Poor Latch Research Articles

Feeding Issues in Infants Referred for Frenotomy.

The diagnosis of ankyloglossia has increased significantly around the world over the last decade. Frenotomy is indicated in infants with ankyloglossia to improve breastfeeding, although there is little scientific evidence of its efficacy. The purpose of this study is to evaluate whether infants being referred for frenotomy had feeding issues prior to the procedure. A retrospective chart review was undertaken for all infants under one year of age referred with ankyloglossia to a pediatric otolaryngology practice or a pediatric hospital between 2018 and 2020. Data included age at referral, gender, comorbidities, feeding issues, whether ankyloglossia was diagnosed, and whether frenotomy was done. Frequencies and non-parametric comparisons were calculated. Of the 646 consultations made for tongue tie, a diagnosis of ankyloglossia was made in 94.7% (N=612) of the patients based on clinical judgment. The most common feeding complaints were poor latch (57.1%, N=369) and painful latch (50.3%, N=325). Eighty one (12.5%) patients did not have a reported feeding difficulty. Most patients had an anterior tongue tie (85.8%, N=554), with some showing signs of restricted tongue movement (30.1%, N=184). Ankyloglossia was 4.03 times more likely to be diagnosed (p<.001) and frenotomy was 1.76 times more likely to be performed (p<.001) in the hospital setting compared to the clinic setting. Conclusion:Children under the age of one referred to otolaryngology for ankyloglossia were often diagnosed concordantly, although some lacked feeding issues that would indicate frenotomy. There are still knowledge gaps about infantile ankyloglossia in referring medical personnel.

Use of At-Breast Supplementers to Facilitate Feeding Solely at the Breast for Infants with Retrognathia: Two Case Studies.

Objective: Infants with significant retrognathia often have difficulty forming a latch adequate to establish exclusive breastfeeding. This article describes the use of at-breast supplementers (ABSs) to facilitate extended breastfeeding relationships, even when supplementation is necessary for growth. Methods: Two cases are described where infants with severe retrognathia initially struggled with weight gain necessitating supplementation but were able to ultimately exclusively feed at-breast with the use of ABSs. Results: While the two cases differed in the form of supplemental milk used and duration of ABS use, both dyads breastfed for beyond 2 years. Conclusions: Feeding solely at the breast and subsequent extended breastfeeding may be possible even for infants who require supplementation, including those with anatomical or functional challenges such as retrognathia. The ABS is a relatively simple system that may be beneficial for difficulties such as poor latch and low milk supply. More awareness and education is needed so that clinicians consider supporting dyads with this approach.

What is tongue-tie and does it interfere with breast-feeding? - a brief review.

The most common symptom attributed to ankyloglossia is difficulty breast feeding due to poor latch, inefficient milk extraction and/or maternal nipple pain. During the past two decades, despite a declining birth rate, there has been a dramatic increase in the number of infants diagnosed with and treated for ankyloglossia in the United States, Canada and Australia. Despite a dramatic increase in the diagnosis and treatment of ankyloglossia in these countries, there remains no universally agreed upon definition of ankyloglossia and none of the published scoring systems have been rigorously validated. However ankyloglossia is defined, the majority of infants with ankyloglossia are asymptomatic. Perhaps, infants with ankyloglossia have a greater incidence of difficulty breast feeding. Lingual frenulotomy may decrease maternal pain and at least transiently improve the quality of breast feeding in some infants however no published studies take into account the fact that sucking and feeding are soothing to infants and the observed improvements immediately following frenulotomy may be a response to the pain associated with the procedure rather than a result of the procedure itself. While there are almost certainly some infants in whom tongue-tie interferes with breast-feeding, there is currently no good evidence lingual frenulotomy leads to longer duration of breast-feeding. Frenulotomy appears to be a generally safe procedure however there are reports of serious complications. Finally, there are no studies of long-term outcomes following frenulotomy during infancy and given traditional thinking that the lingual frenulum is a cord of connective tissue tethering the tongue to the floor of the mouth may be incorrect and the frenulum contains motor and sensory branches of the lingual nerve, the procedure may be less benign than previously thought.

Treatment modalities in breastfeeding babies with marasmus and kwashiorkor associated with ankyloglossia

Introduction: Successful breastfeeding depends on an infant's ability to latch onto the mother's breast correctly. A poor latch will cause insufficient milk transfer which will cause poor growth. Each type of mammal produces different components of milk which make it species-specific and adjusts to their needs, growth rate, and breastfeeding habits. Human breast milk has many benefits for human babies because it contains various substances both nutrition and protection. This study aims to present two infants who suffered from Ankyloglossia, which hindered the baby's ability to breastfeed and eat solid food Case Presentation: The study presented two infants who suffered from Ankyloglossia, which hindered the baby's ability to breastfeed and eat solid food. These babies were diagnosed with marasmus and kwashiorkor. After revision on both the lip- and tongue ties, supplementation with pasteurized human milk donor, and good complementary feeding, the babies finally reach optimal growth and development. Conclusion: The sucking ability of the baby during early breastfeeding was proven to be important and should be examined, to achieve further successful breastfeeding.

LATCH Score as a Tool to Predict Weight Gain in Term Babies at Six Weeks Post-discharge: A Prospective Cohort Study

Introduction: The LATCH score is an acronym representing L- LATCH, A- Audible swallowing, T- Type of nipple, C- Comfort, H- Hold. It is a comprehensive yet simple breastfeeding assessment tool used to evaluate breastfeeding practices. Babies with a poor LATCH score at discharge are at an increased risk of early breastfeeding cessation and inadequate weight gain. According to World Health Organisation (WHO), only about 44% of infants aged 0-6 months worldwide were exclusively breastfed from 2015-2020, with a goal of increasing this rate to atleast 50% by 2025. There have been very few studies conducted in developing countries regarding this matter. Aim: To determine the correlation between the LATCH score and weight gain at six weeks post-discharge in term babies. Materials and Methods: This prospective cohort study was conducted at MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India, from January 2023 to June 2023. The study included 355 healthy term and singleton babies. LATCH scores were assessed at the time of the first feed, 24 hours, 48 hours, 72 hours, and at the time of discharge. Mothers with a low LATCH score and the reasons for the low score were identified, corrected, and counselled until discharge. Weight gain velocity was analysed at the six-week follow-up. Analysis of Variance (ANOVA) was used to compare the mean values between variables, and Pearson’s correlation was used to analyse the correlation between the LATCH score and weight gain at six weeks post-discharge in term babies. Results: In the present study, the mean age of mothers was 26.21±5.40 years, and there were 200 males and 155 females babies. The mean LATCH score at the time of the first feed was found to be 3.91±1.09, which improved to 5.61±0.890, 7.03±0.742, 7.67±0.578, and 9.12±0.662 at 24 hours, 48 hours, 72 hours, and at the time of discharge, respectively. The reasons for a poor LATCH score were mainly attributed to primiparous mothers (42%) and incorrect positioning (35.5%). A significant positive correlation was found between the improvement of the LATCH score and weight gain at the six-week follow-up. Conclusion: The LATCH score was found to be a simple tool for identifying mothers and infants who require breastfeeding support and timely intervention to sustain breastfeeding. The LATCH score can serve as an effective predictor of weight gain at the six-week follow-up.

Systematic review of the evidence for resolution of common breastfeeding problems-Ankyloglossia (Tongue Tie).

Tongue tie is a common problem affecting breastfeeding due to poor infant latch and/or maternal pain. Evidence of whether treatment improves breastfeeding outcomes is conflicting. We conducted a systematic review and meta-analysis to examine the effectiveness of tongue-tie treatment on breastfeeding difficulties. We searched peer-reviewed and grey literature in MEDLINE (OVID), PubMed, CINAHL Plus, EMBASE and PsycINFO, from 01/1970 to 09/2019. randomised and non-randomised clinical trials, and quasi-experimental study designs, involving breastfeeding interventions for full-term singleton infants, using standardised measure of breastfeeding difficulty. qualitative and purely observational studies, lacked operational definition of breastfeeding difficulty, lacked control/comparison group. We assessed risk of bias, summarised study quality and results and conducted meta-analysis using random effects modelling. Six studies on tongue-tie division were included (4 randomised and 2 non-randomised). Meta-analysis of standardised mean differences in breastfeeding difficulty scores in four studies showed statistically significant differences in favour of frenotomy (Pooled SMD +2.12, CI:(0.17-4.08)p=0.03). Similarly, a statistically significant difference in favour of frenotomy was observed for pain (Pooled SMD -1.68, 95% CI: (-2.87- -0.48). Results support that infant frenotomy is effective for improving standardised scores on breastfeeding difficulty and maternal pain scales and could improve breastfeeding outcomes.

A study to assess the Lactation initiation practices among Intranatal Mothers admitted at labor room in Pravara Rural Hospital, Loni and its effects on Maternal and Fetal outcome

Background: Lactation is the secretion of milk by the mammary glands. The action of suckling an infant. Early initiation of breastfeeding is the first step in the success of a baby to learn to suckle first early after birth so that breast milk remains in production. Breast feeding is one of the oldest practices known to mankind for all infant, breast feeding remains the simple. Healthier and least expensive feeding method that fulfills the infant needs. It is considering as the most complete nutritional source for infants because breast milk contains the essential fats, carbohydrates, protein &amp;immunological factors early initiation of breast feeding with one hours of birth is associated with a reduced risk of neonatal mortality. Methods: A observational research study was undertaken in labor room of Pravara Rural Hospital Loni Bk. A total of 60 intranatal mothers was selected with the help of systematic random sampling technique was used to assess the lactation initiation practices among intanatal mothers and to assess the maternal and neonatal outcome Latch score and APGAR SCORE was used to assess the neonatal outcome. Observational checklist was used to assess the lactation initiation practices and maternal outcome. Study Findings: The result showed that (81%) new born had all essential newborn care after the birth only the 5% of it did not get enough new born care. in relation to LATCH score was assessed the score shows that mean score was (2±1.92) which indicates poor score of latching where as in audible swallowing mean score was (0.67±0.81) it also indicates poor latch score in type of nipple mean score was (2.41±7.71) it indicates moderate latch score comfortable position mean score was 1.91±0.86 it indicates poor score Holding position mean score (2.15±0.94) it indicates poor score. Frequency and Percentage wise distribution LACH Score neonatal shows that L-in that highest frequency and percentage i.e. score 0 shows 38(63%), score 1shows 35(58%),Score 2shows 34(17%), A-Audible swallowing in that 0score shows 20(33%),1score shows22(36%),2 score s19(31%), T-Type of nipple in that 0score shows that 43(18%) 1Score shows 18(30%) score 2 shows 16(26% ) C-Comfort level in which 0 score shows 56(38%) 1 score shows 63(38%) 2 score shows 63(35%) H-Holding position 0score shows 35(58%) 1score shows 43(17%) 2 score shows 42(70%).APGAR score after the delivery within 15min new born APGAR score 91% newborn were mild depression ,5%were moderately depressed, 5% were severe depression it interprets that no neonatal mortality and morbidity. Conclusion: The intranatal mothers have lack of knowledge about breast feeding practices. This problem significantly have impact on maternal and fetal outcome, it was evident that nursing interventions such as lactation initiation practices does have significant impact in enhancing the maternal and fetal outcome.

Effect of Frenotomy on Maternal Breastfeeding Symptoms and the Relationship Between Maternal Symptoms and Problematic Infant Feeding.

The relationship between maternal symptoms and problematic infant feeding in the context of tongue-tie is unknown. In a sample of infants with tongue-tie undergoing frenotomy and their mothers, the aims of this study were to: (1) describe changes in maternal symptoms pre- and post-frenotomy, and (2) evaluate the relationships between maternal symptoms and symptoms of problematic feeding pre- and post-frenotomy. Mother-infant dyads were recruited from 1 pediatric dental office between July and November 2020. The sample included 102 mother-infant dyads; 84 completed the follow-up survey. Maternal symptoms of painful and difficult latch, creased/cracked nipples, bleeding, or abraded nipples, chewing of the nipple, and feelings of depression were significantly less common after tongue-tie revision. Poor latch onto the breast was associated with feeding difficulties at both time points. Frenotomy resulted in a decrease of symptoms in breastfeeding mothers. Maternal symptoms and feeding problems persisting post-frenotomy warrant further evaluation.

What’s new for the clinician? - Excerpts from and summaries of recently published papers

The World Health Organization (WHO) considers breast milk as the best source of nourishment for infants. Although exclusive breastfeeding is recommended up to 6 months of age, globally only 40% of children under this age are exclusively breastfed and this is mainly due to negative breastfeeding experiences. There are many different causes for negative breastfeeding experiences such as poor weight gain, necessitating supplementation, poor latch, maternal nipple pain, and oral restrictions like a tongue-tie (ankyloglossia) and/or lip-tie. Ankyloglossia (either the decrease in mobility for the tongue by classic anterior tongue-tie or a submucosal restriction, a posterior tongue-tie) and a superior tethered labial frenulum can cause altered latch and sucking mechanics. Studies have shown that a frenotomy, if adequately performed, can improve breastfeeding scores and relieve nipple pain with little or no serious complications.

Breastfeeding Practices and Problems Among Obese Women Compared with Nonobese Women in a Brazilian Hospital.

Background: Women who are obese have lower rates of breastfeeding initiation and duration and are less likely to breastfeed exclusively compared with women who are not obese. To develop programs to improve breastfeeding practices among this group of women, we investigated the association between maternal obesity and breastfeeding practices and problems in the first days postpartum.Methods: We analyzed medical records from postpartum women at a rooming-in maternity ward in State of São Paulo, Brazil, between 2016 and 2018. We included those who had intended to exclusively breastfeed, had given birth to a singleton and were admitted to rooming-in. We analyzed exclusive breastfeeding and nonexclusive breastfeeding each day of hospitalization and the presence of breastfeeding problems, comparing women in the obese category (body mass index [BMI] ≥30 kg/m2) to normal and overweight women (≥18.6 to ≤29.9 kg/m2).Results: Two hundred and twenty-four postpartum women participated, including 86 women in the obese category. More than 50% of women with obesity reported a breastfeeding problem in the first and second postpartum days (p = 0.026 and p = 0.017, respectively) compared with the 41% and 38% nonobese group. Children of obese women were 2.8 times more likely to have poor latch during breastfeeding (95% confidence interval [CI]: 1.29–6.10) compared with the nonobese group on the third day.Conclusion: Maternal obesity increased the probability of breastfeeding difficulties and nonexclusive breastfeeding at discharge. Professionals need to support breastfeeding techniques in the days immediate after delivery to improve breastfeeding outcomes for mothers with obesity.

Using Videos to Teach Medical Learners How to Address Common Breastfeeding Problems.

IntroductionThough breast milk is the recommended first food, only 84% of mothers try breastfeeding, and 19% of those babies are supplemented with formula by the second day of life. Mothers often fall short of their breastfeeding goals, which has been traced in part to primary care physicians’ discomfort and lack of confidence in assisting breastfeeding mothers. A video-based educational intervention was developed to enhance learner comfort and confidence in supporting breastfeeding.MethodsPrior to watching the videos, two separate groups of learners (25 primary care residents and 40 medical students) were given two assessments to assess their baseline knowledge and self-perceived comfort and confidence with breastfeeding based on the American Academy of Pediatrics residency breastfeeding curriculum. We gave the learners a checklist to guide their observations while watching the videos. The learners repeated the assessments after watching the videos.ResultsStudents who participated showed a statistically significant increase in breastfeeding knowledge and self-perceived comfort and confidence in assisting mothers with common breastfeeding problems. Additionally, residents increased their knowledge and confidence, but not their comfort with breastfeeding.DiscussionThe videos seem to have been most helpful in assisting learners with confidence with helping breastfeeding mothers and knowledge of breastfeeding. The videos also improved student comfort but were less effective in increasing residents’ comfort as residents generally self-rated their comfort level as high preceding the video curriculum. These videos provide an effective way to begin sensitizing learners to the importance of breastfeeding, common challenges, and potential solutions for new mothers.

Candida and Breastfeeding: A Critical Commentary on the Dilemmas Around Diagnosis, Treatment, and Management

ObjectiveThe etiology of nipple pain in breastfeeding women can be challenging for healthcare professionals. The most common cause of nipple pain or damage in breastfeeding women is poor latch and positioning of the baby at the breast (Duncan, 2015). However, when position and attachment is not identified as the cause, controversy exists as to the etiology of the pain with nipple or breast thrush identified as a probable suspect.ReviewThe literature was reviewed to explore the diagnosis and management of thrush in breastfeeding women.FindingsThere is a lack of robust evidence in the literature to support an accurate diagnosis of candida as the cause of nipple and/or deep breast pain in breastfeeding women. Diagnosis and management strategies vary between the USA and Europe.ConclusionIt is important that clinicians supporting and working with breastfeeding women are aware of the differential diagnosis for both breast and nipple pain, as well as utilize their clinical skills effectively to offer the correct treatment and management to women presenting with candida like symptoms (Amir et al., 2013, Wilson-Clay &amp; Hoover, 2017). Culture and sensitivity of mothers expressed milk may be supportive of a diagnosis; however, analysis of mothers' milk is not without its challenges. Breastfeeding women should not be treated for potential candida infection with a traditional clinical examination alone.

Retrospective Cohort Study on Effect of Frenulotomy Techniques on Breastfeeding

Objective: The aim of this study was to compare the outcomes between frenulotomy by bedside technique and surgery under general anesthesia to successful breastfeeding in ankyloglossia infants.Methods: A quantitative research of retrospective cohort study was conducted in Naresuan University Hospital, Thailand between July 2012 and June 2017. We enrolled all infants born and identified the infants diagnosed with ankyloglossia. The severity of ankyloglossia was assessed. The outcome of two types of frenulotomy were compared.Results: Ankyloglossia was diagnosed in 187 (6.3%) of 2,968 infants born. The main breastfeeding problems in both groups were maternal sore nipples, cracked nipples and poor latch on. The infants in the bedside technique group had more successful rate of exclusive breastfeeding at day 7 when compared with the surgical group (87.3% and 39% respectively, p&lt;0.001). More percent increment of infant’s body weight at day 7 in the bedside technique group than the surgical group (60% and 20.8% respectively, p&lt;0.001). Overall maternal satisfaction in the bedside technique group was notably higher than that in the surgical group (96.4% and 59.7% respectively, p&lt; 0.001). The length of hospital stay was less in the bedside group for 1.22 days. More weight gain was found in the bedside group.Conclusion: Frenulotomy is the procedure that should be performed in indicated ankyloglossia infants. The bedside technique frenulotomy is preferable than surgery under general anesthesia attributed to a more satisfactory outcome.

Tongue-tie division in neonates with breastfeeding difficulties: a systematic review

Objective To systematically review the effect of Tongue-tie division on infants with breastfeeding difficulties. Methods The Cochrane Library, PubMed, CNKI and Wanfang data were searched for relevant articles. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria and extracted data regarding study design. RevMan 5.3 software was used to conduct Meta-analysis. Results A total of 151 articles were retrieved and finally 15 articles were included, which involved 1 133 infants. Tongue-tie division provided objective improvements in poor latch, inefficient feeding, poor weight gain. Subjective improvements were also noted. But the results were inconsistent on pain improvement. Tongue-tie division increased breastfeeding rate. Conclusions Available evidence suggests that Tongue-tie division can improve breastfeeding, complications are rare, and it is acceptable by families. Key words: Breast feeding; Pain; Ankyloglossia; Tongue-tie division; Latch

Making Sense of Studies That Claim Benefits of Frenotomy in the Absence of Classic Tongue-Tie.

By performing an in-depth analysis of one high profile example, this article aims to help breastfeeding support professionals understand the methodological flaws that characterize recent studies claiming to show the efficacy of frenotomy for the diagnoses of posterior tongue-tie and upper lip-tie. The example study does not address definitional confusion or control for the effects of the passage of time. It does not consider the effects of caring attention, validation, and lactation consultant support. It also does not consider the extensive research over the past three decades that has established that reflux in the first 6 months of life is benign, even though increased reflux frequency may correlate with unsettled infant behavior. The study authors relied on the hypothesis that reflux is caused by excessive air swallowing in infants with poor latch due to posterior tongue-tie and upper lip-tie, which lacks credible physiological mechanisms or supporting evidence. The authors' claim that conducting a randomized controlled trial to investigate the efficacy of frenotomy would be unethical contradicts the basic principles of good science. This article argues that our breastfeeding women and their babies deserve the most rigorous scientific methods available, and acknowledgment of the biases inherent in less rigorous research, if we are to make appropriate decisions concerning intervention with frenotomy and to prevent unnecessary oral surgery.

Breastfeeding Infants with Ankyloglossia: Insight into Mothers' Experiences

Breastfeeding difficulty from ankyloglossia can affect both the mother and baby in a breastfeeding dyad. With renewed emphasis in today's culture on breast milk, mothers may feel increasing pressure to breastfeed, and the inability for some to do so may cause significant distress. Recently, online parenting forums have seen exponential growth; these forums allow mothers to connect with peers undergoing similar life transitions. The purpose of this study was to review online discussions regarding ankyloglossia to understand mothers' experiences with breastfeeding. We performed an ethnographic content analysis of 76 online threads and 501 posts regarding ankyloglossia based on six domains: (1) initial expectations, (2) breastfeeding complications, (3) questions, (4) diagnosis, (5) treatment, and (6) outcomes. About one-fourth of women who participated in online forum discussions had initial expectations to breastfeed, however, many found it impossible due to poor latch or pain. Concerns were frequently exacerbated by healthcare providers who reportedly missed or overlooked ankyloglossia. Although these complications made breastfeeding a challenging experience, mothers often described both subjective and physical improvements after frenotomy. Breastfeeding difficulty was a commonly voiced concern in online ankyloglossia forums. Forum analysis is an effective way to gain insight into patients' experiences, which allows providers to anticipate concerns and provides more effective counseling.

Case 2: Poor Feeding and Physical Anomalies in a 1-day-old Male Newborn

A male infant is born at 39 0/7 weeks of gestation with a birthweight of 2,917 g. He is born to a 28-year-old gravida 3, para 2-0-1-2 mother who received appropriate prenatal care. The infant requires no resuscitation at delivery, has Apgar scores of 9 and 9 at 1 and 5 minutes, respectively, and is transferred to the newborn nursery for routine care. Upon initial nursing evaluation in the nursery, the infant is noted to have 2,3-syndactyly of the bilateral feet (Fig 1) and a small phallus (Fig 2). The primary pediatrician’s initial examination reveals the syndactyly and a hypospadias with palpable testes in the inguinal canal. The infant is noted to have very poor latch and suck when attempting breastfeeding on the day of birth. One day after birth, the infant continues to have inability to feed at the breast. Follow-up examination notes ambiguous genitalia and laboratory/imaging studies are ordered. Initial laboratory investigation reveals a low total serum testosterone at 67 ng/dL (reference range for newborns: 75–400 ng/dL) and electrolytes remarkable for sodium of 141 mEq/L (141 mmol/L), potassium of 5.7 mEq/L (5.7 mmol/L), chloride of 109 mEq/L (109 mmol/L), bicarbonate of 24 mEq/L (24 mmol/L), serum urea nitrogen of 12 mg/dL (4.28 mmol/L), creatinine of 0.27 mg/dL (23.9 μmol/L), glucose of 54 mg/dL (3 mmol/L), and a serum calcium of 8.7 mg/dL (2.2 mmol/L). An …

Aerophagia Induced Reflux in Breastfeeding Infants With Ankyloglossia and Shortened Maxillary Labial Frenula (Tongue and Lip Tie)

Background: Infants with tongue and possible lip tie often have a poor latch in which there is often an inadequate seal around the breast and disorganized swallowing. As a result, many of these infants swallow air during breastfeeding. Many of these infants suffer from symptoms of reflux. Methods: This was a retrospective analysis of questionnaire/intake surveys of 1,000 infants over 5 years in private surgical practice. The inclusion of these infants was determined based on painful breastfeeding, poor lip seal, infant taking H2 blockers or proton pump inhibitors. These infants underwent release of their restrictions with CO 2 laser. Results: This study shows a correlation between aerophagia in infants with short maxillary labial frenula (maxillary lip tie) and ankyloglossia and reflux. A new term has been created to describe this entity: aerophagia induced reflux (AIR). Five hundred twenty (52%) showed improvement or complete reversal of symptoms of reflux to the end point of cessation of reflux medication. Two hundred eighty-three (28.3%) had no change in reflux, and 191 (19.1%) showed post-surgical improvement in post-feed irritability and less reflux symptoms but not successfully weaned off medications. Conclusion: There appears to be a relationship between maxillary lip tie (ankyloglossia and shortened maxillary labial frenula) and AIR. Treatment of these infants with a relatively simple frenotomy procedure may reduce or eliminate reflux. As a result, many of these infants may be spared from invasive testing or medications that have been shown to have potentially significant side effects. This may change diagnostic and treatment algorithms. Int J Clin Pediatr. 2016;5(1):6-8 doi: http://dx.doi.org/10.14740/ijcp246w

Breastfeeding Difficulties at Three Months are Associated with Formula Use in Vietnam

Breastfeeding (BF) difficulties after lactation is established are not well understood, and lack of support may lead to infant feeding practices that undermine exclusive breastfeeding (EBF). We assessed the association between BF difficulties at 3mo and formula feeding (FF) between 3‐6mo in a subsample of eligible mothers (n=604) as part of a 2010 Alive &amp; Thrive baseline household survey in Vietnam (n=4029). Almost 14% of all mothers reported BF difficulties, including perception of insufficient milk (PIM, 38%), breast pain (15%), and poor latch (15%). Only half of mothers sought support for PIM compared to three‐quarters for pain or latch. Regardless of type of difficulty or support sought, use of formula was the most common recommendation to mothers. Over half of mothers FF in the first 6mo, but use was dynamic; 27% reported first use between 3‐6mo. In multivariable analysis, BF difficulties were associated with higher odds of FF at 3‐6mo (OR, 2.32; 95% CI 1.38, 3.91), as was maternal work outside the home (OR, 2.03; 95% CI 1.30, 3.18), FF at birth (OR, 1.86; 95% CI 1.27, 2.73), and child age (OR, 1.34; 95% CI 1.06, 1.68). No association was found for education, SES, having heard about EBF, food security, BMI, BF difficulties at birth, or recent child illness. In Vietnam, later BF difficulties are associated with formula use. Targeted support for PIM, breast pain, and latch is necessary if EBF goals are to be achieved. Reduced formula use at birth and support for working mothers are also necessary to decrease formula use between 3‐6mo.Funding Source: Alive &amp; Thrive, funded by the Bill &amp; Melinda Gates Foundation and managed by FHI360

PO-0982 The Impact And Importance Of Early Diagnosis Of Posterior Ankyloglossia: A Case Series

<h3>Background</h3> Ankyloglossia is a developmental anomaly causing restricted tongue mobility. Posterior types are usually identified latest and least commonly. Currently, there are no standardised national/international guidelines for diagnosis. This case series aims to highlight the importance of early diagnosis to reduce cases identified only following significant morbidity. <h3>Methods</h3> Over a 2 year period, consecutive patients diagnosed with posterior ankyloglossia were identified. <h3>Results</h3> Of the 15 patients identified, mean age at diagnosis was 24 days (range 4–42). 8(53%) had regained their birthweight however, for 3(38%) of these, weight gain was slow/inadequate. The remaining 7(47%) had lost weight with a mean weight loss of 8.54% (range 2.56–16.06). 13(86%) were exclusively breastfed, 1(7%) both breast- and formula-fed, and 1(7%) formula-fed. Presenting features included poor latch (60%), weight loss (47%), sore nipples (40%), irritability (40%), poor weight gain (20%), increased feed duration (20%), and lethargy (20%). 9(60%) were diagnosed by breastfeeding co-ordinators, 4(26%) by community midwives, and 1(7%) each by a paediatrician and neonatal nurse. All patients underwent a frenotomy following which both weight gain and feeding improved in 11(73%). Behavioural improvements were noted in 8(53%). 11(73%) mothers felt their baby’s symptoms had improved. All of the 6 mothers who initially described symptoms of their own reported improvement. <h3>Conclusion</h3> For many infants, posterior ankyloglossia is often detected only once feeding has deteriorated enough to result in significantly poor weight gain or weight loss. To prevent this and other morbidities shown in this small case series, a standardised assessment tool may be a useful method to facilitate earlier diagnosis and improve clinical practice.