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Talking Tongues: New Lingual Frenulum Research Challenges Previous Beliefs

How would it change your practice if you learned that just about everything you think you know about the lingual frenulum is wrong?  

New research to be presented at the International Lactation Consultant Association’s Annual Conference in Texas in July suggests exactly that, with serious implications for lactation professionals’ work.

As a Pediatric ENT Consultant at Starship Children’s Hospital in New Zealand, Nikki Mills, BHB, MBChB, FRACS, Dip Paeds, IBCLC, sees a lot of baby’s tongues. And, she is often asked to perform frenotomies.

Over time, Mills began to have more questions than answers about the procedure.

Why did some of her patients seem to get great benefit from the procedure, breastfeeding more successfully afterward, while others saw no benefit at all?

“As a surgeon who was being asked to divide frenulums in babies, I really wanted to know what it was that I was cutting,” Mills says. “I wanted to understand exactly what tissues I was dealing with and what they did.

“I believed that understanding should be the basis for deciding when a frenulum should be cut—and when it should not,” Mills continues. “For me, it was a fundamental question.”  

But when she went looking for research to answer her questions, Mills came up empty handed.

“No one had ever looked at the anatomy and function of the lingual frenulum in detail,” she says.

She decided it was high time someone did.

So she scaled back her clinical practice and spent the next four years researching.

As part of her investigation, she dissected fresh neonatal cadavers to better understand the anatomy and function of the lingual frenulum.

What she discovered was out of sync with everything she had been taught.

“What I found was very different from what has been the popular understanding of the lingual frenulum,” she says. “It’s challenging because when I present my research, it makes everyone who thinks they understood the lingual frenulum rethink and reframe what they thought.

“We have started to think of any lingual frenulum as a tongue tie,” Mills continues. “We’ve created a situation where normal anatomy is called an anomaly.”

At the ILCA conference, she will explain her published research in detail, as well as its implications for evaluating and treating breastfeeding problems.

In addition, she will present research she has recently published on the effect of positioning on babies who are having difficulty with swallowing and breathing during breastfeeding.

Mills placed breastfeeding parents and their infants inside MRI machines, capturing dynamic MRI images of what happens during sucking and swallowing.

Because most previous research has been done with bottle-feeding infants, these MRI studies represent a leap forward in understanding what happens during breastfeeding.

“We wanted to understand and define the impact of different breastfeeding positions on tongue position and dynamic airway collapse with the tissues above the voice box, and also with milk flow,” she explains. “What happens when the baby is positioned in different ways?

“When a baby is having trouble breathing, breastfeeding is often the first thing to go,” she continues. “Parents are told they must bottle feed. I wanted to know, what can be done to modify positioning to create a greater possibility of supporting safe breastfeeding in at least some of those babies?”

Mills will present these findings, along with tips for how IBCLCs can apply them when working with babies with Laryngomalacia and other challenges.

From her unique perspective as a clinician and a researcher, Mills will discuss:

  • How the field of lactation support is getting it wrong when it comes to the lingual frenulum.
  • Why assessing lingual frenulum in isolation is a costly mistake.
  • How her new data inform decisions about when frenotomy is indicated and when it is not.
  • The results of her dynamic MRI studies of babies feeding at the breast, the first of their kind, and implications for using positioning to help babies with sucking and swallowing difficulties.

This year’s conference will be hybrid, offering both online and in-person options in Houston, Texas, US. To learn more about the #ILCA21 conference, offered both virtually and in person, visit here.

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