Beruflich Dokumente
Kultur Dokumente
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Dr. Brian Palmer ©2018Carole Dobrich
Dr. Betty Coryllos 5
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Focus is always the mother baby dyad The recent meeting in Toronto July 26-29, 2018
Over 250 attended
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Goal – happy
breastfeeding dyad
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What are we looking at when we evaluate? The Frenotomy Decision Tool for
Breastfeeding Dyads
One or more variants may be noted.
Tongue length
Elasticity
Tongue mobility (elevation, lateralization, extension) Development Use
The position where the attachment is under the tongue
Function
Tongue behaviour
Validation Feedback
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Now lets do some tongue exercises Now let’s help put the pieces together
Photo ©Hannah Taylor
Development Use
Validation Feedback
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Before After
to Thrive. PEDIATRICS, 125(6), e1500-e1504. doi:10.1542/peds.2009-2101
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Early Development
Development
Follow the
• Srinivasan, A., Dobrich, C., Mitnick, H., & Feldman, P. (2006).
Ankyloglossia in breastfeeding infants: The effect of frenotomy on guide for
maternal nipple pain and latch. Breastfeeding Medicine, 1(4), 216-
224. doi:10.1089/bfm.2006.1.216 using the
FDTBD
• Our research showed at 3 months post frenotomy that 21 out of 27
(77.8%) were still breastfeeding; 23 out of 25 (92%) were pain free;
and 22 out of 25 (88%) felt that the frenotomy had helped.
https://t4.ftcdn.net/jpg/01/12/39/93/240_F_112399334_dl7O
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Part 1. # 1 Mother with nipple pain/trauma while Part 1. # 4 Poor milk transfer observed (high
breastfeeding suck/low swallow ratio – few audible swallows)
Part 1. # 2 Infant with inability to latch or Part 1. # 5 Infant (> 5 days) with weight gain < 20g/d
maintain latch, clicking sounds, milk leakage without supplementation
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An infant with a visible or palpable membrane anterior to or Part 2. # 3 Inability to protrude tongue past gum line and/or
at the base of tongue restricting tongue movement and central dimpling of tongue on extension
leading to any of the following: (bowl or heart shape)
Part 2. # 1 Inability to elevate tongue at least mid-way Part 2. # 4 Diminished lateral movement
with wide open mouth of tongue
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Part 2. # 5 White tongue with absence of white patches An infant with a visible or palpable labial membrane at the
elsewhere (pseudoleukoplakia) center of the upper lip between the lips and the gums
leading to any of the following:
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Photo ©Goldfarb breastfeeding clinic ©2018Carole Dobrich
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Validation
Validated by 2 pediatricians Case history
in Indonesia – version 2016 • Obvious anterior tongue tie with limited lateral movement,
extension and elevation
• Special thank you to Dr Anjar Setiani and Dr Asti • Observed baby at breast
Praborini • Strong MER
• Their research indicated the FDTBD is a reliable tool • +++noisy, slurping, releasing breast and drinking very
quickly
• Currently the 2018 version is being validated in Canada • Mum stated feeds take about 20+ minutes and feeds
with Dr Louise Dumas and myself. about 16 times in 24 hours
• Content validity is complete • Mother “stated” no pain
• Working on inter-rater reliability
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Case history
Case history
• Mother & six week old baby referred to clinic for tongue tie
• Mother explained this was a typical feed
• Referral noted no pain, excellent weight gain (60gm/day),
noisy feeder • Gave information about frenotomy
• Parents considered cancelling appointment as felt BF OK yet • Patient had discussed it already with her partner.
came because maybe it will have an impact on speech. • Wanted procedure done.
• Baby evaluated • Is it really necessary???
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Observe a feeding
Thank you
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