Breastfeeding(help) in times of Covid-19

It’s a nasty paradox. With the threat of a virus that causes airway infections breastfeeding is even more important than normal. And that just when we all get the advice to minimise close physical contact. Breastfeeding is about as close as it can get.

When feeding a baby it is important to keep the risk of infection as small as possible.
The first and foremost step is proper handwashing, check here for your own favorite song to help you take the time for that. When bottle feeding good hygiene is even more important than normal; frequent sterilising of all equipment and proper preparation of the milk is needed always, and certainly now.

If a parent shows any symptoms, however mild, feeding your baby is a challenge. When a baby is bottlefed (with expressed breastmilk or formula) the feed can be given by a carer that shows no symtoms. For breastfeeding a mouthcover can be effective if available and properly used. Or, in extreme cases, expressed milk can be given.

Breastfeeding is the preferred way to feed your baby during a pandemic like this. And luckily the virus is not transmitted through breastmilk as far as is now known.

But what if you need help with breastfeeding? During my work I get into close physical contact with both mom and baby, even if and when I work hands-off. And it is that kind of close contact that is to be avoided right now.

The coming weeks I will do my very best to work by video-conference: skype/facetime/zoom or whatevere works for you. So if you are considering an appointment please make it. I will then call you to discuss the best way to have a virtual meeting. For example on a moment you have someone with you to handle the camera/phone so I can take as close a look as possible under the circumstances.

Ideal? No. But at the moment it is the safest offer I can make. As soon as the risks have gone down I’ll be happy to see you in person. Until then we’ll use the blessing that is modern technology is under these circumstances.

Cutting the mast?

I regularly hear an analogy of a sailing vessel to explain why it is important to treat a tonguetie invasively. In this analogy the tonguetie is the sail. Only freeing the superficial tie (the sail) would be inefective because the stiff base of the tie (the mast) remains and hinders movement. Cutting through the mast is therefore important for a succesfull treatment.

Now I am not a Sailor, but I have sailed. And I know that on a sailing boat you do explicitly not want to cut your mast. No mast no sailing vessel, and without a mast sails are a useless pile of fabric. The analogy seems therefore to be essentially not fitting the desired message.

This can mean 2 things:

  1. The analogy is not functional. If the ‘mast’, the stiff base of the tonguetie, indeed needs to be released, then a sailing vessel is not the model to explain that.
  2. The sailing vessel is a usefull analogy and that implies we need to treat with care and more knowledge is needed.

We could look at the sailing vessel with the tongue as a sail, the boat as the base of the mouth and jaw. In which case the rigging (the ropes connecting the sail to the boat) is the tonguetie.

And then releasing the tonguetie makes sense. Because rigging* that is too tight hinders the mobility and maneuverability of the boat. Loosening a rigger improves the functionality of the vessel. Provided one leaves the mast standing. No mast no sailing vessel.

Tonguetie treatment is going deeper and deeper into the mouths of very young babies Treating a tonguetie is a very old procedure recorded even in the Bible. But as far as I know this was never before done so invasively. In the old literature there appears to be no mention of diamond shaped wounds and aftercare.

Althoug we see clear improvement in breastfeeding and oro facial mobility at short term we do not know what the long term effects are going to be. We can not know the effect after 5, 10 or even 50 years for the simple reason that the procedure in the current form has not been performed long enough. In other words: we do not know what the effect of cutting the mast will be in the long run.

Primum non nocere: do no harm. We either need a better analogy, or the sailing vessel analogy indicates that treatment needs to be done with great care. Tonguetie treatments is proven effective, but how invasive it needs to be done should remain high on the agenda of every provider.

* and even then not every bit of rigging!