This study assessed indications for and safety and outcome of simple division of tongue tie without an anesthetic. There were 215 infants younger than 3 months (mean 0-19 days) who had major problems breastfeeding, despite professional support. Symptoms, tongue tie details, safety of division, and complications were recorded. Feeding was assessed by the mothers immediately, at 24 hours, and 3 months after division. Prior to division, 88% had difficulty latching, 77% of mothers experienced nipple trauma, and 72% had a continuous feeding cycle. During division, 18% slept throughout; 60% cried more after division (mean 0-15 seconds). There were no significant complications. Within 24 hours, 80% were feeding better. Overall, 64% breastfed for at least 3 months (UK national average is 30%). Initial assessment, diagnosis, and help, followed by division and subsequent support by a qualified lactation consultant, might ensure that even more mothers and infants benefit from breastfeeding.

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Aims-To develop criteria to prevent unnecessary rectal biopsies in constipated children. Methods-A retrospective review of 186 rectal biopsies from 141 children, comparing the age at onset of symptoms with the diagnosis of Hirschsprung's disease. Results-All of the 17 children with Hirschsprung's disease had the onset of symptoms before the age of 4 weeks. Twenty seven children had delayed passage of meconium (more than 48 hours) of whom 10 had Hirschsprung's disease. Three children with Hirschsprung's disease were referred after the neonatal period (2 months, 11 months, and 3 years) but all had the onset of symptoms before 4 weeks of age. Conclusion-If the age at onset of constipation is after the neonatal period, a rectal biopsy is unnecessary. (Arch Dis Child 1998;79:266-268)

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Surgery was associated with a 22% early complication rate and a 15% risk of relapse. 21% of patients required a second unplanned intra-abdominal procedure. Surgical intervention was associated with an increase in BMI SDS, but not in height SDS.

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A TAT significantly shortens time to full enteral feeds in infants with CDO significantly reducing the need for central venous access and PN.

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