This article is courtesy of Mr. Ng Chee Eng, Paediatric Surgeon of a private hospital in Penang.

TONGUE TIE & NURSING

QUESTION

Mothers of babies with this condition have difficulties in breastfeeding because of sore nipples. This condition is diagnosed by lactation consultant and paediatrician. Currently, are paediatric surgeons still performing the procedure to snip the part of the tongue to enable breastfeeding? What are involves? Does the baby has to go under general anaesthesia (GA)? Other than breastfeeding problems, will the baby have problems with his speech later on?

ANSWER

Whether a tongue tie needs to be released / snipped depends on its severity and whether it is causing any problems.

Latching on to the nipple/breast and breast feeding can be difficult if not impossible with a severe tongue tie. Release is then clearly justified and during the first few weeks of life, it can be done without any anesthesia and without any distress to the baby. However if the membrane (frenulum) that holds the tongue down is thick, then release will need to be under GA because of the risk of bleeding. All older children are done under GA.

Regarding speech, again it depends on the severity of the tongue tie. Some of these children may mispronounce certain syllables. However it must be said that the vast majority of children with tongue ties speak normally. Tongue tie that is detected very early but did not cause any problems like breast feeding, should not be released until he/she is much older, maybe even at 2 to 3 years old. The tip of the tongue does become longer and the underlying membrane / frenulum may recede with the child’s growth. If there is still a speech problem, release is indicated but even then I always caution the parents that the speech may not improve. They are always advised to seek a Speech Therapist’s assessment and advice.

There is also another indication for release of a severe tongue tie even when there are no problems with feeding or speech and that is to allow the tongue greater movement and mobility within the mouth. This is important for purposes of mouth hygiene as they are able to sweep the inside of the mouth of food debris.

The Japanese / Koreans / Chinese – I think what is happening is that the the parents want their children to speak better English by lengthening the children’s tongues. These children have normal tongues to start with. I am very doubful if it works and I will certainly not do it even at the request of the parents.

In summary, release of tongue tie is only justified in severe cases especially if there are difficulties with it. Generally a severe tongue tie is one that the tongue is unable to protrude beyond the lips. In newborns, some of them can’t even protrude beyond the gum margin.

I hope I have answered your queries about this fascinating subject.

Ng C.E.

Maternal/Infant illnesses

* It is safe to breastfeed even when mother and baby have illnesses
* Most drug medications are compatible with Breastfeeding
* Maternal Mastitis can be treated with antibiotics for 10 days
* Continue Breastfeeding from both breasts
* Neonatal Jaundice is compatible with Full Breastfeeding

Working and breastfeeding your baby is possible by storing expressed breast milk

Feed Early -

* Within half hour of birth, in the Labour Ward
* First feed lasts for 10-20 minutes. First day baby feeds 5-6 times a day

Feed Frequently

* Room in with baby while in Hospital
* From 2nd day, baby feeds about 1.5 to 2 hourly
* Baby feeds about 10-12 times per 24 hours
* Each feed lasts for 20 to 40 minutes or more
* No limit to duration or frequency of feeds to satisfy suckling needs
* No need to time the baby and feed whenever baby is hungry
* At night feed 2 hourly before 12 midnight, then at 2-3 am and again at 5-6am. Good to co-sleep in the same bed with baby.

Feed Properly

* Hold baby at breast level, lying on his side, chest to chest
* Stimulate the rooting reflex with nipple touching baby’s lips
* Quickly bring baby to breast when his mouth opens wide
* Baby latches on properly and prevents sore nipples, when the nipple and much of the areola are in the baby’s mouth
* Allowing suckling till baby sleeps and lets go of the nipple himself
* Do not pull the baby off the nipple when he is still latched on
* When off the nipple, and baby cries, put him back on the same breast
* Allow him to complete one feed on one breast
* Feed on the other breast at the next feed, 1-2 hours later
* Colostrum is more than enough for baby till Mature Milk comes in
* No need to give water, glucose or formula milk
* Avoid bottles and pacifiers and other artificial nipples as these cause nipple confusion, and breast rejection

Baby has enough milk if

* He is contented for 1-2 hours after a feed
* He passes clear dilute urine 5-6 times a day
* He passes bright yellow watery stools 6-8 times a day
* He puts on at least 20 grams of body weight a day
* He regains birth weight after 2 weeks

Breast milk supply can be increased by

* Frequent feeds day and night
* Allowing unlimited breastfeeding to satisfy baby’s suckling needs
* Mother to eat and drink sufficient quantities to satisfy her hunger and thirst
* Cultural foods like ginger and rice wine are compatible with breastfeeding

Breast Engorgement

* Apply cold wet compresses over the breast to reduce swellings
* Feed frequently 2-3 hourly round the clock. Safe to take 2 Panadols for pain

Information courtesy of Dr S.L. Koe, Paediatrician & Lactation Consultant. Tel. no. : 03-798 30539)

3 Steps to Breastfeeding

Dear Parents,

The information given here will help the mother to breastfeed successfully. The supportive role of the father is of utmost importance. The mother needs support and encouragement from him and grandmothers to build up the confidence that she has enough milk. Having enough information prevents breastfeeding problems and crises and provides the solutions to these should they arise. The baby can be breastfed completely for 6 months, thereafter solids are given together with breastfeeding to 2 years and beyond.

The Art of Successful Breastfeeding

Introduction

Successful Breastfeeding depends on

1. Having enough information on normal breastfeeding
2. Having support from knowledgeable Medical staff in the Maternity Unit and Family members
3. Having a Positive and Confident attitude that it can be done

Breastfeeding Benefits to the Child

1. This provides the best possible nutrition to the young child
2. It reduces the incidence of coughs and colds, ear infections, bronchitis, pneumonia, meningitis and diarrhoea through its protective factors.
3. It protects the child from colic, asthma, eczema, nose and food allergies
4. It is essential for the optimal physical, emotional and mental development of the child. Breastfed children are also smarter

Breastfeeding Benefits to the Mother

1. This promotes mother and child bonding
2. It prevents uterine bleeding in the mother after delivery
3. This is a natural form of Family Planning
4. This reduces the risk of breast and ovarian cancer in the mother
5. This saves time and precious expenses need not be used for buying milk powder and health care.

The Star Online

Wednesday, August 2, 2000

Woman

Breastfeeding at work

Favourable conditions in the workplace go a long way to encouraging breastfeeding among working mothers. In conjunction with World Breastfeeding Week (Aug 1 to 7), SHAMALA VELU takes a peek into a little room set up by a thoughtful employer for its breastfeeding mums, and comes away sufficiently impressed.

WAN Sabrina Mohamad has a quick lunch and then hurries off with a breast pump into the “Mother’s Room” where she spends about 15 to 20 minutes of her lunch break expressing milk.

“Breastfeeding is something I hold close to my heart,” says Sabrina, 30, a senior industrial hygienist who works for Motorola Malaysia in Petaling Jaya.

A mother of three, Sabrina takes pride in breastfeeding all her children. In fact, her youngest, a nine-month-old boy, is still taking breast milk thanks, to his mother’s disciplined attitude.

Sabrina’s colleague, Dayang Lily, 29, shares her sentiments about breastfeeding.

Lily, a systems engineer and mother of two, has been breastfeeding her 10-month-old baby girl, thanks to the facilities provided in the office.

“It really helps if there’s a private room in the office for mothers to express milk. This will encourage them to continue breastfeeding,” said Lily.

Lily and Sabrina, who have been working for Motorola for the past seven years, consider themselves lucky mothers.

Unlike most mums who have had to give up breastfeeding completely soon after they return to work, Lily and Sabrina, who have heard so much about the benefits of breast milk, have the satisfaction of providing their babies with the best.

“It doesn’t cost much to set up the room and supply a refrigerator,” said human resource manager Latifah M. Daud who is also breastfeeding her infant.

Most mothers pump three times a day–during coffee break in the morning, lunch time and tea time. Anyone using the room must sign in and sign out after leaving..

“Before storing expressed milk in the refrigerator, milk bottles have to be tagged with the mother’s name and phone extension number to avoid any mix-up,” explained Dayang.

The milk is later taken home in a cooler box to feed the baby.

The “Mother’s Room” is sub-divided into two to cater to two people at any one time. Although it is not furnished with a breast pump just yet, it has two cabinet drawers and a refrigerator.

Creating awareness on breastfeeding is high on Motorola’s agenda for the year as it concurs with the company’s programme on “Preventive Health Medicine” which starts this month.

So how was the “Mother’s Room” initiated?

According to Latifah, it was a group of young mothers who first approached her early last year.

“They were using the surau and the office clinic to express milk during the day but it was not very conducive as there was no privacy and proper washing amenities,” she explained.

Privacy and security for the mothers were important considerations which had to be looked into, said Latifah.

It was only early this year that the Mother’s Room was conceived. However, the focus now is on creating awareness on hygiene when breastfeeding.

“We are planning to rent a breast pump as it is more efficient and faster,” explained Latifah.

If the response is good, more Mother’s Rooms may be set up in various sections of the office building, said Latifah.

With its worker-oriented approach, it is little wonder that Motorola was given the “Caring Employer Award” by the Human Resources Ministry last Saturday for initiating various programmes for the benefit and welfare of its staff.

“The cost is high, but the returns are good because they come in the form of higher productivity and fewer medical leave,” said Latifah.

Copyright © 1995-2004 Star Publications (Malaysia) Bhd (Co No 10894-D)
Managed by I.Star.

Source – The Star Online dd August 3rd, 2004

Strengthening ties

In celebration of World Breastfeeding Week (Aug 1-7)

WE OFTEN view breastfeeding as something practised by mothers in underdeveloped countries. Due to this distorted perception, one of the most beautiful means of mother and baby bonding has not been given the recognition it deserves.

It is time for everyone to look at this nurturing act in a new light. Breastfeeding opens up a whole new world that many of us have not explored. It is not about breasts or a hungry baby: it is about building a relationship and taking stock of the meaning of parenthood.

Most urban children may not have witnessed a mother lovingly nurturing her baby.

Some do not even know that humans can produce milk. What they have seen are probably a litter of puppies, kittens or other wild animals fighting for their mothers’ milk on the cartoon or documentary channels. Has anyone ever seen a Hollywood blockbuster or any of those family series featuring a mother breastfeeding her baby? No!

We have been brought up to think that milk comes from the udder of cows which dot the vast, green meadows.

We would expect the older generation – grandmothers and grandfathers – to be more aware of the importance of breastfeeding. But sadly, many of them grew up in a generation sold on the idea that imported goods are best. It was a status symbol in the 1960s and 1970s to be able to afford not to breastfeed.

However, let us look at the developed nations. Research has shown that developed nations have the highest rate of breastfeeding. These mothers are from the higher-income and higher education group. This clearly proves that breastfeeding is the smart choice of smart families.

With all the medically proven research to show that breastfeeding is beneficial to the health of mothers and babies, we must seriously look at how we can take advantage of this wonderful gift from nature. How can we ignore all the health benefits and magical bonding that breastfeeding offers?

There is no better protection and security for baby than in the mother’s warm embrace, lovingly nurtured with her precious milk.

Medical research has shown that newborns who are breastfed run a lower risk of getting many chronic illnesses later on in life. Hence the older generation should re-think and encourage their daughters and daughters-in-laws to nurture their descendants in the best possible way.

Everyone of us can play a part in breastfeeding. We can spread the news of the goodness of breast milk to people who do not have the advantage of acquiring the latest information. When we come across a mother nursing her baby in public, we can give her a smile of admiration instead of showing her to the nearest nursing room.

We should stop thinking of women’s breasts as mere sex objects. Women who are afraid that breastfeeding can affect their figure and image ought to find out the truth instead of blindly believing in myths.

If everyone starts to see breastfeeding in a different light, more mothers will be encouraged to breastfeed. In our fast developing country, we may forget the basics of good parenting.

We want the best for our children but in our eagerness, we may forget that money and substitutes are not enough. Children need the time, love and care of their parents. What better way to bond with the baby than through breastfeeding.

Chan Lilian, Penang

A taste of human milk

Now what does human milk taste like? Even experienced midwives and my breastfeeding counsellor pulled faces and admitted they didn’t know, when I asked them. I wouldn’t even dare to taste my own milk. Probably it is because we have associated milk with other bodily fluids which are seen as gross. And we know that fresh cow and goat’s milk have the subtle smell of the animals.

However, I got my two very curious and adventurous sons aged nine and six to taste my milk and they got hooked on it. They eagerly looked forward to finishing off leftover milk from their baby brother and when there was any excess, they made air bandung (milk mixed with rose syrup) with it!

I could not understand why they liked it so much until one day when I accidentally squirted some into my mouth. My instinct was to spit it out and run to the sink to disinfect my mouth. However, I was still recovering from my caesarean operation and was unable to leap out of the sofa and dash to the bathroom. Thus I had no choice but to swallow it. That was how I found the answer to this mysterious question. Human milk tastes like diluted condensed milk. It is light and sweet with absolutely no sickening flavour whatsoever – unless you drank too much salted fish soup!

At least three nurses from two different hospitals told me that there are women who produce breast milk and sell them in bottles for about RM100 in Penang. I can visualise feeding cow or any other animal’s milk to my brood but never another woman’s milk! It is such an intimate and private bond.

However, there are instances when some kind women would voluntarily donate their milk to help sickly babies who desperately needed it.

Please note that you must never give your baby another woman’s milk without your doctor’s approval because there are risks of serious infections being transmitted to your baby through breast milk. I know several mothers of premature and sick babies who successfully nurtured their very fragile babies by providing them with their milk. One of them, Winnie, had a premature daughter at 25 weeks who weighed only 825gm. Today, her daughter is a healthy three-year-old, thanks to her determination to breastfeed her child.

Another friend whose son had meningitis when he was a few weeks old attributed his healthy growth and intelligence to her efforts in breastfeeding him till he was five years old.

My fourth son, Vincent, was fully breastfed for more than four months and though he had many health complications, he is fondly remembered as an “apple cheek, chubby baby” by all. (Vincent lost his fight at seven months old due to premie-related illnesses.)

Painful reality

Firstly, most of us are not aware how terrible breast engorgement can feel like. On top of the pain of episiotomy or caesarean stitches and other birth-related traumas, we are hit by this discomfort when we return home from hospital.

The agony is akin to being run over by a steam-roller and then having two hot, heavy steel orbs placed on your chest. Once I was caught stuck to my bed after waking up from a nap, not being able to move or even raise my voice to call for help.

Luckily I had my handphone and called my son who was downstairs to come to the rescue with a double dose of painkillers. But don’t be discouraged because breast engorgement is really a much-awaited sign that your milk production is in full gear. It only lasts a day or two, and if you faithfully stick to the advice given by your midwife, you will be fine. It is worth the pain, trust me.

Secondly, you are going to be inundated with lots of well-meaning but negative advice from relatives and friends. It takes a very strong, determined and self-assured woman to overcome them.

If all medical personnel tell you that breast milk is best, then why allow unqualified advice to dishearten you?

Perhaps our local culture and taboos place too much emphasis on the recovery of the new mother at the expense of the well-being of the baby. Malays, Chinese and Indians alike have a myriad of amusing old-wives tales and practices where the care of the new mother is concerned.

You may find that some of these beliefs and practices are handed down from your great-grandmothers. For example, my Chinese ancestors may be able to go without a bath or shampoo for weeks or stay cooped up in a room with no air-conditioner or fan because they probably lived in the northern part of China where it must have been freezing cold.

My advice is to listen to your body and trust your own maternal instincts. Remember to place your baby’s health ahead of yours. Women in developed countries do not treat themselves like a piece of crystal after childbirth. Neither do women in undeveloped countries.

I have read with amusement how women lost their self-confidence as they aged and blamed breastfeeding and sagging breasts for failing to capture their husbands’ interests.

I even came across a hilarious letter in a magazine in which a woman wrote in to ask the doctor for advice on how to stop her breast-milk because her husband wanted to claim back his properties!

The act of feeding your baby is not exactly the most seductive pose. New mothers may have some inhibitions about transforming themselves from being a desirable woman into a milk-producing mammal.

New fathers, take note of this crucial tip. Never joke with a hormone-laden, sensitive new mother, no matter how supportive and loving you are, that she resembles the bovine species.

I remember my husband cracked this joke about me when I had my firstborn. He brought this bundle of nerves, who was bawling for milk, and said something like: “There, go find your moo-moo cow”. Not only did I bawl along with my baby, I also boycotted feeding my son from then on.

Of course, now I do not feel sensitive about any joke because I know that my ability to nurture my own flesh and blood is more important than anything else.