Here are some excellent resources for ankyloglossia. I am also attaching an article regarding why reflux is often an associated co-morbidity. These sites add to our understanding of posterior tongue tie, anterior tongue tie, as well as lip and cheek ties. Dr. Ghaheri has wonderful videos and pictures. I hope these resources inform your practice!
Assessment Tool for Lingual Frenulum Function developed by Alison Hazelbaker
Steehler, M. W., Steehler, M. K., & Harley, E. H. (2012). A retrospective review of frenotomy in neonates and infants with feeding difficulties. Int J Pediatr Otorhinolaryngol. doi: 10.1016/j.ijporl.2012.05.00
Just returned from teaching at Blythedale Children’s Hospital in Valhalla, NY. What an amazing program and staff they have, servicing a wide range of children from post-NICU through school age, with multiple complex co-morbidities. The pediatric therapists attending included those from Barcelona Spain and Australia, and we all appreciated the opportunity to problem-solve our patients and service delivery across settings. The grounds are beautiful and covered with animal topiaries that greet the children and their families. My colleague Theresa and I enjoyed their hospitality and the opportunity to share our passion for helping children with feeding and swallowing problems, and their families. Here we are in front of the hospital.
I have heard that rice cereal is not good to thicken with breast milk. Do you have research or articles we could use for a discussion with our neonatologists because they prefer we use it as they do not want commercial thickeners at all. We have discussed gel mix but they do not want us to use it. Any suggestions?
The many dieticians I have met have explained it to me as follows. It is the enzymes (such as Amylase, Lipase and Protease). The enzymes in breast milk serve a variety of functions, some of which we do not even know yet. Some enzymes are necessary for the function of the breasts and the production of breast milk, some enzymes help a baby with digestion, and some are essential a child’s development. Amylase is the main polysaccharide-digesting enzyme in MBM and it digests starch. So it averts binding of the MBM with rice cereal. Our MDs don’t allow commercial thickeners, either and gel mix is not approved by FDA for preterm in NICU. However some NICUs do.
Doesn’t leave a lot of options so one must look individually with the team at each infant, based on history, whether he can breastfeed (which is typically safer for most preterms unless there is a structural airway problem – and then breastfeeding not necessarily more protective). Depending on the etiology of the aspiration, plan will be different. Some infants may have a period of PO feeding formula (which has increased viscosity compared to MBM) or slightly thickened formula with rice cereal – not ideal ever, but may need to balance multiple factors and utilize as an interim plan related to likelihood of, and timing of, etiology for bolus mis-direction resolving.
One of my SLP colleagues was kind enough to share these excellent resources for those of us who work with infants and children S/P surgery for Congenital Heart Disease. Very informative for my practice.
Pediatric patients with congenital heart defects have their own set of challenges such as heavy amounts of sedation, bypass, pain from surgical incision, and weakness from recovery. A good resource is the National Pediatric Cardiology Quality Improvement Collaborative Website. This group is studying a specific cardiac population HLHS (Hypoplastic Left Heart Syndrome) but there are some good resources. Another website to look for information in regards to neurodevelopment specifically with congenital heart patients is the Cardiac Neurodevelopmental Outcome Collaborative (CNOC) website. These two groups are looking at standard practices in regards to feeding and nutrition. Best practices sometimes come within your unit and your team. Find a physician champion, provide in-services to staff, develop protocols that promote safe and effective feeding practices for your patients. And try to get involved in small research studies or PDSA cycles, (Plan, Do, Study, Act) and share your experiences with other clinicians. Use the basics that you know about feeding safety but be creative with your feeding plans for families when feeding is so important to them.