Divide et impera

Photo: Philoppos II of Macedonia, father to Alexander the Great

Divide and conquer is a motto presumed to originate from the warlord Phillip II of Macedonia. It is a warfare technique that can be used politically in order to set 2 concurring entities against each other in order to prevent them from attacking a third party together. In the infant food world it is used to set mothers up against each other, those who choose mothers milk or powdered milk. All in all a rather negative notion, that divide and conquer thing. But, on the other hand, dividing and, because of it, conquer problems can be positive as well. Some kids can seeming to attach well to the breast and seem to suckle well, but still hurt mom’s nipples and get insufficient milk. At closer look it may be that their tongues do not function as planned because it is too tightly tied to the bottom of the mouth, or the tie is too thick or connected too far to the tip of the tongue. In other words: the bond between tongue and mouth bottom is a too tightly knitted one. Dividing tongue and mouth-bottom into two separate entities can make the child being lord and master of his own drinking technique: mom’s pain disappears and baby gets all the milk he needs. Even in the longer run dividing tongue and mouth-bottom will turn out profitable. Children with tongue ties can have problems learning certain language-sounds, can have breathing difficulties (especially during sleep) and develop very rummaged-looking sets of teeth. And later on licking ice cream cones can be hard or impossible and the same for kissing the lover. A bit of divide and conquer could come in handy in the medical world considering the clipping of tied tongues. In medical circles is seems to be a trend close ranks on the statement  to not do frenulotomies; a trend which may seem to go alongside the trend to not bother to look for the most adequate measures in treating breastfeeding problems, but to hang out with the old wife’s telltales, or the trend to view breastfeeding as not quite interesting nor important. Just imagine that it would be a necessity to have an internet source for hcp’s willing to treat warts as there is for those who will clip tongue ties. (Dutch main breastfeeding site offers a list with Dutch and one with Flemish hcp’s to do frenulotomy.) http://www.borstvoeding.com/zoekdskndgn/tongriempje-nl/nederland.html
http://www.borstvoeding.com/zoekdskndgn/tongriempje-b/belgie.html There are, however researchers who do dive into the pool of what is to know about ankyloglossia and breastfeeding and come up with fine studies. Geddes et al (2008) publishes about a study in which they made visible what is going on inside the mouth of a nursing infant with a untreated or treated tongue tie. Clipping significantly increased adequacy of suckling and milk transfer. Buryk c.s. (2011)carried out a single-blinded randomized trial and found that frenulotomy significantly increased the quality of breastfeeding performance.
Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE, Simmer K: Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics. 2008 Jul;122(1):e188-94. Epub 2008 Jun 23.
Buryk M, Bloom D, Shope T: Efficacy of Neonatal Release of Ankyloglossia: A Randomized Trial. Pediatrics 2011; peds.2011-0077