Not all breastfeeding babies with tongue-ties automatically need to get surgery, says new study

Many new parents receive the confusing news that their newborn baby has a tongue-tie. It means the skin attaching their tongues to the bottom of their mouths is longer than normal. And while this condition can cause complications from infancy on, a new study shows that not all newborns need to get surgery to correct it.

The condition is known as ankyloglossia, which occurs in 4-10% of people, usually looks like nothing but an extra strip of skin under the tongue. But because that skin (called the lingual frenulum) acts like a taut rubber band restricting movement, babies with a tongue-tie often have difficulty forming a good latch to nurse. This can mean they don’t get enough milk, so they have to nurse for longer. Meanwhile, they’re causing their mother a whole lot of pain because their latch is shallower and mostly clamping down on the tip of the nipple.

I speak from experience here: When my son had a tongue-tie, it felt like I was feeding an angry piranha. He was definitely not getting enough to eat, and my milk supply was steadily decreasing.

But this new study published in JAMA Otolaryngology Head & Neck Surgery suggests that not all babies diagnosed with ankyloglossia need to undergo a frenotomy—a simple procedure in which a doctor snips the skin with a pair of surgical scissors.

Infants don’t usually need anesthesia, because this tissue doesn’t have many nerve endings or blood vessels. Their mother is asked to breastfeed them immediately after the snip, to get the tongue moving properly and reduce the chance of the skin growing back. According to the Mayo Clinic, complications from frenotomies include bleeding, infection and damage to the tongue or salivary glands, but they are rare.

What’s not rare is the number of patients getting frenotomies: Referrals for the procedure in the U.S. went up tenfold, from 1,200 in 1997 to 12,400 in 2012.

“We have seen the number of tongue-tie and upper lip tether release surgeries increase dramatically nationwide without any real strong evidence that shows they are effective for breastfeeding,” study co-author Christopher J. Hartnick, MD MS, of the Massachusetts Eye and Ear Infirmary, said in a press release.

The researchers looked at 115 infants (between 19-56 days old) who were referred for a frenotomy. Instead of sending them straight into surgery, the babies and their parents met with a pediatric speech-language pathologist for a feeding evaluation. These specialists observed the babies breastfeeding and gave parents feedback and tips to overcome any challenges they were experiencing. After this, 72 (62.6%) patients did not have the frenotomy after all, while 10 (8.7%) had a labial frenotomy (releasing extra tissue from the lips) and 32 (27.8%) had both a labial and lingual frenotomy.

“We don’t have a crystal ball that can tell us which infants might benefit most from the surgeries, but this preliminary study provides concrete evidence that this pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure,” Hartnick said.

For now, parents’ best bet is to consult more than one specialist to identify the best plan of action. In addition to lactation consultants, children with tongue-ties might need to see speech pathologists later. In some cases, the frenulum loosens over time. In others, they might wind up needing the procedure after all.

Anecdotally, I’ll add that I visited with lactation consultants and my son’s pediatrician more than once before deciding he should have a frenotomy. It was no fun for me (who wants a strange man sticking scissors in their baby’s mouth?), but my kid was fine. It didn’t solve all our problems, but feeding was much less painful immediately afterward.

The bottom line here seems to be that not everyone needs to rush into a procedure just because it’s easy. Our kiddos deserve more than a one-size-fits-all approach to their health.

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