Adapted from Tongue Tie: What More Can We Offer?
A presentation by Myrte van Lonkhuijsen for the LLLI 60th Anniversary Online Conference. Write-up by Mary Francell, Atlanta, Georgia, USA
LLLI’s 60th Anniversary Online Conference was full of interesting presentations, but I was particularly fascinated by Myrte van Lonkhuijsen’s “Tongue Tie: What More Can We Offer?” She began by discussing how a classic anterior tongue tie (where an infant has a short, tight frenulum attached to the tip of the tongue or just behind it) is usually easily identified and treated with a quick snip by a doctor or midwife. Yet other variations in oral anatomy may not be so clear cut (so to speak!). For example, a baby could have a receding chin, or what appears to be a submucosal or posterior tongue tie (tight frenulum at the base of the tongue) that could actually be the result of subtle torticollis (“twisted neck” or tension in the neck muscle). In addition, parents may be reluctant to have their infant’s tongue clipped or bodywork performed for a variety of reasons, including cost or availability of services.
Lonkhuijsen then asked, “Can we offer more? Could breastfeeding itself be part of the solution?” The answer might be found in paintings of mothers and babies from previous centuries. While today’s parents are often instructed to hold their babies in a rounded, almost horizontal position, these images show the child breastfeeding in a more vertical hold, with the mother’s arm reaching down the baby’s back. In addition, the mother supports her breast in a scissors hold, almost lifting the breast into the baby’s mouth, which parents today are often discouraged from using.
Based on this “medieval” way of nursing, Lonkhuijsen has developed what she calls the “concorde” hold, because it lifts the breast but angles the nipple downwards, like the nose of a Concorde aircraft. The nursing parent sits comfortably, holding the baby close with an arm along the spine and legs supported in the parent’s lap. A forefinger close to the areola, parallel to the child’s lower lip, supports and helps lift the breast over the jaw. The parents’ arm also pulls the baby’s lower body closer, allowing the head to tip back gently. Lonkhuijsen has developed a free handout based on this technique called “Breastfeeding the Concorde-way: a manual” the pdf version is available at Myrte_Concorde-manualK_20122016. This position encourages relaxation, an open mouth and a wide range of motion for the lower jaw, while also teaching the baby that a better latch provides more milk.
Other medieval paintings provide more clues on the effectiveness of this technique. Lonkhuijsen contrasted two images of adult royalty—one with a prominent chin and one with a highly recessed chin—and speculated that the one with the small chin might have been tongue-tied. However, we can infer that these people were both breastfed, for the simple reason that, at the time, they would not have survived into adulthood without it. Lonkhuijsen suggested that perhaps perfect oral anatomy is not required for successful nursing, and drinking at the breast itself can encourage and promote optimal orofacial development.
She discussed other techniques that can also help babies with oral challenges. Mirroring involves the parent playfully encouraging the infant to extend the tongue by opening their own mouth wide with tongue extended to chin or nose. Using a code word such as “open” while mirroring can make this even more effective. Breast compressions (described in The Womanly Art of Breastfeeding on pages 112-113) can increase milk flow for babies who may have become accustomed to bottles. Stronger milk flow can also be encouraged by taking a deep breath and letting the shoulders relax.
Even if an infant does undergo a tongue tie revision, Lonkhuijsen argues that breastfeeding itself can provide the best possible aftercare, since nursing involves intense tongue movement in an extended position at least eight times in 24 hours. To breastfeed effectively, babies need a position that allows optimal oral space and movement. Babies also need to experience that extending the tongue is worthwhile. The concorde hold is another tool we can offer to help parents work with their babies to make nursing comfortable and rewarding, especially when the baby experiences oral challenges.