The Tongue-Tie Phenomenon – “Fad” or Fact?
The important thing to clarify in the TONGUE-TIE discussion is the difference between classic tongue-tie and posterior tongue-tie and it’s common associate – upper lip tie. Putting these two very different versions of tongue-tie under one heading complicates the story. A classic tongue-tie which is easily seen and can be assessed regarding the degree which it impacts on tongue mobility, or not, is not a new “thing”. Classic tongue-tie which causes limitations to the mobility of the baby’s tongue IS likely to impact on breastfeeding effectiveness and comfort for both mother and baby. When appropriately assessed by a breastfeeding health professional using a reliable assessment tool (eg Hazelbaker ATLFF) in conjunction with observing a breastfeed and offering adjustments to positioning and attachment technique to enhance latch and milk transfer as well as comfort for the mother – the decision to divide the frenulum to release the tethered tongue so it can function optimally is a no-brainer. Simple Frenotomy is likely to be helpful to both mother and baby, and enable the breastfeeding relationship to recover and flourish.
The recently “discovered” Posterior Tongue tie (PTT) and commonly co-implicated Upper LIp Tie (ULT) phenomenon is an entirely different story. I acknowledge that in rare instances a baby’s tongue mobility may be compromised by a deep restriction – evidenced by a dip or dent seen at the centre of the tongue and a cleft seen in the tip of the tongue, which results in the baby being unable to LIFT the tongue to perform the peristaltic action required to remove milk effectively from the breast. If a baby whose tongue has features as described also has problems sustaining an effective latch, and the mother experiences pain in spite of optimal positioning and attachment, a truly restricted posterior tongue tie is likely to be present and impact on breastfeeding effectiveness over time.
Visual assessment of the appearance of the base of the tongue without evident restriction of function is NOT sufficient reason to recommend severance of the base of the tongue by laser or scissors. Frenectomy (a cut by scissors or laser deep into the base of the tongue) is a very invasive procedure regardless of who provides it, and the post-procedure “exercises” parents are required to perform to stretch the wound 4 times a day to avoid it’s re-adhering during healing is nothing short of torture for the baby and the parents. The provider of the the deep severance of the tongue from the base of the mouth often also recommends severance of the totally normal upper lip frenulum, “just to ensure everything is done” in one procedure.
Babies with extremely sore mouths which take weeks to heal are then expected to breastfeed “better”. Guess what? Many do not. In fact, many breastfeeding relationships are permanently damaged by this (often) unnecessary procedure. And those who heal are sometimes subjected to repeated procedures, because the first procedure failed to “cure” the perceived breastfeeding problem.
The real problem is the “PTT and ULT bandwagon” which, unfortunately, some health practitioners have jumped on, believing this “quick fix” is the answer for all breastfeeding problems. Yes, tongue tie CAN have a really negative impact on breastfeeding, especially when mobility of the tongue is restricted.
The exponentially increasing number of procedures being conducted by a few laser-wielding dentists do not represent the true incidence of this rare condition. I am concerned that PTT and ULT is being diagnosed and frenectomy recommended by allied health professionals and non-professionals who have no credentials in lactation or breastfeeding. This is causing confusion among parents who contact me for a second opinion, and in most cases examination of the whole story and observation of a breastfeed reveals there is no tie and issues are resolved with appropriate breastfeeding advice and adjustments.
As a very experienced IBCLC I have performed frenotomies myself on babies with classic tongue-ties and refer babies with restrictions caused by PTT to ENT specialists when indicated. Unfortunately the “fad” title does have some truth to it here in Australia within the context of the number of referrals which are happening without appropriate breastfeeding support. Lactation Consultants, Chiropractors, Osteopaths, even Paediatricians – are not all the same. I am embarrassed that Lactation Consultants have been implicated in the media as contributing to the PTT/ULT epidemic, and worse – the suffering of many babies who do not require or deserve invasive oral surgery. I am not alone expressing concern about “The Tongue Tie Epidemic”. Dr Pamela Douglas has written extensively about her concerns regarding this phenomenon, and I unreservedly stand by her interpretation and position about this very troubling situation for breastfeeding mothers and babies in Australia.
Lois Wattis Clinical Midwife, International Board Certified Lactation Consultant, Author of New Baby 101 www.newbaby101.com.au
06
Apr
2016|
4 comments.
Nicola Senior – I appreciate your contribution to this discussion and your comments about you own experience with your baby. I have observed similar struggles to your own and helped hundreds of mothers restore their breastfeeding relationships, including performing frenotomies myself and referring babies with deep restrictions to ENT specialist for release. As an experienced breastfeeding specialist who has worked in an acute setting for over 8 years and been an IBCLC for over 12 years I really do understand the impact tongue restrictions have on babies’ and mothers’ ability to breastfeed successfully and comfortably. As explained in my FB response and in this article if you read it carefully, the problem is PTT and ULT are also being “diagnosed” by people who have no breastfeeding expertise or experience, and procedures ARE being performed on babies whose problems could be resolved with appropriate breastfeeding support without surgery. I hope this clarifies my position and the reason I have written on the topic. Kind regards, Lois
Thanks for your reply, please provide stats that many babies are being treated unnecessarily. Another point to be made is that tongue ties effect people well beyond the breastfeeding as a baby. Given that I had surgery at 16 years old for my tongue, I remember the pain, speech problems, chewing problems, swallowing problems, food aversions and gagging that I went through as a child. I just hope the babies that you gave breastfeeding support don’t need a frenuectomy as an adult. Please look at things holistically with an understanding of the true reasons why parents are desperate. I saw many, many health professionals including lactation consultants in the first few weeks of my babies life. We were discharged from hospital with finger feeds, she never once latched, with excuses such as my nipples were too big for my baby and she was lazy. I also had my babies anterior tie cut at 1 week. Unfortunately the ENT surgeon we saw does not believe in the PTT nor the ULT. So unfortunately things went down hill from there. At 3 months my poor baby was so unhappy, and pain, and lost weight. I was able to find IBLC in my area that was able to help me find the help needed. All this to say, there are the genuine cases out there, which you have acknowledged, but please, begging you as one of those desperate mums, don’t judge and label the procedure, and please refer mums onto health professionals that have experience and expertise.
Both myself and my sister having had new babies this and last year were told by Midwives we had tongue tied babies even though they had both been assessed at birth by a Paediatrician as not having tongue tie. When I told the midwife the paediatrician had cleared my baby, she got very confrontational and sternly told me that the Dr was wrong. Both our babies don’t have any feeding issues and I find it abhorrent that healthcare professionals are attempting to suggest such intrusive unnecessary procedures. Thankfully both my sister and I trusted our instincts and got a third opinion and didn’t subject our babies to these painful procedures/treatment.
The breastfeeding activists have matters too far
My baby was unfortunately subjected to what you say here. I took her to a ENT (a preferred provider!) and he recommended against treating my daughters PTT – I was struggling with pumping so I took her to another preferred provider who said it was the worst PTT he had ever seen & he is a busy Dr & cut my babies tongue. She bled profusely. She was never the same nor was I. She couldn’t ever take a paci afterwards, she has vomited about once a day since due to swallowing air & hypersensitive gag. She refused to eat anything which put us in the hospital for a week & she wound up on formula – which she was allergic to. I couldn’t follow through with the stretches afterwards she was in too much pain, didn’t trust me & developed oral aversion. She’s 17 months now & doesn’t say mama. 🙁 to think about everything breaks my heart & reduces me to tears.