“My baby isn’t gaining weight.” “She won’t take the bottle.” “Breastfeeding is painful, am I doing something wrong?”
These are some of the questions and comments posed by mothers in breastfeeding support groups, online forums, and in the waiting rooms of pediatricians' offices. Often, the first advice mothers get is to check for “tongue-tie,” or ankyloglossia — the tethering of an infant’s tongue to the floor of their mouth by a small piece of tissue called the frenulum that makes it difficult to properly latch on and suck.
The condition can be corrected with a simple surgical procedure that involves snipping or cutting away the tissue. But is it necessary for most babies?
That’s the question researchers at the Pediatric Airway, Voice, and Swallowing Center at Massachusetts Eye and Ear in Boston set out to answer after they noticed an influx of parents seeking second and third opinions on whether their babies needed the procedure, which takes about one minute and is usually done without anesthesia.
“We have seen the number of tongue-tie and upper lip tether release surgeries increase dramatically nationwide without any real strong data to show these are effective for breastfeeding,” lead author Dr. Christopher Hartnick, director of the division of pediatric otolaryngology at Mass. Eye and Ear, said in a statement.
So they launched a study including 115 babies who were referred to a pediatric ear nose and throat surgeon for tongue-tie and/or upper-lip tie surgery. Upper-lip tie occurs when a small piece of tissue tethers the upper-lip to the gums.
For 63% of the infants, the procedure wasn't needed, according to their findings published Thursday in the journal JAMA Otolaryngology — Head & Neck Surgery. The babies learned to successfully breastfeed following a thorough feeding evaluation from teams of clinicians, including a speech-language pathologist.
The study did not specify if the children were misdiagnosed or if they underwent alternative non-surgical treatments to relieve their tongue problems.
“We don’t have a crystal ball that can tell us which infants might benefit most from the tongue-tie or upper lip release,” said Hartnick. “But this preliminary study provides concrete evidence that this pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure.”
The findings raise the question, if many babies don’t need tongue-tie surgery, why are so many of these surgeries being performed?
Does tongue-tie procedure help?
Tongue-tie occurs in 4 to 11 percent of all newborns, according to a 2017 Cochrane reivew. Tongue-tie surgeries, or frenectomies, are performed on babies who have a tight frenulum.
However, previous studies have suggested that a tongue-tie does not always complicate breastfeeding and releasing it does not always improve breastfeeding. Indeed, it’s possible that improvement observed by parents may sometimes be due to wishful thinking — in other words, the placebo effect.
Most experts say that the surge in tongue-tie surgeries is tied to successful worldwide efforts to increase breastfeeding. In fact, more than 80 percent of U.S. mothers start nursing after giving birth, but less than half are exclusively breastfed at three months, according to the Breastfeeding Report Card by the Centers for Disease Control and Prevention.
“As a new mother, you can’t go to any parenting- or breastfeeding-support website without hearing that tongue-tie is the predominant reason your child is having difficulty latching or why breastfeeding is painful,” said Dr. Jonathan Walsh, a pediatric otolaryngologist-head and neck surgeon and assistant professor at Johns Hopkins School of Medicine.
Some mothers may check for tongue-tie by seeing if the baby has a misshapen tongue or difficulty sticking out his or her tongue. However, tongue-tie can be difficult for mothers to spot on their own, resulting in the condition going unnoticed until after a few weeks of painful breastfeeding, said Walsh.
Despite a lack of evidence linking the surgery to improved breastfeeding, the number of these procedures performed has been rapidly rising in recent years, said Walsh, who authored a study in 2017 that looked at the rates of tongue-tie surgeries from 1997 to 2012. Walsh was not involved with the new research.
“In general, rates of tongue-tie diagnosis … are increasing dramatically in the U.S. and around the world, resulting in more children receiving treatment,” Walsh told NBC News. His 2017 study found an estimated 10-fold increase in tongue-tie surgeries from 1997 to 2012.
Walsh said that the rise in tongue-tie procedures is not only the result of public health efforts to increase breastfeeding practices but also the result of more lactation services, greater awareness, and a broader definition of tongue-tie.
What should mothers do?
Some mothers who have trouble breastfeeding are able to adjust their breastfeeding position or review latch techniques with a lactation professional.
As with any surgical procedure, there may be complications, including bleeding, infection, or damage to the tongue or salivary glands. While the complications are rare, Walsh advised moms to consider seeking a second opinion on the diagnosis or whether to have the procedure, with the goal of sparing babies from unnecessary discomfort.
“If you take a step back and critically examine these children, many times you may find another diagnosis or another alternative treatment,” Walsh said. “Just because you have the diagnosis doesn’t mean you have to have a surgical procedure,” said Walsh.