Ankyloglossia: Update on Trends in Diagnosis and Management in the United States, 2012‐2016

Wei, Eric X.; Tunkel, David E.; Boss, Emily F.; Walsh, Jonathan M.

doi:10.1177/0194599820925415

Cited by 24 publications

(41 citation statements)

References 11 publications

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“… 32 , 33 It is not surprising then, given our global context of overuse of medical, surgical and pharmaceutical interventions, and relative lack of research into clinical breastfeeding support, that overmedicalisation and overtreatment are significant problems in the care of breastfeeding women and their babies. 34 – 38 …”

Section: Discussionmentioning

confidence: 99%

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Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

Douglas

2021

Womens Health (Lond Engl)

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Background: Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny nipple epithelium and white flakes of skin. Current guidelines diagnose these signs and symptoms as mammary candidiasis and stipulate antifungal medications. Aim: This study reviews existing research into the relationship between Candida albicans and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of C. albicans in the human milk microbiome. Method: The author conducted three searches to investigate (a) breastfeeding-related pain and C. albicans; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review. Results: There is little evidence to support the hypothesis that Candida spp, including C. albicans, in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. Candida spp including C. albicans are commonly identified in healthy human milk and nipple-areolar complex mycobiomes. Discussion: Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance. Conclusion: Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.

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Section: Discussionmentioning

confidence: 99%

“… 34 Other examples include overtreatment with infant frenotomy for diagnoses of oral connective tissue restrictions. 34 , 36 , 37 …”

Section: Discussionmentioning

confidence: 99%

Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

Douglas

2021

Womens Health (Lond Engl)

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“…Ankyloglossia is more common in male than in female infants 60 . Recognition of tongue‐tied neonates in the hospital has increased dramatically in recent years 61 . In one study of 1041 newborns, 50 (5.8%) had ankyloglossia.…”

Section: Postglandular Causes Of Impaired Lactationmentioning

confidence: 99%

Impaired Lactation: Review of Delayed Lactogenesis and Insufficient Lactation

Farah

Barger

Klima

et al. 2021

J Midwife Womens Health

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It is estimated that as many as 1 in 20 women worldwide are unable to successfully breastfeed or provide adequate nutrition for their infants through their breast milk alone. Compromised nutrition in the early stages of life places the infant at risk for insufficient growth as well as serious and potentially disabling or life‐threatening complications. This review summarizes risk factors associated with impaired lactation that may result in either delayed lactogenesis or insufficient lactation. The risk factors for insufficient lactation are categorized into preglandular, glandular, and postglandular causes. Impaired lactation can occur despite maternal motivation, knowledge, support, and appropriate breastfeeding technique. Although there is no clear way to predict who will experience impaired lactation, knowledge about the risk factors can enable health care professionals to better identify at‐risk mother‐infant dyads. Early intervention may help prevent infant complications associated with inadequate nutritional intake.

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“…[26][27][28][29][30][31][32][33] Similarly, breastfed babies demonstrating back-arching, fussing, and pulling off the breast or whose mothers experience nipple pain are currently at risk of unnecessary lingual and/or labial frenotomy, which may also result in unintended outcomes. [34][35][36][37][38][39][40][41] Given these concerns, it is essential that every effort is made to optimise breastfeeding prior to considering medical or surgical intervention, yet current approaches to fit and hold are not demonstrated to help.…”

Section: Introductionmentioning

confidence: 99%

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

Douglas

Perella

Geddes

2021

Preprint

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Background Lactation consultants frequently advise adjustments to fit and hold (or positioning and attachment) with the aim of optimising intra-oral nipple placement. However, approaches to fit and hold interventions vary widely, with little evidence of benefits, and effects of fit and hold on infant tongue movement have not been examined. The aim of this preliminary study was to investigate whether a gestalt breastfeeding intervention alters tongue movement, using measurements from ultrasound imaging to determine nipple placement and intra-oral nipple and breast tissue dimensions. Methods Ultrasound measurements were conducted in five breastfeeding dyads, infants aged between four and 20 weeks, while feeding in their usual or ‘standard’ position and again after brief application of gestalt principles of fit and hold. Four of the mother-baby pairs, who had received comprehensive lactation support, reported persisting nipple pain. Three of these infants had difficulty latching and fussed at the breast; three had been diagnosed with oral ties. A fifth pair was breastfeeding successfully. Results Ultrasound demonstrated that the distance from nipple tip to junction of the hard and soft palate decreased, intra-oral nipple and breast tissue dimensions increased, and nipple slide decreased after a brief gestalt intervention. Conclusion These preliminary findings suggest that changes in fit and hold impact on infant tongue movement. Further research investigating short-and long-term outcomes of a gestalt breastfeeding intervention in larger cohorts is required.

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Ankyloglossia: Update on Trends in Diagnosis and Management in the United States, 2012‐2016

Cited by 24 publications

References 11 publications

Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

Impaired Lactation: Review of Delayed Lactogenesis and Insufficient Lactation

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

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