Breast milk is the ideal nutrition for growing babies, but breastfeeding can sometimes be challenging, especially in the early days. One common issue parents face is their infant's difficulty latching onto the nipple, which can cause pain for the breastfeeding parent and concerns about whether the baby is getting enough milk.
Tongue tie, or ankyloglossia, has been highlighted as a potential cause of breastfeeding difficulties. However, experts caution that tongue tie might be overdiagnosed, leading to unnecessary surgeries while overlooking other reasons for nursing challenges.
What is Tongue Tie?
Tongue tie occurs when the band of tissue connecting the tongue to the floor of the mouth is unusually short or tight, limiting the tongue's range of motion. This condition affects an estimated 4% to 10% of newborns.
Is Tongue Tie Responsible for Nursing Problems?
Although traditionally believed to cause breastfeeding issues, research has yet to establish a clear connection. Despite this, tongue-tie release surgeries, known as frenotomies, have surged by 110% since 2012. This trend has sparked debate among healthcare providers and parents.
Concerns that untreated tongue tie could lead to speech, sleep, and dental issues later in life may also be driving the increase in surgeries.
Diverse Opinions Among Experts
Healthcare providers, including breastfeeding experts, otolaryngologists, pediatric dentists, lactation specialists, and primary care doctors, often use different criteria to diagnose tongue tie and recommend surgery.
Research Findings on Tongue Tie and Breastfeeding
There is a lack of definitive studies on tongue tie in nursing infants, but current research shows:
Less than half of infants with physical signs of tongue tie struggle with breastfeeding. A U.S. study of 115 babies referred for tongue-tie surgery found that 63% did not need the procedure to resolve nursing issues.
A muscle under the baby's tongue can stretch and lengthen with continued feeding, potentially alleviating nursing problems.
Healthy nursing may depend more on movements in the middle of the baby's tongue, making the tip less crucial (and surgery less effective). This insight comes from advanced imaging studies of milk flow in infants' mouths.
Tongue-Tie Surgery and Nipple Pain
While more studies are needed to understand the role of tongue tie in nursing, research indicates that tongue-tie release can reduce nipple pain, at least in the short term. For parents experiencing severe pain during breastfeeding, the procedure might offer relief.
Long-Term Impact of Tongue-Tie Surgery
If you’ve heard that early tongue-tie surgery can prevent future issues, consider these key points:
Tongue tie will not delay speech development, though it may affect articulation. Children who can't easily touch their tongues to the roof of their mouth may struggle with certain sounds. Speech therapy can help if needed.
There is no evidence that tongue-tie surgery improves dental health or prevents sleep apnea. These conditions have complex causes, and surgery alone cannot protect against potential future problems.
Claims that frenotomy can alleviate reflux, fussiness, bedwetting, and other issues lack evidence.
Lip Ties and Cheek Ties: Not Linked to Breastfeeding
Surgery for lip ties or cheek ties does not improve breastfeeding, even though lip-tie surgery is often combined with tongue-tie surgery. The bands connecting the lips and cheeks to the mouth's interior do not play a direct role in latching or sucking.
Making an Informed Decision About Tongue-Tie Surgery
Breastfeeding issues have various causes and solutions. For accurate diagnosis and treatment, coordinated care involving your baby’s pediatrician, lactation coaches, feeding therapists, and surgeons is essential. This team approach helps prevent misdiagnosis and unnecessary procedures.
Why Coordinated Care Matters
Coordinated care allows for thorough evaluation, testing different approaches, and close follow-up. It helps avoid unnecessary tongue-tie surgeries, which could worsen feeding issues, affect function later in life, and increase medical costs.
Monitoring newborns with potential tongue tie involves careful examination of sucking reflexes, tongue movement, and feeding sessions. Comparing pre-feeding and post-feeding weights can offer more insights before considering surgery.
Parents should receive ample support and follow-up care to monitor their baby's feeding, weight gain, and overall health. If breastfeeding doesn’t improve after surgery, other causes must be explored.
What to Expect if You Opt for Tongue-Tie Surgery
Tongue-tie surgery can be performed by pediatric dentists, otolaryngologists, trained pediatricians, and other qualified providers. Look for a provider who can bill insurance to avoid health inequities.
Frenotomy is usually a quick, in-office procedure performed without general anesthesia. Both sterile instruments and lasers are effective, with no evidence favoring one method over the other. The procedure takes just minutes, and after a short observation period, babies can go home. Over-the-counter pain relievers can help manage post-surgical discomfort. Long-term complications are rare, though parents should watch for persistent bleeding or pain.
Post-Surgical Stretches: Not Proven Effective
Post-surgical stretches and exercises for infants recovering from tongue-tie surgery have not been proven effective and may even hinder nursing temporarily. The American Academy of Pediatrics (AAP) does not recommend these exercises.
A Call for More Research
The AAP supports further research to develop consistent diagnostic criteria for tongue tie in newborns and infants and clear guidelines for when surgery is necessary. Long-term outcome studies will help parents make more informed decisions about the procedure.
