LATCH Scores Research Articles

The Effect of Counseling Provided on the Second Post Partum Day Through Home Visits on Breastfeeding Success in Turkey: Randomized, Controlled Trial

Background: It is known that breastfeeding offers numerous benefits for the mothers and their babies. In this sense, “Promotion of Breast Milk and Baby Friendly Hospital” initiation was started in 1992 all over the world. Systematically trainings are provided at the baby friendly hospitals in order to promote breastfeeding and to continue breastfeeding behavior. However, the efficacy of the planned counseling services for breastfeeding provided following the birth at the baby friendly hospitals reduces due to the early discharge. The present research was conducted in order to determine the effect of counseling provided on the second post partum day through home visits on breastfeeding success. Methods: Design: Randomized-controlled. The research was consisted of 100 women (intervention group=50, control group=50) who resided in Çorum Province, Turkey. Women of the intervention group were provided with trainings and counseling related to breastfeeding at the hospital after birth and at home following the discharge (on the second postpartum day). The data were collected using Descriptive Data Collection Form used to obtain information about mothers’ characteristics, Breastfeeding Evaluation Forms used to analyze the aspects about breastfeeding and LATCH Breastfeeding Charting System. Results: The mean LATCH scores and LATCH subscale scores of the intervention group were higher on the second postpartum day than those in the control group. Moreover, the rate of babies fed only with breast milk by the women in the intervention group during the last 24 hours was higher than those in the control group. The difference between intervention and control group was significant in terms of breastfeeding success on the second postpartum day, in favor of intervention group (p<0.05). Conclusions: Counseling given through home visits on the second postpartum day affected breastfeeding success positively.

A systematic review of frenotomy for ankyloglossia (tongue tie) in breast fed infants

AimsTongue tie effects at most 2% of infants and may be a normal variant. National Institute of Clinical Excellence has recently supported the use of frenotomy, while acknowledging that evidence...

Sucking characteristics of successfully breastfeeding infants with ankyloglossia: a case series

Partial ankyloglossia is a congenital oral anomaly characterized by restricted movement of the tongue resulting from a lingual frenulum that is either short, inelastic, or is attached distally, too near or onto the gingival ridge (1). The prevalence of ankyloglossia is not well documented because of the lack of a standard definition or a reliable clinical method of classification (2). Studies of neonates, infants and adolescents quote the incidence of ankyloglossia to be between 0.1% and 10.7% (2,3). Recently, a resurgence of breastfeeding difficulties in infants with ankyloglossia has been reported, with a frequency ranging from 25% to 44% (3,4). Feeding difficulties associated with ankyloglossia include painful nipples (4–6), poor latch (6), reduced milk supply, neonatal dehydration (7) and decreased duration of breastfeeding (4). Controversy exists regarding the management and treatment of ankyloglossia (8), although studies show that in infants with feeding problems, frenotomy improves maternal nipple pain (5,6,9,10), latch scores (6,10), tongue action, milk transfer and milk supply (10). Fortunately, the majority of infants with ankyloglossia are able to breastfeed successfully. The controversy surrounding ankyloglossia most likely stems from the lack of knowledge of the effect the condition has on feeding, and in particular breastfeeding. Five fully breastfed infants with ankyloglossia presented for a research study designed to assess the sucking characteristics of normal breastfed infants. The study was approved by the Human Ethics Committee of The University of Western Australia. Sub-mental ultrasound scans of the infant oral cavity were made during a breastfeed to image tongue motion (Fig. 1A,B). Intra-oral vacuums were measured simultaneously via a supply line filled with sterile water connected to a pressure transducer (11). The test-weigh method was used to measure milk intakes for the monitored feed and three mothers measured every feed for a 24-h period (12). All infants recorded normal growth and the three mothers who measured every feed for a 24-h period recorded normal levels (range 478 to 1356 g per 24 h) (12). The data are shown in Table 1 (Infants 3–5). Infants 1, 2 and 3 displayed no compression of the nipple; however, weak vacuums were recorded for Infant 1 (Fig. 2A,B; Table 1). Infants 2 and 4 recorded strong maximum vacuums. Infant 4 had strong minimum vacuum and displayed compression of the base of the nipple on ultrasound (Fig. 2C,D). Infant 5 had very weak maximum vacuum and compression of the tip of the nipple (Fig. 2E,F). Mean maximum vacuums quoted in the literature range from )145 (11) to )197 mmHg (13) for breastfeeding infants. Mean minimum vacuum has been measured at )64 mmHg in one study of breastfeeding infants (11). The importance of the level of vacuum has become apparent with a recent study demonstrating an association between strong infant sucking vacuums and nipple pain (14). Conversely, similar to pumping vacuums (15), low sucking vacuums have been associated with reduced efficiency and effectiveness of feeding(16). Although these infants with ankyloglossia had intra-oral vacuums outside the normal range, they were able to obtain enough milk to grow satisfactorily and none of the mothers experienced nipple pain during feeding. It is possible that the vacuum exerted by the infant is influenced by both the restriction of tongue movement or nipple ⁄breast shape. Further research is required to investigate this. Ultrasound imaging during breastfeeding showed that two of the infants compressed the nipple. One infant compressed the base of the nipple and the other compressed the tip of the nipple. Previous ultrasound imaging of infants Acta Paediatrica ISSN 0803–5253

Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effect on Milk Removal and Sucking Mechanism as Imaged by Ultrasound

There is evidence that infants with ankyloglossia can experience breastfeeding difficulties including poor attachment to the breast, suboptimal weight gain, and maternal nipple pain, which may lead to early weaning of the infant. No studies have investigated the cause of these breastfeeding difficulties. The objective of this study was to determine the effectiveness of frenulotomy in infants experiencing persistent breastfeeding difficulties despite professional assistance by measuring changes in milk transfer and tongue movement during breastfeeding before and after frenulotomy. Twenty-four mother-infant dyads (infant age: 33 +/- 28 days) that were experiencing persistent breastfeeding difficulties despite receiving professional advice were recruited. Submental ultrasound scans (Acuson XP10) of the oral cavity were performed both before and >or=7 days after frenulotomy. Milk transfer, pain, and LATCH (latch, audible swallowing, type of nipple, comfort, and hold) scores were recorded before and after frenulotomy. Infant milk intake was measured by using the test-weigh method. For all of the infants, milk intake, milk-transfer rate, LATCH score, and maternal pain scores improved significantly postfrenulotomy. Two groups of infants were identified on ultrasound. One group compressed the tip of the nipple, and the other compressed the base of the nipple with the tongue. These features either resolved or lessened in all except 1 infant after frenulotomy. Infants with ankyloglossia experiencing persistent breastfeeding difficulties showed less compression of the nipple by the tongue postfrenulotomy, which was associated with improved breastfeeding defined as better attachment, increased milk transfer, and less maternal pain. In the assessment of breastfeeding difficulties, ankyloglossia should be considered as a potential cause.

Ankyloglossia in Breastfeeding Infants: The Effect of Frenotomy on Maternal Nipple Pain and Latch

The aim of this study was to measure the effectiveness of frenotomy in ankyloglossic infants, by quantifying the changes in latch and maternal nipple pain using standardized tools. Infants below 12 weeks of age were recruited from the Goldfarb Breastfeeding Program between August 2004 and February 2005. Infants were selected based on the Frenotomy Decision Rule for Breastfeeding Infants (FDRBI), a new clinical tool for future validation. Latch was assessed using the Latch Tool. Maternal nipple pain was assessed using R. Melzack's Short Form McGill Pain Questionnaire, consisting of the Pain Rating Index (PRI) and Present Pain Intensity (PPI). Frenotomy was performed, followed by repeat latch and pain assessments. Mothers also received breastfeeding counseling throughout and after the procedure. A telephone questionnaire was administered 3 months later. Twenty-seven (27) mother-infant dyads participated in the study. No complications were seen with frenotomy. All infants had an equal or higher latch score after frenotomy, with an improvement in mean latch score of 2.5 (p < 0.0001, 95% confidence interval [CI], 2.038, 2.925). Maternal pain scores decreased significantly after frenotomy, with mean improvements of -11.4 points (p < 0.0001, 95% CI, -15.544, -7.345) on the PRI subscale and -1.5 points (p < 0.0001, 95% CI, -1.952, -1.011) on the PPI subscale. Seventy-seven point eight percent (77.8%) of subjects were still breastfeeding after 3 months; 92% were pain free after 3 months; and 88% felt the frenotomy had helped them. Timely frenotomy and breastfeeding counseling is an effective intervention, improving latch and decreasing nipple pain.

The LATCH Scoring System and Prediction of Breastfeeding Duration

This study aimed to determine whether LATCH scores assessed by professional staff during in-hospital stays are predictive of breastfeeding at 6 weeks. Participants were English-speaking breastfeeding women, 18 years or older, with healthy singletons. LATCH scores were obtained once every 8 hours on day 1 and daily subsequently until discharge. Data were obtained from hospital charts and telephone interviews on day 4 and week 6 postdelivery. At 6 weeks, 188 of 248 (76%) women were contacted and 66.5% were breastfeeding. LATCH scores were higher among women breastfeeding than those who had weaned. Using receiver operating characteristic (ROC) curves, a score of 9 or above at 16 to 24 hours was the most discriminate of the 5 time periods examined (area under the ROC curve = 0.72). Furthermore, women who met this criterion were 1.7 times more likely to be breastfeeding at 6 weeks than women with lower scores. The LATCH assessment tool is a modest predictor of breastfeeding duration.

Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study

Purpose Ankyloglossia (“tongue-tie”) occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms. Methods Twenty-five mothers of healthy infants with ankyloglossia were recruited because of sore nipples. Infants were randomized to either of 2 sequences: (1) frenotomy, breast-feeding, sham, breast-feeding (n = 14) or (2) sham, breast-feeding, frenotomy, breast-feeding (n = 11). The mothers as well as all personnel taking care of the child after each sham or frenotomy procedure were masked as to the study sequence. In every sequence, and after each sham or frenotomy procedure, a standardized latch score and pain score were obtained from the mother. Results There was a significant decrease in pain score after frenotomy than after sham ( P = .001). There was also a nearly significant improvement in latch after the frenotomy in these mothers ( P = .06). Conclusion Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties.

Comparison of the breastfeeding patterns of mothers who delivered their babies per vagina and via cesarean section: An observational study using the LATCH breastfeeding charting system

Background Breastfeeding has many advantages for both mothers and infants. Several factors related to the mother and the baby, however, have a negative effect on the initiation of breastfeeding. Mode of delivery is one of these factors. When delivery takes place by cesarean section, the mother becomes a surgical patient with all the inherent risks and problems. Cesarean delivery under general anesthesia rates are currently rising our country, but the effects of this factor on the initiation and duration of breastfeeding are unclear. Objective The purpose of this study was to assess and compare the breastfeeding process in mothers who had cesarean deliveries (CD) with those who delivered vaginally (VD). Design This study is an observational and comparative study. Setting The environment of the research was the private hospital in Istanbul. Participants The samples in the research were volunteer participant mothers who were delivered of healthy neonates. There were 118 incidents of CD under general anesthesia and 82 of VD chosen for the study. Methods Data was obtained using an “Introductory Information Form” which was prepared as suggested by related literature, and by using the “(LATCH) Breastfeeding Charting System.” Results According to the LATCH Scoring System, the average score for the first breastfeeding was 6.27 and 8.81 for the third in CD mothers and 7.46 for the first breastfeeding and 9.70 for the third in VD mothers. Statistically meaningful differences were defined between the first ( t = 10.48 ; p < . 001 ), second ( t = 7.82 ; p < . 001 ), and third ( t = 7.12 ; p < . 001 ) breastfeeding sessions in both CD and VD mothers. Conclusions It was found that the pattern of delivery affects breastfeeding and that CD mothers need more support and help as compared to VD mothers. CD mothers were seen to need more support, particularly in positioning their babies for breastfeeding.

Effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally.

Epidural anesthesia is commonly administered to laboring women. Some studies have suggested that epidural anesthesia might inhibit breast-feeding. This study explores the association between labor epidural anesthesia and early breast-feeding success. Standardized records of mother-baby dyads representing 115 consecutive healthy, full-term, breast-feeding newborns delivered vaginally of mothers receiving epidural anesthesia were analyzed and compared with 116 newborns not exposed to maternal epidural anesthesia. Primary outcome was two successful breast-feeding encounters by 24 hours of age, as defined by a LATCH breast-feeding assessment score of 7 or more of 10 and a latch score of 2/2. Means were compared with the Kruskal-Wallis test. Categorical data were compared using the Mantel-Haenszel chi-square test. Stratified analysis of potentially confounding variables was performed using Mantel-Haenszel weighted odd ratios (OR) and chi-square for evaluation of interaction. Both epidural and nonepidural anesthesia groups were similar except maternal nulliparity was more common in the epidural anesthesia group. Two successful breast-feedings within 24 hours of age were achieved by 69.6% of mother-baby units that had had epidural anesthesia compared with 81.0% of mother-baby units that had not (odds ratio [OR] 0.53, P = .04). These relations remained after stratification (weighted odds ratios in parenthesis) based on maternal age (0.52), parity (0.58), narcotics use in labor (0.49), and first breast-feeding within 1 hour (0.49). Babies of mothers who had had epidural anesthesia were significantly more likely to receive a bottle supplement while hospitalized (OR 2.63; P < .001) despite mothers exposed to epidural anesthesia showing a trend toward being more likely to attempt breast-feeding in the 1 hour (OR 1.66; P = .06). Mothers who had epidural anesthesia and who did not breast-feed within 1 hour were at high risk for having their babies receive bottle supplementation (OR 6.27). Labor epidural anesthesia had a negative impact on breast-feeding in the first 24 hours of life even though it did not inhibit the percentage of breast-feeding attempts in the first hour. Further studies are needed to elucidate the exact nature of this association.

Predicting breastfeeding duration using the LATCH breastfeeding assessment tool.

The authors tested the validity of the LATCH breastfeeding assessment tool, controlling for intervening variables in 133 dyads. LATCH scores, mother's evaluation of an index feed, and intended duration of breastfeeding were assessed postpartum and followed 6 weeks. Women breastfeeding at 6 weeks postpartum had higher LATCH scores (mean +/- SD = 9.3 +/- 0.9) than those who weaned (mean +/- SD = 8.7 +/- 1.0), due to only one measure, breast/nipple comfort. Women who weaned before 6 weeks reported lower breast/nipple comfort (1.5 +/- 0.5) than those who were still breastfeeding at 6 weeks (1.7 +/- 0.5, P < .05). Total LATCH scores accounted for 7.3% of variance in breastfeeding duration. Total LATCH scores positively correlated with duration of breastfeeding (n = 128; r = .26, P = .003) and to mothers' scores (n = 132; r = .58, P = .001). Correlations among LATCH measures ranged from .02 to .51. The LATCH tool is a useful identifies the need for follow-up with breastfeeding mothers at risk for early weaning because of sore nipples.