Influence of Tounge-Tied Baby with Slow Weight Gain on Severe Maternal Depression

 

Written by dr. Novita Adelina

 

Baby M, male, one month and 22 days old, came to our lactation clinic with his aunt, Mrs. S (the mother’s sister and as well as the baby’s wet nurse) complaining about a weight gain issue. Babby M is the second child of the couple, Mr. F and Mrs. I. At the clinic, Mrs. I did not come along. The baby was born through vaginal delivery in a hospital. His birth weight was 3260 grams. The elder sister of the baby, five-years-old, was exclusively breastfed for six months and weaned at the age of two without being given any formula milk.

 

A normal weight gain of healthy infants aged 0-3 months is between 25-30 grams/day. However when the baby was one month old, he weighed 4320 grams. In other words, he only gained 700 grams (23 grams/day) from his birth weight. At that time, a pediatrician said that the baby’s weight gain was inadequate and suggested to give formula milk for the baby if the weight gain did not improve at the age of two months.

 

Due to the weight gain problem, the mother felt depressed and stressed because she felt she had failed to be a good mother. Initially, the mother was just gloomy and sad. As time went by, the mother was angry and had tried to hurt her husband. Mother also said that she felt jealous of her older sister, Mrs. S, who at that time was also nursing her baby (one week older than baby M). Mrs.I had physically attacked Mrs. S by clawing and hitting her. Mrs. I also experienced hallucinations, but fortunately, she has not hurt baby M and has no suicidal ideation.

 

The baby’s father and mother’s family finally decided to take the mother to a psychiatrist and got the mother hospitalized. The psychiatrist diagnosed Mrs. I with severe depression with symptoms of schizophrenia. Mrs.I got medicine for her illness, namely Clozapine, Olanzapine, and Trihexyphenidyl (THP). All of these drugs are considered safe to use during breastfeeding. 1

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Due to the Mrs.I’s conditions, Mrs. S took care of baby M and breastfed him. Before she became ill, Mrs.I was having a good and close relationship with her sisters, Mrs. S and Mrs. O. Mother has had perfectionist personality. At school ages, mothers always get the highest achievements in school. She went to a university with a privilege due to her excellent academic ability. Before getting married, she was a career woman. She often cried a lot when there were problems in the office. When her first baby was two years old, the baby got diarrhea and dehydration. Triggered by this problem, Mrs.I suffered from severe depression and treated by drugs as well, so she was stable and regained her healthy mood again. However due to lack of further complaints, she was no longer given medical treatment (psychiatric drugs).

 

 

 

Mrs. O, which is another sister of Mrs. I, has had a breastfeeding problem due to a tongue-tie and lip-tie. The problems were managed after a simple frenotomy, and she breastfed her baby well. When Baby M patient was born, Mrs. O saw a tongue tie and told Mrs. I. Hence, Mrs.I denied her and ignored the tongue-tie despite the breastfeeding difficulties she had, and the baby’s weight gain was proven to be not as good as expected.

 

The breastfeeding and baby’s weight gain problem should be well managed in order to help maternal depression management. At the initiative of the mother’s father and family, the baby was taken to the clinic to get treatment. The baby was diagnosed with slow weight gain due to the tongue-tie and lip-tie based on the physical examination. The frenotomy was finally done. Soon after the procedure, Mrs. S felt that the baby suckles with a stronger yet painless suckle, and the baby’s mouth opens wider during the breastfeeding process.

 

After the procedure, the patient did come to do the follow-up. During the follow-up another information was found from Mrs. S, that Mrs. I decided to give the baby formula milk with bottles and also give a pacifier to soothe him. She was afraid that the psychiatric medicine she took would impact her baby if she breastfed him. Moreover after being given formula using bottles, baby M experienced nipple confusion as he refused to latch on Mrs. S breasts.

 

DISCUSSION:

 

When babies have difficulty of breastfeeding, it may trigger maternal depression. Mothers have basic needs to directly breastfeed their babies, any condition that interferes with the healthy breastfeeding relationship between the mother and the baby could induce a sense of failure. Furthermore, it may trigger psychological disorders. A study said that the lowest postpartum depression (PPD) rates were found in a group of mothers who wanted to breastfeed and successfully breastfeed their babies. Conversely, the highest PPD is found in mothers who want to breastfeed their babies but fail to breastfeed effectively. 2

 

Other studies said that early weaning occurs in mothers who have symptoms of depression when the baby is two months old, which is obtained from the results of the Edinburg Postnatal Depression Scale (EPDS) with results more than or equal to 13. Therefore, families and health care workers must be able to know the symptoms and management of mothers who have depressive symptoms. 3

 

 

In these patients, the difficulty of breastfeeding was impacting the baby’s healthy weight gain. Through the physical examination, the baby had a tongue-tie and lip-tie, which is also contribute to the baby’s inadequate weight gain.

 

After the procedure, the patient did not come to visit the clinic for further follow up. Unfortunately, the baby was weaned early and got formula milk. This case has shown that it is a crucial issue for health workers to get a more thorough knowledge about lactation. Not only the matter of giving the ‘milk’ and see the baby’s weight, but also to see the whole process of breastfeeding as a process of growth and development of the baby and also the well-being of the mother. Thus, breastfeeding should take precedence for the health of both the mother and baby. By increasing knowledge about lactation, health workers could also find out which medicines are considered to be safe to use during breastfeeding.

 

Babies who are not breastfed have higher cortisol levels. Cortisol is a hormone that is easily measured and is a marker of stress in the human body. The number of cortisol in babies who are not breastfed is the same as cortisol in babies whose mothers are ignored and might have an impact on emotional disturbances in adulthood. Hence, this fascinating field would requires further research.

 

During her childhood, the baby’s mother was weaning early and only breastfed for a short time. This eary development may be related to the mental illness she had during her adulthood. Therefore, it is better for the mothers who have babies with difficulty in breastfeeding, to get a holistic management, therefore the healthy breastfeeding relationship can be preserved for both the mother and baby’s short term and long life well-being.

 

 References

 

Hale, T. Medication and Mother’s Milk. 2019. Spencer Publication Company

MA et. Al Prevalence and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction. Journal of Woman’s Health. 2014 23: 5. 404-12

C, Iacovou. M, Sevilla, A. New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions. Maternal Child Health Journal. 2015. 19. 897-907

W, Granger.DA, Goldberg.WA, Nathans. L. Asynchrony of Mother-Infant Hypothalamic-Pituitary-Adrenal Axis Activity Following Extinction of Infant Crying Responses Induced During the Transition to Sleep. Early Human Development Journal. 2012. 88: 4. 227-32

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