How Common Are Tongue-Ties in Babies and Does Correcting Them Really Make Breastfeeding Easier?
“Tongue-ties” may seem to be increasingly diagnosed among newborn babies, but how common are they actually — and do they really need to be addressed to make breastfeeding easier?
PEOPLE spoke with Dr. Casey Rosen-Carole, Medical Director of Lactation Services and Programs and Assistant Professor of Pediatrics and OBGYN at University of Rochester School of Medicine and Dentistry, about this trend. And she says that even among medical professionals, the debate is a frequent one.
“On the one hand, parents and lactation consultants have been screaming for help for years,” she says. “On the other, providers have been worried about the lack of evidence. In addition, some providers have gone further and will claim that 80 percent of babies have tongue-tie and need to be treated with frenotomy, or else a series of illnesses will follow them for life including sleep apnea, recessed chin, eating difficulties, speech disorders, etc.”
Tongue-tie — a.k.a. ankyloglossia — “is a condition present at birth that restricts the tongue’s range of motion,” Mayo Clinic defines. It occurs when “an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth, so it may interfere with breastfeeding.” According to a study published on the National Center for Biotechnology Information’s website in March 2017, ankyloglossia is present in somewhere between 4 and 11 percent of newborn babies.
“My sense is that the increased diagnosis and management of tongue-tie in the past decade is partially due to increased advocacy, increased breastfeeding rates, less willingness to ‘just bottle feed instead’ and finally, groups of physicians (BFM providers) who will work with families and lactation consultants to treat ankyloglossia,” Dr. Rosen-Carole tells PEOPLE of the potential reason for hearing about tongue-tie more often.
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Doctors seem to be split on whether a frenotomy (a surgical procedure to “clip” the tissue in an attempt to fix the problem) is necessary in babies, depending on the case. In many instances, the issue may resolve itself with a loosening of the lingual frenulum as time passes, Mayo Clinic explains.
“Histories of polarization between these viewpoints leads to misunderstanding and communication disorders, and parents are caught in the middle!” Dr. Rosen-Carole — who is also an International Board Certified Lactation Consultant (IBCLC) — tells PEOPLE, explaining that only those infants “with a functional limitation of their tongue” may require a frenotomy.
“If a family has sought breastfeeding help and it remains painful or the baby can’t latch, treating a tongue-tie may be considered as a viable option,” she adds. “I see the difference a frenotomy can make for parents every week in my practice. A family can go from the edge of stopping breastfeeding due to pain and recurrent maternal infections, to crying in relief because the frenotomy eliminated the mother’s nipple pain while breastfeeding.”
“The frenotomy procedure has been around since at least the middle ages, and tongue-tie release is even cited in ancient texts,” says Dr. Rosen-Carole. “I don’t think we are making this whole thing up.”
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Elizabeth Sjoblom, an RN and IBCLC at Lactation Partners of Chicago, tells PEOPLE that before decisions are made regarding surgery or any type of treatment, it’s important for parents to consult a specialist on the matter — and consider all angles, even outside of breastfeeding.
“It is always about looking at the whole picture, especially with such a controversial topic and mixed opinions (no one wants to do unnecessary procedures on a newborn),” she says. “A full oral exam should be done for all newborns and any obvious abnormalities with the anatomy noted. If it is found that the newborn has a tongue-tie, they should be referred to a pediatric dentist or pediatric ENT for a full evaluation of the tongue function/movement as well.”
Sjoblom advises moms who choose not to nurse to still “have a full understanding of any oral limitations your baby may have in the future,” nothing that an infant “transferring milk well and gaining weight well could still be a baby with limited function of the tongue and even jaw movement.”
Signs of these limitations for breastfeeding mothers can include “prolonged feeds, gumming/chewing on the nipple, poor weight gain and unsustained latch,” Sjoblom says. Other symptoms can include recurring plugged milk ducts, mastitis, nipple thrush, cracked/bruised/bleeding nipples and severe pain when baby latches, she tells PEOPLE.
Sjoblom encourages staying proactive and ruling out “other causes of pain including (but not limited to) the mom having Raynaud’s disease or poor latch in general,” she tells PEOPLE, explaining, “It can take days to weeks to work on improving good latch technique with a newborn, so not all nipple pain is a sign of a bigger issue beyond good breastfeeding practice and maturity of the newborn.”
Dr. Rosen-Carole says “There is good work being done to show an 80 to 90 percent improvement with laser frenotomy, and ultrasound work showing the difference in suck mechanics from before and after frenotomy,” noting, “the laser procedure limits the risk of bleeding, which was the most common negative outcome cited in reviews.”
She also tells PEOPLE she thinks of ankyloglossia “like many other things in medicine,” drawing a comparison between the opinions over tongue-tie treatment and prescribing attention-deficit/hyperactivity disorder (ADHD) medications to children.
“Should we be careful when diagnosing and treating a child with ADHD? Yes. Are there people who are over-prescribing these medications? Probably. Does that mean that no one needs ADHD medications and it doesn’t help anyone? No,” says Dr. Rosen-Carole. “In fact, there are probably kids who need ADHD medications and don’t get them ever. So like other things in medicine, we need to have careful strategies to properly assess, manage and discuss with parents so they can make the best decisions for themselves and their children.”
