ניתוק שלישי- הכותבת היא מדריכת הנקה מנוסה

נפתלי, בן 3 וחצי חודשים. עבר ניתוק ראשון בגיל יומיים, שני בגיל שבועיים.
" בגיל שלושה חודשים החלו סימנים של " קפיצת גדילה"

קפיצת גדילה -במהלך יומיים שלושה התינוק "בונה חלב" כלומר מעביר מסר לגוף לייצר חלב לתינוק גדול יותר. קפיצת גדילה מסתיימת בד"כ תוך 24-36 שעות ולעתים אף שבוע ומופיעה לעתים בזמנים קבועים של 2-3 שבועות מהלידה, 6 שבועות, 3 חודשים וחצי שנה.

לעתים התינוק עושה זאת שלא "לפי הספר אצל נפתלי בעצם קפיצת הגדילה כאילו לא הסתיימה. אחרי יומיים הוא נרגע ו"חזר לעצמו" ויום אח"כ שב לנהוג כתינוק שחווה "קפיצת גדילה" . המשכתי לעקוב וידעתי שייתכן וצריך לשוב ולנתק.
נא שימו לב ! - אפשר היה בקלות לשייך את הסימנים האלו למשהו התנהגותי. כאן יכלו להיכנס לסיפור דודות ושכנות ואפילו-

רופא ילדים/אחות טיפת חלב ,ולומר ש:כנראה אין מספיק חלב/הוא מפונק/הוא התרגל וכדומה וצריך להוסיף לו תמ"ל/לתת לו לבכות ,ושאר עצות - והדרך הזו מובילה היישר להפסקת ההנקה! -חוויתי עם כמה אמהות הפסקת הנקה שהיוותה בעצם סיומה של שרשרת רעב-תוספת תמ"ל-הנקה לא מספקת, בעיקר בגילאים האלו.
יש לציין בפני רופאים שההמלצה בארה"ב היא הנקה בלבד עד גיל חצי שנה. פה מדובר בתינוק בן 3 וחצי חודשים.
הקושי לזהות את הסימנים האלו ולשייך אותם לצורך בניתוק חוזר נובע מהעובדה שהסימנים הללו של רעב מוגבר לא הופיעו בעקביות במשך שבועיים שלושה אלא בגלים- יומיים כן, יום לא וכו'.
חשוב להדגיש בפני אמהות -לא לוותר על התהליך ולחשוב שהניתוק נכשל ולחפש פתרון אחר.
חשוב לשוב למרפאה. זו העצה שאני נותנת לאמהות שמגיעות אלי.



בברכה,
טל וייזל .
אם ומדריכת הנקה

בס"ד
הסיפור של ד.ג. נוסח מקוצר - השמות והמכתב המקורי שמורים במרפאה

לידת ביתי, הילדה ה-12 במשפחה,היתה קשה מאוד. הייתי בסכנת חיים , ולכן קיבלתי את הילדה רק אחרי חמישה ימים. הייתי חלשה וכאובה אך עם נחישות ורצון להניק- הנקתי את 11 ילדי הקודמים עד שנה+. מאוד מאוד כאב לי בזמן ההנקה, התינוקת פלטה דם, ואף שכולם הרגיעו אותי הרגשתי ש"זה לא זה" – אבל בכל זאת ניסיתי.

בבית החלמה ליולדות, כל ארוחה היתה סיפור בפני עצמו: כאבים, פליטות דם וכו'. התינוקת עלתה במשקל מעט מידי , ואמרו לי "את חלשה, התינוקת תתרגל, תתחזקו ביחד".

וכך חזרתי הביתה. כאבים עד השמים- התינוקת אכלה הרבה זמן, ישנה הרבה , ועלתה לאט מדי במשקל.
משך חמישה חודשים נזקקתי לקחת 3 פעמים אנטיביוטיקה בגלל דלקות בשד, סבלתי מאוד וכל ארוחה ישבתי ובכיתי, ואז התינוקת התחילה לרדת במשקל, לא היו לי כוחות להלחם יותר והתחלתי לתת לה דיסות, מטרנה וכו' .
בסביבות גיל חצי שנה ניסיתי לתת לה אוכל סמיך יותר כגון פרות וירקות, הילדה הקיאה ולא עלתה מספיק במשקל.

לקחנו אותה לרופא גסטרו תינוקות, הוא בדק אותה חיצונית ואמר לי "את אישה זקנה, שכחת איך מטפלים בתינוקות, לכי הביתה ותני לה בסבלנות מה שהיא צריכה".
הרופא נתן לנו תפריט והורה לנו לחזור בעוד 3 שבועות, לא חזרנו,כמובן, הייתי פגועה ממנו והרגשתי שיש לתינוקת שלי בעיה שהוא לא זיהה.
הילדה גדלה לאט, נמוכה וקטנה, עצבנית ורעבה ולא דיברה אף מילה. לחם או ביסקוויט לא אכלה בכלל. ואז שמתי לב שאין לה תנועה בלשון בזמן הלעיסה, היא בלעה את האוכל,כמעט נחנקה- והקיאה. הילדה סבלה מעצירות קשה מאוד והיה סבל גדול לילדה ולנו לראות בסבלה, וכשהיו יציאות הם תמיד היו מלוות בדם. אף אחד לא הבין למה הילדה לא רגועה ועצבנית כל הזמן.
במסגרת עבודתי בגני ילדים נחשפתי לחומר שד"ר פורר כתב, קראתי כל מילה והרגשתי שזה המקום הנכון (גם אם לא כ"כ בזמן הנכון ) . הגענו עם הרבה חששות, במרפאה פגשנו תינוקות בני יומם ואני אכלתי את הלב למה הגענו כ"כ מאוחר,בתי כבר היתה בת שנה וררבעה חדשים .ד"ר פורר טיפל בילדה במסירות ומאוד הרגיע אותנו.
תוך שלושה ימים הילדה למדה ללעוס לחם, עוף ועוד, ואחרי שבועיים, היא עלתה כמעט 2 ק"ג !
מאז הטיפול היא רגועה, מרוצה, ישנה טוב ולא עצבנית.
היום כשישה שבועות אחרי הניתוק יש לנו ילדה שמחה, מדברת ! - אומרת את כל שמות ילדי המשפחה, יודעת להביע מה היא רוצה, לישון, לשתות... היא עלתה יפה במשקל (לפי מראה ) אוכלת הכל עם מזלג כמו גדולה - עוף, שניצל, ירקות, פרות, לחם..

Obstructive sleep apnea is a common form of sleep-disordered breathing characterized by repetitive episodes of partial or complete upper airway obstruction," the authors write as background information in the article. The condition usually causes breaks in sleeping, reduced blood oxygen levels and daytime sleepiness, and may contribute to cognitive (thinking, learning and memory) difficulties, psychosocial impairments, trouble driving, heart disease , stroke and death..
the most common obstruction is mixed -soft palate plus tongue base, 43.5%, followed by soft palate -34%, tongue base alone 22.5%.[ Alltogether 66% Obstructive Tongue-base ! ]

Chul Hee Lee et al. Evaluation of Soft Palate Changes Using Sleep Videofluoroscopy in Patients With Obstructive Sleep Apnea. Arch Otolaryngol Head Neck Surg., 2009 http://www.sciencedaily.com

הפסקת נשימה בשינה – אפניאה
אפניאה גורמת להפסקות-שינה, ירידה ברמות חמצן בדם, ישנוניות ביום, ותורמת להפרעות חשיבה,לימוד וזיכרון, לקשיים פסיכולוגיים, לבעיות נהיגה, מחלות לב, שבץ ומוות. שיקוף וידיאו של הפסקות נשימה בשינה הראה ש היו מקרים מעורבים של חך אחורי ארוך ובסיס לשון חוסם, 34% חך בלבד ,ו22.5% - בסיס לשון43.5% [סה'כ 66% בסיס לשון חוסם!] -

תאריך: 12:16 16.7.2008
מאת: אמא לשישה מתוקים
נושא: סיפור שהתחיל רע ונגמר בנס.

לפני כשנתיים נולדה ביתנו החמישית (!) – רחל אוריה שתח'. כאם מנוסה בהנקה מלאה, הנקתי עד רחל את כל ילדי כמעט שנתיים, הנקה מלאה וממושכת ללא בעיות של עלייה במשקל, מיעוט חלב, שאיבות וכד'.
בשבוע הראשון לחייה חשתי שמשהו אינו כשורה אולם לקח לי זמן להתעורר ולבדוק זאת. כששקלתי את רחל לאחר עשרה ימים הסתבר לי שהיא איבדה ממשקלה , וירדה ממשקל הלידה שהיה 3530 גר' למשקל של 2780 גר' !. בשאננותי -שנבעה מחוסר הבנה והכוונה מקצועית ע"י מי ששקלה את התינוקת- החלטתי להמשיך את ההנקה עוד יומיים לעיתים יותר תכופות ולראות מה קורה. במקביל התייעצתי עם מס. יועצות הנקה ששמעו את הפרטים ולצערי אף אחת מהן לא העירה את תשומת ליבי לכך שירידה כה ניכרת במשקל היא מסוכנת ועלי לחשוש להתייבשות... במהלך היום הזה המשיכה רחל לרדת במשקל, והבחנתי בסימנים מדאיגים נוספים: חוסר במתן שתן, עור צפוד ותשישות. חשוב לציין שמידי שלוש שעות האכלתי את רחל, ונראה היה לי שהיא יונקת, כי היא התחברה לשד ומצצה בחוזקה, אולם לא שמעתי את בליעות החלב. שכנעתי את עצמי שתינוקות כה קטנים לא לוגמים בקול ולכן איני שומעת דבר.
בשלב זה החלטתי להתחיל לשאוב חלב, ולתת לרחל לשתות מבקבוק. כששאבתי יצא לי חלב צהוב הדומה בצבעו לקולוסטרום שהוא החלב הראשוני, למרות שהייתי כבר כמעט עשרה ימים לאחר הלידה...
בשעות אחר הצהריים של היום ה12 החלטנו סוף סוף לפנות למיו-ילדים לאחר התייעצות עם אחות, ששמעה שרחל לא נותנת שתן כבר מס. שעות.
הגענו למיון ילדים בביה"ח קפלן. סיפרנו את הסיפור, רחל בשלב זה כבר הייתה אפטית, ואנחנו לחוצים ומודאגים. האחות התבוננה בה בהלם. היא אמרה לנו שלא ראתה תינוקת במצב כזה כבר שנים רבות. במהירות לקחו בדיקות לרחל שגילו את מצבה: התייבשות חמורה, אי ספיקת כליות, בצקת נשימתית, אוריאה בדם בערכים מטורפים, בקיצור: מבהיל.
הובהלנו לטיפול נמרץ ילדים, כשרחל מחוברת לנוזלים. מיותר לציין את מצבי הנפשי, פרצתי בבכי, והייתי מבוהלת למדי. המחשבה שרחל לא אכלה כמעט כלום עד היום הייתה מבהילה ומזעזעת עבורי .
ברוך השם וברוך שמו, רחל הגיבה לעירוי הנוזלים מהר מאוד, ולאט לאט "תיקנו" הרופאים את רמת המלחים בגוף והחזירו אותה לאיזון. ראינו בעיניים משעה לשעה את השינוי.
בנסיון לברר מה גרם להתייבשות החמורה הועלו מס אפשרויות ונבדקו: בעיות מטאבוליות, חוסר בחלב, נתרן גבוה בחלב האם, ועוד. אולם לא נמצא דבר בכל הבדיקות וכל המערכות נראו תקינות ב"ה.
אני התחלתי לשאוב חלב. בתחילה לא היה לי כמעט חלב, עד כדי כך שכעבור חצי שעה של שאיבה נותרו בבקבוקי רק 10cc אולם לאט לאט הכמות עלתה ורחל עברה להזנה מלאה של חלב אם דרך בקבוק.
השתחררנו לאחר שישה ימים. יצאנו מבית החולים בטראומה: בנוסף להרגשת הכשלון שלי כאם וההאשמות העצמיות: איך לא ראיתי? איך לא שמתי לב? חשתי ביקורת רבה מצד האחיות כאלו אני אם "ילידה" שמוכנה לפגוע בביתה רק בשביל להניק. מיותר לציין שבמצב כזה כל כך רגיש, זקוקה האם רק לתמיכה וחיזוק ולא לעוד עיניים מבקרות ומאשימות...
אמנם היינו אסירי תודה לרופאים שהיו שליחים נאמנים של הקב"ה והצילו את חייה של רחל אולם לא קיבלנו תשובה מספקת: מדוע בעצם לא ינקה? מה היא הסיבה? התייעצתי בטלפון עם מס. יועצות הנקה תוך כדי שהותנו בבית החולים ואחת מהן הזכירה את המונח "לשון אחורית". כששאלתי על כך את הרופאים הם ביטלו את דברי בזלזול ולא ייחסו להם כל חשיבות.
בחודש הבא נכנסנו לתהליך של מאבק לעלייה במשקל. שאבתי חלב סביב השעון, והאכלנו את רחל מבקבוק. בגלל גודלה הקטן ובשל חולשתה נרדמה רחל פעמים רבות במהלך המציצה ולקח לנו שעות מרובות להאכיל אותה. מידי יומיים הלכנו להשקל, ולאט לאט טיפסנו במעלות המשקל עד שבגיל חודש בערך עברנו את משקל הלידה.
רציתי מאוד לחזור ולהניק את רחל והרגשתי שאני לא מוכנה לוותר על ההנקה. לאחר חודש ניסיתי לעבור בהדרגה להנקה, אולם בכל פעם שניסיתי, (הפעם עם יד על הדופק ובעירנות מוגברת) ראיתי שכמות החלב שלי יורדת מייד, ורחל לא עולה במשקל.
ניסיתי לדלות מידע מיועצות הנקה שונות אולי מישהי מהן תוכל לעזור לי, עד שלבסוף יצרתי קשר עם יועצת הנקה מבני ברק ששמעה את הסיפור ואמרה לי חד משמעית שירידה כל כך דרסטית במשקל אצל אם מנוסה בהנקה לא יכולה להגרם כתוצאה משום דבר אחר מלבד "לשון קשורה". היא הסבירה לי בפירוט ובסבלנות מה זה בדיוק אומר, והפנתה אותי לד"ר רועי פורר שמתמחה בניתוק לשון מסוג זה.
הייתי מסופקת אולם מוכנה לנסות.
הגעתי עם רחל. רועי התבונן במבנה הלשון שלה, והסביר שזה דומה לאדם שרגליו קשורות ודורשים ממנו לרוץ...
הוא ניתק לרחל את הלשון (clipping) ע"י חתך קטן ללא הרדמה והיא התארכה משמעותית. גם בשפה העליונה בוצע ניתוק ומייד נשלחתי להניקה.
כבר במרפאה חשתי בשינוי, וכשיצאתי משם רציתי לצעוק בקולי קולות לכל העולם: יש פתרון! לכל מי שעדיין לא יודעת!!!
תוך יום חשתי בשינוי. רחל חזרה ליניקה מליאה, ועלתה במשקל כדרך כל ילדינו, והפכה לתינוקת שמנמונת ומתוקה -ואני -לאם רגועה עם קצת יותר נסיון חיים...
עברו מאז שנתיים ובשעה טובה נולדה ביתנו השישית: מעיין. אני עדיין תחת רישומי הטראומה הקודמת החלטתי להגיע בהקדם האפשרי למרפאתו של ד"ר פורר ולוודא שאין בידי עוד מקרה כמו של רחל. אולם לפני כן פניתי לרופא הילדים במחלקת התינוקות של שערי צדק, שם ילדתי. סיפרתי לו את סיפורה של רחל וביקשתי ממנו להסתכל בפיה של ביתי החדשה ולראות האם הכל כשורה. להפתעתי הרבה, סירב הרופא לבדוק זאת בטענה כי אין דבר כזה וכי הסיפור שסיפרתי לא ייתכן ולדבריו ירידה כזו במשקל נבעה אך ורק ממחסור בחלב. חבל שלא יכולתי לצלם את כל ליטרי החלב שהוקפאו במקררנו אחר כבוד באותה תקופת שאיבות מטורפת. לא עזרו הסברי הנמרצים על כך שראיתי את השינוי במו עיני ושזה הדבר היחיד שהשיב לי את יכולת ההנקה...
הסתבר שגם היא מעיין סובלת מלשון תת-תפקודית והגענו לניתוק כבר בגיל חמישה ימים, וברוך השם עברנו הפעם ללא סבל מיותר.

החלטתי לפרסם את הסיפור כיוון שהוא יכול לעזור במקרים דומים. נדהמנו לשמוע שהרפואה ברובה מעדיפה שלא להתייחס ללשון קשורה בטענות שונות. מד"ר פורר שמענו אודות אלפי ניתוקים ללא כל סיבוך. עוד נדהמנו לשמוע ששמונים אחוז מבעיות בהנקה ובעלייה במשקל אצל תינוקות יונקים קשורים לסיבה הזו, וכן קשיים בהנקה דוגמת כאבים עזים בפטמות ,ועוד.
לסיום: טוב להודות לה'. קיבלנו את בתנו בנס תודות לכל השליחים הנאמנים.
ואתם- תעבירו את זה הלאה...

Naveh's Story

I breastfed my oldest son for two years, with no problem. When Naveh was born – although he nursed without breaks, without pain or infections, and with flowing milk, he was not calm, he did not enjoy nursing and he cried a lot.
When he was three months old, I started pumping milk. Although after the previous birth, I was able to pump large amounts every day, for 7 months. This time the amounts were very small, and after pumping, I felt as if I had fasted for two days, and did not have a drop of liquid in my body. A month later, my milk ran out. Naveh did not like eating, it took him a long time to finish a bottle, and he also sucked in a strange way, so I bought another nipple that worked… until Naveh was 7 months old.

And then every time we tried giving Naveh a fruit or vegetable, he vomited.
The doctor said that Naveh simply does not like fruits and vegetables, and that I shouldn't force him. She also discovered that he weighed very little for his age, and did not gain any since he was five months old! Therefore, she recommended taking him to a pediatric outpatient clinic at a big Hospital, to find out why the child was "not thriving", and she even said that it was possible that Naveh is suffering from an emotional problem. The possibility of celiac (sensitivity to gluten) also came up. A week later, Naveh ran a high fever. An E.N.T. specialist diagnosed liquid in the ears and recommended administering antibiotics. We didn't give him anything, and that day the fever went down.
At the outpatient clinic I said that the baby's caretaker cuts off the tops of the bottle nipples, so that he can eat, and that all his bowel movements were hard, and accompanied by great pain, he had one every few days, and the feces were very dark in color, close to green. I asked the doctor if it was possible that the child is suffering from a short or tied tongue, and she didn't agree to even check it, and told me that when I returned in a week for blood tests, she would allow the hospital dietician to check his tongue(!). She decided the child suffered from sensitivity to milk, and that such children tend to starve themselves, and that he may also be sensitive to gluten and asked that I replace the Materna formula with Nutramigen, which can only be bought at a pharmacy with a doctor's prescription. I told her that I believed that he was hungry, and was trying to eat, but gave up very quickly.
I left the hospital very disappointed. I had a feeling that it was not about sensitivity but a physiological problem, but not one part of the body was examined. We changed the food. Naveh did not eat more, and after a week his weight even dropped a little. The doctor became very nervous and said that she didn't care if the child was sensitive to milk – at the moment, the important thing was that he gain weight, which is why she recommended that we go back to Materna.
Poor, confused Naveh, no longer wanted the Materna either, and we were in a serious problem, and at every meal we prepared a different formula.
Neighbors told me that they knew babies who had tongue-tie and similar problems, and they referred me to lactation consultant, Sarah Sternlieb, who determined that the tongue was tied and very short and gave me a scientific article by Dr. Furer, and stories of mothers.
When I read "Ido's Story", I recognized similar symptoms: very light sleep, heavy breathing, constant constipation, liquid in the ears, feeding while lying down etc. That night I could not fall asleep, I played back everything that I read, as well as Naveh's suffering, in my head and I was angry with myself for not realizing all of it sooner. The next day, we arrived at Dr. Furer's for a tongue and lip clipping.
Several days later, the head of the department at the Hosptial called and asked why we hadn't showed up. When I told her about the tongue-tie, she was scornful and said that its only effect was in speech, and even that, not always either, which is why doctors recommend not to clip at all. I offered to send her the article and she shouted that research doesn't interest her.

The head of the clinic was actually interested, as were the nurses.

5days after the neighbors sent me to a new path, Naveh ate a cracker for the first time. A day later -some ground fruit. Not large amounts yet, but we already begin to see a change…

Ido's Story

[Galit's letter is presented to the champions of breastfeeding, so that we fortify our understanding of the ramifications of our work on the life of the patients and their families over time. Please try to imagine what these children and their parents could have gone through in the coming years had we not been fortunate enough to help them. Dr. Furer]

Hello to all,

I would like to share my personal story with you, with the hope that maybe it will help someone and I'd be very happy if you circulate it among as many parents/doctors as possible or to whomever you see fit …

My Ido is fourteen months old.

On the day Ido was born the doctors called me and explained to me that my baby has a "tied tongue"..

I didn't really understand and asked them what it meant, and they explained to me that it might cause problems with breastfeeding and maybe problems with the sounds sh and s, which can easily be solved by a speech therapist.

I nursed Ido for five months. I then began giving him ground food, followed by solids. The child ate well and exhibited no special problems.

From the age of six months, Ido began losing weight, he nursed less, and at 7 months I had no milk left.

He began to breathe solely through his mouth (which was open most of the time) and his tongue stuck out.

Starting at seven months old, he began to constantly contract ear infections and to lose his appetite (which is normal for a sick child). At the recommendation of our physician, we gave him the Prevenar vaccine, which brought down the infections- but his appetite did not return, and he preferred drinking from a bottle, mostly milk, to eating solids…

The antibiotics that he took no longer had an effect on him and he had to be given stronger antibiotics through vaccines, and this hurt his liver and kidney functions, among other things, and greatly weakened him.

In the meantime, Ido continued losing weight (from the 75^th percentile he went down to the 25^th and then to 10^th and then to 1). He was constantly sick, and too tired to eat, he received antibiotics…got well for a week.. ate (only ground food – the minute he hit a lump of anything, he would spit it out and wouldn't continue, and milk) and then it happened all over again. I couldn't feed him sitting down since his mouth was open (the more he grew – the worse it got), and if I fed him with a spoon, all the food spilled out, and I wasn't even able to insert a spoon because there was no room for it in his mouth, and so I had to feed him slightly lying down and with liquid food…

His immune system weakened – and he tended to catch all types of viruses my daughter brought in from kindergarten (he was with me at home). Every time he caught something, it would last for several days in which he would not eat anything, and the doctor explained to us that it takes him longer to recuperate because he is so weak…(on those days he was hardly awake, he slept hours upon hours, day and night)…It got to the stage that Ido was awake for two to three hours a day and even that, not always. On the days in which he did not sleep that much, he would whine and cry endlessly, and it was impossible to calm him down. He was agitated, not calm, very dependent, very skinny and his development also suffered as a result…

He underwent many blood tests that showed that he contracted CMV (Cytomegalovirus) and he was extremely weak, gaunt and pale (there were even moments when we feared we might lose the child… and we prayed to get through it).

The doctors were concerned that it might be celiac, they told me that he should undergo ear tube surgery… and on the way "it's advisable to remove the tonsils"… They sent me to sleep labs (where they weren't able to test everything and wanted us to come again), they checked for blood diseases etc.

One time, Ido contracted throat infection and we took him to the emergency room fearing dehydration. We were greeted very nicely at the emergency room, where concern was expressed over the fact that he had not gained any weight in four months and in the last month he had even lost weight.. (they were less concerned about the problem for which we came)… We were there for 5 days and they didn't come up with anything. A different professor came in every time and tried to guess the nature of the problem. They finally `decided' that the child has "eating problems" and referred us to a dietician, a speech therapist, follow up etc..

In the eating-disorder clinics they claimed that it was for psychological reasons that the child could not swallow…

At the same time we also began homeopathic treatment. The homeopath obviously said that there was no need for an ear tube surgery. He gave us some powder… and told us that we need to give him "richer" foods so that he would gain weight, but the child could not even swallow hot cereal.

And then, one day when I went to pick up my oldest daughter from kindergarten… one of the mothers who heard me talking about Ido's problems approached me and gently asked if I'd ever been told that he has tongue-tie… I told her that I had, but that the most that tongue-tie could cause was in nursing and there was no problem in that, and so I hadn't thought about it. She then told me that tongue-tie can cause many more problems and gave me Dr. Roee Furer's phone number in Jerusalem (02-6236319, 0547-424400). At the same time, I conducted an extensive search in the internet, and discovered articles about the problems that can be caused by tongue-tie, and apparently nursing is just one of them… (and if you ask me, it's not the main one either)… speech problems is also a minor issue which can be fixed… Apparently, tongue-tie harms the breathing tract, the tonsils; it causes sleep disorders, eating disorders, problems with oral hygiene, the entire teeth structure.. ears, nasal discharge etc.. etc…

(If interested in Dr. Furer's article go to http://roeefurer.blogspot.com)

I called him, and he already saw me that next day and tried to calm me down… what upset me was that everyone at the clinic were babies, several days to several weeks old… they still didn't care who held them…

The little ones came out crying and were immediately calmed after a few minutes of breastfeeding (mothers arrive after having been sent there by lactation consultants, who, apparently, are very familiar with this issue, while other physicians – including ENT specialists - are unfamiliar with it and do not accept it).

Ido had to be sedated because of his age, and he went in hysterical, only because the doctor took him from me. It ate at my heart that he had to go through this, at this age.

I must note that the clipping took exactly one minute. Afterwards, they called me in and the minute I picked up Ido, he calmed down.

As for today – merely two weeks after the clipping… the child is eating…for the first time he is able to eat food which is not ground up.. his tongue is no longer sticking out… his breathing has improved miraculously! (although it's not fully regular. So I will take him for a check up, in case he has to have some more clipped.. sometimes two cuts are required.)

The child is calm, he plays, he laughs and most importantly – he has already gained 300 grams... he no longer has a runny nose, which was an inseparable part of him…

I am telling this story in order to make people aware of this issue..

This year was extremely difficult for us…every week we saw all kinds of doctors who thought that I was just a hysterical, impatient mother. Only when he stopped gaining weight did they start taking me a little more seriously.

The doctors claim that despite everything, he will need a tonsillectomy since for an entire year he breathed through his mouth, which "agitated" his tonsils, and caused recurrent infections – Dr. Furer teaches that a free tongue scrubs the tonsils in every swallow, and the germs can no longer settle on them. He also told me, without examining me – only from hearing me talk, that I too have a tied tongue …and slowly I realized that I also had many problems with my ears when I was little, and I had an operation… and since the age of three, I'm a regular at dentists and, later on, at an orthodontist's…

Apparently, the tongue is an inseparable part of the ear-nose-throat medical profession, and it would have been only right, had at least one of the doctors I had seen, would have noticed! (I met at least 5 E.N.T. doctors!☺). The day after the clipping, I went into a forum for child surgery to find out more about the connection between tongue-tie and ENT problems, and this is the answer I received from a professor, whose name I'm withholding. Listen to this! "Tongue-tie has merely cosmetic significance, except for a possible interference with nursing, and this has not been proven fully, either. Beyond that, there is no connection between the partition in the tongue and other complaints and certainly not ear infections…"

It is unfortunate that tongue-tie is defined as a problem related only to breastfeeding, while it might cause additional and more severe problems. There are various levels of tongue-tie. It is important to remember that tongue-tie can cause a problem in nursing for one person, and none for the other, and there may be future speech problems, and maybe not. The same applies to the other issues I mentioned. The picture is complex and requires examination, but somehow, it is all tied together.

And another amazing story –

I have a daughter who is a bit older, she is two years old, and I was unable to nurse her and she tended to spit up a lot. I gave up after a month. In her case, no one said anything to me at the hospital. Today when she is two years old she hardly eats anything, except for puddings, cottage cheese and other cheeses, soups (only the liquid and not any vegetable)…Up to now I thought that it had something to do with being spoiled. And, later on, after talking to Ido's doctors, I began to think she had serious eating problems. This week – after Ido's miracle, I looked at her tongue – and discovered that it was also tied! (This phenomenon is hereditary, and usually when one child has it, the other may, as well), and I feel so guilty about my daughter not having eaten for several days and me thinking that she was being spoiled … She wakes up hungry at night very often, and the only thing she can eat is liquid yogurt..

Next week we'll go to get her tongue clipped as well. I'm scared to death, but know that it will help her eating, for a start, and in the future with other problems.

This came out a little long… (and I really did try to make it short and not go into details about all the agony we experienced in the course of the year)… If possible, pass this story on to as many people as possible – and if anyone has any questions, I'll be happy to answer them and share my experience.

And a gigantic thank you to Meital, Tahel's mother – who pointed me in the right direction…as far as I'm concerned, she saved my little one…

Pessach, 5768 Galit.

[Postscript – Ido returned to the clinic to have a second clipping. He was chewing a roll, smiling and active, without the congestion, redness, snorting and weakness which were apparent two weeks earlier. His sister also had her tongue clipped – and within two hours they `attacked' a crust of bread for their pleasure! One month after the treatment, Ido is eating schnitzel without help from a psychologist…his weight is gradually increasing. Dr. Furer May 20, 2008]

BS”D
[ last updated Sep. 1, 2008 ]

Subfunctional Tongue and Upper lip release in nursing babies
And the repercussions of neglect in children and adults

Death and life are in the power of the tongue” King Solomon"

A mother’s milk supplies a baby with most of what he needs for his development, as well as with natural and immunological protection, the building of his body’s systems and the security, intimacy and warmth that will sustain him throughout life. Breastfeeding is the most natural, simple, healthy, easy and inexpensive method of feeding a baby and maintaining his health. Keep in mind, as well, that that is how we were created…

For more than half a century, and due to understandable economic considerations, great efforts have been made by the wealthy manufacturers of infant formula (in the Western world) and cow’s milk (in weak countries) to do away with breastfeeding – by taking advantage of the inherent difficulty of the natural process versus the easy compromise (baby mortality in the world, a direct outcome, reaches 1,600,000 a year!) and sweeping the medical establishment to their way of thinking.

Evidence is mounting of infant formula being a major cause of juvenile diabetes, obesity in children and adults (clearly life-threatening conditions), life-long allergic sensitivity, chronic ulcerative colitis of varying degrees (usually subclinical, and which can actually be diagnosed and treated by alternative medicine), asthma etc, as well as being connected to an increase in baby mortality(!).

According to Dr. Bueno De Mesquita (a noted family physician and homeopath) – giving formula to babies constitutes the largest uncontrolled experiment ever conducted on human beings!
It is worth noting that expressed breast milk is not on par with genuine nutrition and protection, despite it being many times better than any formula! (the proofs of the importance of breastfeeding are many and unquestionable – see links).

Consequently, breastfeeding was relegated to the sidelines until, absurdly, organizations and information had to be established in order to reinstate knowledge and understanding that are thousands of years old. Recently, breastfeeding has recaptured center stage, and more mothers understand the importance of, and insist on providing their babies with, that which is natural, suitable and healthy. Today, these mothers and lactation consultants the world over are at the forefront of this maternal revolution.

A major obstacle in the path of a great many babies (about 20%!) to proper nursing is the subfunctional tongue ,most known as tongue-tie (ankyloglossia, 6%) or a short tongue. It has recently become apparent that a tight upper-lip frenulum is also a common phenomenon, combined with the first. In light of the abundant experience accumulated in the combined procedure, and the consequent dramatic improvement in breastfeeding, our clinic recommends performing a clipping of both simultaneously.
Treating nursing babies and getting to know their families has opened the way to the crucial discovery, so far unknown – the effects on a person’s entire life!

The tongue is a powerful tool – it drains the ears, nose and sinuses, it scrubs the palate and the tonsils in its movement, it shapes the skull-bones the palate the nostrils and the respiratory tract, and it is the main factor responsible for the activity of the digestive system and the quality of the digestive process.

A tied tongue is a tongue that is connected to the floor of the mouth by a thin membrane which restricts its movement. In distinct cases – known to some of the doctors, the membrane fuses the entire tongue up to the tip, or less, and in the case of a short tongue the floor of the mouth is too forward and it binds the tongue downward. Both cases limiting the tongues movement and abilities .



The babie's subfunctional tongue is incapable of sucking – it has a rolling, instead of a longitudinal, motion and it causes the nipple to chafe, bruise and crack. When the lip is tight – it does not extend forward to latch on to the nipple deeply enough, and the baby squashes it to the point of pain and spasm.
A baby’s recurring loss of latch on the nipple causes `clicking’, a chafing of the baby’s lips, leading to nursing blisters, anger and frequently giving up the effort to nurse, tiredness and falling asleep while nursing. Keep in mind that nursing is the baby’s aerobic exercise (heart lung endurance) and if it goes unrewarded, then the exertion is in vain! Nursing sessions may last an hour and more (instead of 10-20 effective minutes). Letting go of the breast often lets a lot of air to enter the baby’s stomach (“bubble nursing”), resulting in powerful and frequent spit-ups, gas, pain, frequent waking-up from hunger (!) and other reactions, up to malnutrition – either because the baby hasn’t sucked enough, or hasn’t accessed the hindmilk needed for her growth. Some babies have lost up to 1/3 of their weight and even rushed to the hospital in a state of malnutrition ,extreme dehydration,and kidney insufficiency - all life-threatening conditions.
Additional phenomena: Following a decrease in secretions – there is an increase of newborn jaundice to the extent of being exposed to ultra-violet light in the hospital for many days, and postponing circumcision – to those concerned ; frequent spit-up of milk through corners of the mouth or nostrils (reflux) due to limited, interrupted and backward swallowing motions; thrush on tongue and cheeks due to insufficient tongue activity (there is no mechanical removal by sucking); congestion in respiratory tract, nasal discharge and phlegm due to weak swallowing and insufficient draining.
A mother may experience pain in the nipples and breast, to the point of bruising, cracked nipples and breast spasms (whitening and sharp pain); low milk production, or alternately, extreme engorgement up to mastitis, thrush and even clogged milk ducts, lack of sleep for both parents (it is proven that the parents of a nursing baby enjoy an average addition of one-hour of sleep per night!), as well as: tension, frustration and disappointment in addition to the difficulties of recovering from childbirth – conditions which, in many cases, lead to a partial or full early weaning, and loss of the quality bonding between mother and baby, which may be manifested in the child’s physical and emotional health throughout his life! As an example, an up-to-date study shows a connection between non-nursing and hypertension at an older age! In other words, more breastfeeding - less disease and medication.
In an extensive study being carried out in our clinic over the past several years – testimonies are added with regard to the many phenomena experienced by adults - caused by the subfunctional tongue. These problems now necessitate greater awareness::

1. The tongue’s absence from the palate-- also the floor of the nose, causes insufficient development of the upper respiratory passages – for usually, the strong tongue muscle shapes and expands the thin bone while the baby is still a fetus (muscles building bone!), thus opening up the nostrils and determining for life the volume of the nasal breathing. The s.f.tongue is detached from the palate, and has very poor, or non-existent, contact with it- leaving the palate narrow and high –blocking respiratory passages! The constricted nostrils bring about breathing problems ,eating and sleep disorders in all ages. These cases will eventually referred to adenoid (polyp) removal, in order to open the airways as much as possible.
In most cases, from the day a young baby’s tongue is clipped, the process of palatal expansion will have occurred within a few weeks on its own. Until the age of approximately 13, it is possible to perform an expansion for a child using an orthodontic device (retainer) for six months to a year. There is yet no such option for adults.
2. A breastfeeding baby with respiratory difficulty risks inhaling milk into the lungs (aspiration), a condition which might cause choking or a congestion of liquid in the lung. In any case, such a condition creates great tension surrounding the nursing.
In addition, inadequate closure of the windpipe due to weak swallowing may cause the penetration of liquid and chronic bronchitis throughout childhood, as well as a dangerous disposition to pneumonia,allergies, and, again, the use of antibiotics and steroids.
3. Weak and limited swallowing does not drain liquid from the ears (the Eustachian tube is located above the back part of the tongue), causing frequent ear infections,'flooding' of the ears,loss of hearing to various extents - to the point of inserting “tubes” (which has recently been claimed to be an unnecessary surgery),and administration of lots of antibiotics
In severe cases, complications escalated to the point of ruined eardrums and mastoidectomy (removal of infected bone behind the ear) as a result of repeated infections. Research we did in our clinic clearly showed that such a baby’s siblings, uncles, aunts and cousins also suffered from repeated ear infections.
4. The limited tongue does not perform efficient scraping of the tonsils and very often these babies will contract chronic throat infections; they will be carriers of streptococci, which endangers the heart valves, and are the distinct clients of tonsillectomy.
5. Non-drainage of the sinuses (due to narrow respiratory passages and poor swallowing) can cause recurrent or chronic congestion of the nose and sinuses, copious and even inflamed nasal discharge, breathing difficulties, interrupted sleep, and even an atrophy of facial bone development due to the high viscosity of the sinus contents. Obviously, it might also necessitate risking needless antibiotic treatments (there are no medications that are free of short- or long-term effects.)
6. Blocked upper respiratory airways – whether due to structure or to a congestion of mucous and phlegm – result in open-mouth breathing, a drying up of saliva, a major decrease in the mouth’s ability to clean itself, fast-advancing carries and expensive and redundant life-long treatment (research available regarding the connection between poor oral hygiene and tongue-tie).
7. Wanting to pronounce words properly (though lisping may occur anyway ) forces people with tongue-tie to jut out their lower jaw in order to properly articulate labial and dental letters (d tl'n, z s'sh)- thereby making irreversible changes in this jaw, which is stabilized in the early stages of adolescence. A tight upper labial frenulum may cause gapping in the front upper teeth. The steady pressure of the tongue causes the lower teeth to fan outward .A constriction of the palate leads to crowded front teeth. Various combinations of these problems may appear– and require an extensive orthodontics.
8. A tied tongue may be highly sensitive to touch, with a strong gag-reflex in reaction to nursing (!), to the touch of a hand or a foreign body (such as a toothbrush…) and might lead to eating difficulties (sometimes very extreme)- mainly refusal of grainy foods and preferation of soft or fluid.
9. Partial chewing of food causes it to be swallowed too early – when it is not yet sufficiently processed and then it rots instead of being digested – causing toxicity instead of nutrition, and consequently, pain and disturbances in the digestive tract, constipation, diarrhea and gas, up to hormonal and metabolic disorders in extreme cases and emotional problems based on these conditions, as well as sleep problems and problems with skin, blood vessels ,varicose-veins, hemorrhoids, etc. etc. (This is greatly elaborated on in conventional medicine, alternative medicine and psychology. Note an interesting fact: the Chinese diagnose digestive and full-body problems by studying the tongue !)
More and more cases in the clinic prove the efficiency of clipping, for eating and digestion problems in infancy, childhood and for adults: A 3-year-old boy with chronic constipation and accompanying pain – The problem was solved four days after the tongue was clipped. A two-month-old baby with one bowel movement a week (“that’s normal,” they were told at the baby care clinic, “the milk is absorbed in the organs”) – had gone to two bowel movements a day two days after clipping. A baby who weighed less than his birth weight (“liver problems” said the doctors…), children who don’t eat `hard’ foods ,grownups that go only once every two days or more, etc
10. Speech disorders- trouble articulating the letters z, sh, r, ts, d, t, l, n, delay in the beginning of speech, stuttering , and also tongue-tied parents reported emotional difficulty in speech during their childhood, and trouble talking before people at present too;
At one case we performed clipping on the father of a baby that claimed that as a professional singer, he was limited by th his tongue-tie .
11. Severe sleep disturbances – at an older age, also partially due to the changes blocking the respiratory system, may advance from heavy snoring to apnea (loss of breath during sleep). It is also becoming apparent that a lack of contact between tongue and palate is cause for light and nervous sleep, and from there to chronic fatigue. After a tongue release of another father, for reasons of digestion disorder –he reported a deepening of his sleep and great improvement in the his awaking and daily alertness patterns. Similar success was since then achieved in many cases.
Top lactation consultant, Katherine Watson-Jenna (U.S.A.), reports that a senior teacher, about 40 years old, who heard about a clipping performed on her friend’s baby, and intuitively associated her great tiredness at the end of her work day (ongoing talking) to her tied tongue, had her tongue clipped. She solved her fatigue problem forever.

Dr. Brian Palmer, of the U.S., has been dealing with the issue for many years and he may be the first and most thorough in understanding the repercussions for adults. He has even raised the question of a possible connection between this condition and SIDS in babies – one of the many questions examined in our clinic at present ( a visit at his net site is more than recommended ). We are also checking the possible connection to back-aches ,varicose-veins, and thyroid among many other phenomena (mostly led by Chinese medicine ) .
Dr. Ruth A. Lawrence, in her book 'Breastfeeding: A Guide for the Medical Profession', offers indications: a tongue that is fused close to the alveolar ridge and is sticking out; when the baby cries – the tongue tip stays anchored behind; a tongue that is heart-shaped or is indented; a tongue that is difficult to stretch; and a short (less than one centimeter long) and inflexible frenulum. A Canadian article had collected more than eight different essesment tools and did not manage to find any that will serve.
According to Alison Kay Hazelbaker (MA, IBCLC, CST) in her book 'The Assessment Tool for the Lingual Frenulum Function', the diagnosis of tongue-tie must be made: "primarily on function and secondly on appearance".
This is certainly the indication we now embrace. But as we see it, both above-mentioned approaches are lacking in perspective. They focus on the short-term!
We perform regular questioning of the baby’s parents in order to deepen our understanding of the range of phenomena described. According to the database – we find a distinct familial and genetic connection. In the baby’s family there will, almost always, be a first- or second-degree relative who has more than two of the accompanying problems. We are convinced that without observing the shape of the palate, teeth, tongue and skull of the parents and siblings, without studying their medical history, and without understanding what is in store for the baby in the future, given the family profile, and providing the complete treatment it needs – until the full release of the tongue and upper lip, an orthodontic palatal expansion during childhood, repairing and practicing speech, breathing and eating, and maintaining coordination with the practicing doctors (to the degree that we will indeed be fortunate to have physicians interested in learning the issue) – the existing approaches are superficial and yield bitter results. Thus, we recommend – distributing this article among the families who come to us, in order to inform them of the possibility of repair and of the possible repercussions if the matter is neglected.

The generation-long battle against breastfeeding resulted in a situation, in which a nursing mother seeking relief from her pain at a pediatrician’s will often be advised to stop nursing even if tongue-tie is diagnosed. A pediatric surgeon will recommend waiting a year (and who will wait then to nurse?…) and then operating under full anesthesia (!!!!); a baby care clinic nurse will offer similar advice if she wasn’t trained. Only in few cases, so far, will the mother be referred to a lactation consultant and from there to a frenotomy. All that, despite the change in medicine in the United States, Britain and Canada. Every few days, mothers with older babies (3-9 months, and older) arrive at our clinic and complain that the medical system had led them away them from solution.
It is important to perform the clipping at the early breastfeeding stage: at two days to two weeks, so as not to miss the time at which the milk-production is being regulated, and also because the speed and ease of recovery are at their peak the younger the baby is, although the procedure can easily be performed without anesthesia or any other preparation – in less than 30 seconds – up to the age of a year .The procedure is simple, almost risk-free. When required, it is performed at all ages – using mild sedation for children, and merely local anesthesia for adults, without any stitches or pain. The thin membrane or underlying skin is carefully snipped, usually with hardly any bleeding.
Tongue-tie is usually accompanied by a parallel condition of a tied-upper-lip, characterized by 'nursing-blister's on the it; so in most cases -a double clipping is performed, top and bottom (there is no need to repeat a top lip clipping).


The baby experiences pain for a very short time and immediately forgets (the problem is more with the parents’ pain…). After a short inspection of the bleeding, he is immediately given over to the mother to nurse, since the mother’s milk is the best medicine and comfort. Usually, there is no need for continued treatment or an additional examination. In rare cases of restlessness, usually in babies over a month old, one can calm the baby using light painkillers .
Lesions in the oral cavity appear whitish-yellowish in the course of healing – so there is no concern of the site being infected. These sores should not be touched, cleaned or removed in any way; if the baby’s temperature is normal and steady – there is no infectious process taking place, and none is expected. Only in the rare case of a rise in temperature the infant must be taken immediately to the nearest hospital. Joyfully – this warning has so far been useless.
In the vast majority of cases, the mother immediately reports an improvement or a change in the latching and nursing. Usually within three nursing episodes to one week, the full improvement has been reached. The younger the baby is, the sooner the incorrect nursing pattern can be corrected. In cases in which the breast was wounded or in pain – the healing will be gradual, and the time needed by the mother for recovery, should be accepted with understanding.

When there is insufficient improvement or change, or when there is an improvement and then a regression, and even in the case of a change for the worse – these are encouraging signs (!) that prove the possibility of adjustment between mother and baby. In these cases, a repeat procedure is performed on the tongue, approximately two weeks after the first one. For a while after the clipping and until new nursing patterns are established, there is a possibility of increased milk spit-up, as well as a slow change in the rate of the milk production. In these and similar cases, the help of lactation consultants is recommended for continuous advice, under the Dr's supervision.
In the vast majority of such cases, the problem is finally resolved at this point. In few cases, a third treatment is needed – these require special coordination with the doctor and they are rare.

Dr. Roee Furer D.M.D Dental Surgeon
02-6236319 , 0547-424400 : 4 hama'alot st. ,Jerusalem

Some information for medical personnel: at a standard appointment we saw milk coming out of the baby’s nose – upon examination we discovered that the baby has no palate! (an undiagnosed cleft palate) – for your attention

Important note: literature on tongue-tie and its connection to nursing– but there is an absence of information regarding most of the results discussed above. At present, this information is at the stage of formal research, and is being proven and examined at real-time at our clinic.



Recommended breastfeeding sites:
www.drjaygordon.com www.lllisrael.org.il www.merkaz-hanaka.com
www.linok.net www.askdrsears.com www.kellymom.com
Ido’s tongue - tapuz forum
Brian Palmer DDS (older people with tongue-tie – an important slide presentation)
F.D.A. websites
Dr. Jack Newman, BreastfeedingOnline.com – articles, films and websites
British and Canadian health ministries in above-mentioned links

Keywords
Tongue-tie breastfeeding, lingual-frenulum, nipple pain, frenectomy, ankyloglossia