Many parents have encountered conflicting information and advice on the topic of infant tongue tie, particularly in relation to breastfeeding. While some health practitioners regard the presence of a visible frenulum under a baby’s tongue as unimportant, others identify it as a potential cause of a myriad of present and future physical problems. Australia’s Science Channel recently examined this controversial subject in response to alarming statistics indicating the rate of surgery to treat tongue-tie has jumped from 1.22 per 1,000 in 2006 to 6.35 per 1,000 in 2016. That’s an increase from 1,580 in 2006 to 9,947 surgeries in 2016 across Australia.
One of Australia’s leading clinicians and breastfeeding researchers Associate Professor Lisa Amir of LaTrobe University advised “There is both under-diagnosis and over-diagnosis. Infants need to use their tongue to attach to the breast deeply and feed well. If their tongue is restricted this can be difficult for both mother (nipple pain and damage) and the infant (poor weight gain). There is evidence that, for a simple scissors release of anterior tongue-tie, where the frenulum extends to the tip of the tongue, or near the tip, and restricts the infant being able to attach to the breast – there is evidence that this procedure is useful in helping mothers continue to breastfeed.”
Dr Amir believes that the rise of blaming “posterior tongue-tie” (where the frenulum attaches further back under the tongue) is more concerning. “Posterior tongue-tie is being blamed for a wide range of issues (eg. gassy baby, noisy feeding, potential problems in the future) without any evidence. And the current concern about lip-tie is completely unwarranted. The frenulum under the lip usually changes over time and does not play a large part in breastfeeding.”
Tongue-ties are treated by trained clinicians who cut the membrane under the tongue with surgical scissors, releasing it to move freely. “It is a very minor procedure for a simple snip with scissors, but more invasive procedures could potentially have a risk” says Assoc Prof Amir.
Dr Vishal Kapoor is lecturer in Children’s Health at The University of Queensland and lead author of the study which revealed a 420% increase in the incidence of frenotomy (tongue-tie surgery) in children. Dr Kapoor believes the massive increase of surgeries is concerning and an indication of overdiagnosis. The figure calculated in the study uses medicare item numbers, and so the actual incidence of frenotomy is probably much higher. “It is likely that a majority of tongue-tie surgeries are being recommended and performed in the private sector.”
Diagnosis of infant tongue tie by chiropractors and osteopaths has become common-place, and their subsequent referral to particular dentists who perform frenotomy using lasers has become a big business, promoted widely via social media. These laser treatments by dentists are not accounted for on any public data base or via Medicare. Fees for laser surgery in infants’ mouths usually exceed $1000.
Dr Vishal Kapoor says “as well as a lack of proper support for mothers breastfeeding, and the influence of social media and parenting blogs and forums on the internet, there is a mushrooming industry around providing tongue-tie surgeries. Worryingly, some parents are being instructed to massage the area around the wound site after laser tongue tie surgery, which can be painful for babies and cause even more issues through oral aversion.” There is no evidence to support the “wound stretches” which are usually recommended to be performed in the infant’s mouth several times a day, for a sequence of weeks.
Simple scissor frenotomy is likely to benefit the small proportion of infants with significant tongue tie, (around 3%) particularly in response to breastfeeding problems. While tongue-tie can cause nipple pain for breastfeeding mums, a recent review found that around half of babies with tongue-tie won’t have any issues at all. Assoc Prof Amir agrees that there are many potential causes of breastfeeding problems, and that people shouldn’t rush to blame something like tongue-tie. “In particular, be wary of clinicians who are charging hundreds of dollars for procedures.” These clinicians frequently cross-refer to their “PREFERRED PROVIDERS” for extensive follow up treatments such as “body work” after frenotomy.
International Board Certified Lactation Consultants (IBCLCs) are also somewhat divided on the topic of tongue-tie and frenotomy. Most would concur with Dr Amir’s view, and agree that breastfeeding problems are multifactorial. Each mother and baby breastfeeding partnership presents a unique combination of shape, size and function variables, and just one part of this dynamic process is the baby’s tongue. It should be considered and carefully assessed, and treated if deemed necessary, but is only one piece of the gloriously diverse mother/baby breastfeeding puzzle.
Information contained in “New Baby 101 – A Midwife’s Guide for New Parents” is consistent with Australia’s Science Channel’s review regarding tongue-tie and lip tie diagnosis and over-diagnosis. Visit www.newbaby101.com.au and www.birthjourney.com for more evidence-based parenting guidance and practical breastfeeding support.