of my babies had tonguetie, and thankfully i managed to breastfeed all three of them, as they got older we eventually got the op done (the lil lad is 7yrs and we will prb get it done eventually) ,,no one even offered this op when they were born, yet in other countries it is no big deal! silly isn’t it!

  11. I am a Lactation Consultant in Cork and I think you are so right about it being “underground”, up until recently when I would diagnose one I would then have to tell an often stressed and overwhelmed mother what the problem was and that she would have to go to a Dr in Tipperary – she would look at me as if to say “you mean there is no one in Cork who can do this??” and then I would have to go into this long explanation about why this was the case. Having Shane Curtin and Dr Qigely available in Cork has changed things hugely and it is now becoming more nomral and it is wonderful to diagnose it and have it treated ion the same day if needed.

    1. Wow, same day treatment Clare – that’s fantastic! Now we just need to sort the rest of the country out with the same. I wonder if the Corkonions could convince any of their colleagues further afield to take it up?…

    2. Unfortunately Shane Curtain is either finishing up completely or taking a break from performing these procedures. We spoke to him today as we really want someone who can do it with laser so the lip can also be done.

  12. Both my boys had tongue tie my first fed fine so it wasn’t detected til later and caused no problem feeding or with his speech my second was detected by lactation nurse in maternity hosp feeding was a struggle she referred him as a matter of urgency and his tongue tie was sorted within weeks he was then able to feed well I found information and support to be there and lots of encouragement to breast feed just thought I’d share my positive experience I also agree it would have saved me alot of stress while waiting on app and trying to feed if he could have been treated at birth as its such a minor procedure thanks

  13. I found the very opposite of all of this to be true in my case… My boy was diagnosed with full tongue tie in Limerick Maternity Hospital at 28 hours old by our midwife. I was sent to see a Lacation Midwife in the maternity with him at 4 days old and he was out in the regional hospital with Professor John Fenton at exactly 2 weeks old for the procedure. Prof Fenton was a total gent, had me feed my boy straight after it, while explain all the benefits and other things to look out for. Almost 8 months later and we’re still going strong!!

    It’s strange for (and saddens) me to read that article with the straight forward, simple time of it we had!

  14. Hi, my daughter was diagnosed at 7 weeks in Limerick by the brilliant lactation consultant Margaret OLeary. My daughter had a prostieror tongue tie and was a poor weight gainer and my milk supply suffered. I was referred to Prof Fenton in Limerick Regional hospital and given an appointment for 2 weeks later. It made all the difference. I also filled in a questionnaire about tongue ties while I was there and sent back an additional questionnaire 2 weeks after the procedure. I’m now still nursing and my daughter will be 9 months old this week. Agree that more support from the public health nurses is needed. I also joined a support group in Raheen in limerick on Wednesdays, 11-1, with other breastfeeding mothers which was very helpful. A nurse attended each week to offer support also. Highly recommend attending a support group.

    1. sorry for the late reply… Prof Fenton as afar as I know is ENT specialist in the Regional not just pediatrics. But everyone I know with kids who need ENT treatment have went through him…

  15. Your article resonates perfectly for me and I wish my Wife and I had seen something similar in 2009 when our son was born. He will be 4yo in November and although my wife breast-fed successfully for three months, our son was diagnosed early-on for a tongue-tie.

    I wanted him to have to have the minute lazer procedure that takes just 15-30 seconds but the mid-wife and others in the Irish medical profession advised my wife that it wasn’t going to be “necessary”.

    What they omitted to mention was that If a child has a tongue tie then they do not outgrow their infantile swallow and continue to swallow with their jaw apart. This can lead to two major facial growth problems…

    Therefore, 3 years later-on we are referred by our family doctor to an ENT specialist after we notice the regular discomfort he must be experiencing with lack of movement as his mouth has now developed. He was regularly pushing his tongue forward and it exited on each side of his lips, it looks really weird because the middle is “tied” to the floor of his mouth. This will inevitably lead to dental, breathing and other jaw related issues.

    If the upper jaw does not develop fully then the result can be crooked or crowded teeth or the lower jaw being trapped inside the upper jaw and thus restricting the upper jaw to grow properly as well. There’s also a potential for long term breathing problems that may lead to 1. snoring, 2. sleep apnea leading to tiredness and therefore ADHD, 3. multiple ear infections, 4. bed wetting

    We therefore cautiously agreed to an operation in June 2013 to release his tongue and this was performed under the supervision of Mr Ejaz at Mullingar Regional hospital. The unfortunate element of us delaying the inevitable by 3 years, is that we now needed a General Anesthetic (GA) because a child over18 months would never co-operate or stay still enough to perform this minor procedure.

    My Wife was just at the Clinic with our Son today for a follow-up with Mr Ejaz (6/9/13). They’ve informed us that they have to do it all over again because they didn’t do enough “clipping” under the last GA! I’m absolutely sick to my stomach, as I wanted this Tongue-tie sorted as an infant and now he has to have a second procedure under GA because they didn’t do enough on the first one…….

    My advise to EVERYONE is PLEASE follow the lead of all other major western developed world Countries who utilize the “best practices” regarding this condition……such as the UK, USA, Germany, Holland, Canada, Australia & NZ…….Have the tongue-tie eliminated at the EARLIEST possible opportunity and definitely within 18 months. A GA is not the way forward for such a tiny procedure; apart from in backward thinking medical practices that appear in Ireland.

    1. I’m so sorry to hear that David, and it could have been completely avoided. Thinking of your little man and your family at this stressful time. I row in right behind you in a call for use of best internationl practice in treating this condition. Wishing you all the very best.

      1. Thanks for your words of support but what really annoys & concerns me about this whole process is that I find it hard to trust the competency of the HSE or the information they provide us…… Allow me to explain,,,,we had “Fasting” paperwork supplied prior to the previous GA & Operation that clearly stated in an animation, and also in text, that a small amount of water was OK on the morning prior to the GA.

        When we arrived at Mullingar Regional Hospital the Anesthetist questioned whether the complete Fasting process had been adhered too. We explained that he had taken a mouthful of water only in the car on the way to hospital. She was most concerned and explained that a complete Fasting schedule of zero intake is absolutely necessary to avoid choking & sickness during the GA process….. we explained that the HSE had advised us regarding this in their documentation; i.e. confirming that some water was acceptable prior to the GA. We subsequently passed this document over to them to escalate so that no other parent was misinformed….

        Its worrying enough seeing your Son enter a GA process but this sort of misinformation is potentially lethal.

  16. I’m so happy I came across this blog, I was devastated and stressed trying to breastfeed my 3 week old daughter and while I was advised by my phn(and not the midwives in the hospital) that she was tongue tied and we were told that unless it interfered with her speech we didn’t need to worry about it, having read this she is having many of the problems associated with tongue tie and feeding both by bottle and breast and we have decided to get a referral from our go to have this done. I’m just so disappointed with the lack of support I received from the midwives and phn around the difficulties we could experience breastfeeding. We were advised by our phn that the procedure was only carried out in cork but I’m glad to see a listing for dublin.
    Thanks again, this has provided a lot of relief and comfort.

    1. Hi Jean, so sorry to hear you didn’t get the support you needed at this special time. Hope things get sorted for you and the little one ASAP so you can concentrate on enjoying each other. Thanks for commenting.

  17. Pingback: 2013, what a year!
  18. I perform frenuloplasties for infants who are having breast feeding problems because of tongue-tie.
    The cost is €60 for consultation, counselling and procedure.
    Dr. Neville Wilson,
    The Leinster Clinic,
    Kilcock Road, Maynooth.
    Tel: 01-5052135

  19. Hi,I read this article.My baby has tongue tie.He is on complete breast feed.No problem in feeding & he is gaining weight.But,we are concerned about his speech.His DOB is 28/1/2014.It is mentioned in this article that,babies under 3months doesn’t need anaesthsia & then it will be less complicated.We reside in Dublin.Can I get help in this regard.

    1. Hi Pheba, great to hear that your baby is feeding well and the tongue tie is not causing you any problems so far. Would you consider contacting one of the doctors on the above list to see if they can address your speech concerns for you?

  20. I have two daughters with posterior tongue ties. One wasn’t diagnosed till just this week (she is now 5) and the other was diagnosed after she was born by a private lactation consultant hired by me, in January 2014.

    I’m doing a bit of research on tongue tie in Ireland and just reading through this page and all of the comments, I can identify with each one in some way.

    So, I have decided to try to get something done about it. I am going to write to someone… I just need to find out who! Maybe an open letter to my TD and my GP and the board of management in the hospital and the new minister for health. I want this system changed so that every midwife and doctor is trained and tongue tie is dealt with routinely and according to international best practice.

    I am wondering if you know if anyone has done anything formal like this before?

    I know that AIMS can help me to put something formal together in writing and will contact them too. Just thought I’d start with asking people in the know for any info you think might be relevant to a letter like this.

  21. Hello,
    Does anyone knows a dentist in Ireland who could performance lip tie release? I rang a doctor in Cork and he is not doing it any longer. My son had a tongue tie release but I am still having problems breastfeeding, he also has a lip tie.

    Thank you so much
    Cristina

    1. Are you in Cork Cristina? Rachel Quigley does them in Cork but she’s a GP not a dentist. Here are her details:
      Dr Rachel Quigley, GP, Blackrock, Cork. Telephone: 021 4358031

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