POSITIONING & ATTACHMENT
The NICE Clinical Knowledge Summary on breastfeeding problems recommends that problems such as breast pain, nipple pain, low milk supply (true or perceived) and oversupply of milk should result in assessment by someone specifically trained to observe and advise on positioning and attachment to the breast. All breastfeeding parents should receive information on national and local breastfeeding support groups (links are given in the CKS) and be advised to continue breastfeeding where possible.
Health professionals who have not received specific training are not expected to advise on how to improve positioning and attachment. However in addition to making an assessment of any medical problem causing or resulting from breastfeeding difficulty, they should do two things:
Know that problems with positioning and attachment are the most common cause of breastfeeding problems
Refer, or tell people how to self-refer, to others with the appropriate expertise
Remember, expert assessment of positioning and attachment is so important that it's the first line recommended treatment for breastfeeding pain, suspected colic, gastro-oesophageal reflux disease, faltering growth and problems of milk supply, according to NICE
It is generally inappropriate for an untrained health professional to assess for a tongue-tie but referring to others with appropriate expertise will ensure this is considered. First line treatment for tongue-tie related feeding difficulty is expert support with positioning and attachment. If difficulties continue then many families report improvement after tongue-tie release, although there is no robust randomised evidence currently. Health professionals dealing with infants should be aware of local tongue-tie referral pathways.