Ten-fold rise in tongue-tie surgery for newborns ‘without any real strong data’

Children's Health

A US study has suggested that babies with tongue-tie rarely need surgery to help them breastfeed. Numbers of tongue-tie surgeries have seen a ten-fold increase between 1997 and 2012, but experts believe that undergoing the surgery could be avoided with alternative methods of support.

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Tongue-tie (ankyloglossia) is a condition in which the frenulum, the small piece of tissue that attaches the tongue to the floor of the mouth, is too short. A simple, surgical procedure can correct the problem by cutting the tissue away, allowing babies to better feed. It is a very quick procedure that can be done with local anesthesia.

However, experts say that the procedure may well be unnecessary in many babies, and a US study published in JAMA Otolaryngology – Head and Neck Surgery found that 63 percent of the 115 babies included in the study did not need the surgery to enable them to breastfeed properly.

This 63 percent had been referred for tongue-tie surgery, but with help from specialists and feeding evaluations from clinicians and speech and language pathologists, they were able to improve without going through the procedure.

“We have seen the number of tongue-tie and upper lip tether release surgeries increase dramatically without any real strong data to show these are effective for breastfeeding,” lead researcher Dr. Christopher Hartnick from Massachusetts Eye and Ear Hospital said.

“We don’t have a crystal ball that can tell us which infants might benefit most from the tongue-tie or upper lip release. But this preliminary study provides concrete evidence that this pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure.”

According to a 2017 Cochrane review, tongue-tie affects 4 to 11 percent of all newborns. Tongue-tie surgeries has been linked to an overall increase in breastfeeding.

Many women experience challenges when feeding their babies during the first days and weeks. In some cases, this may be due to tongue-tie. There is limited evidence to indicate which babies need a tongue-tie division and which do not.

Services also vary considerably across the UK, with some areas having no NHS provision and concerns about over-diagnosis in others. If you think your baby has tongue-tie, or are worried that he or she isn’t feeding properly, get in touch with a breastfeeding counselor, midwife or health visitor. Getting support early can make all the difference.”

Jane Moffett, NCT Breastfeeding Counselor

Mothers who are struggling with breastfeeding can change their position when they breastfeed or get help with latch techniques from a lactation professional.

Dr. Johnathan Walsh, a pediatric otolaryngologist-head and neck surgeon and assistant professor at the Johns Hopkins School of Medicine said:

“If you step back and critically examine these children, many times you may find another diagnosis or another alternative treatment.”

According to Walsh, the increase in tongue-tie surgeries is due to public health efforts to increase the amount of women breastfeeding as well as more lactation services being available and a broader definition of what tongue-tie is.

As is the case with any surgical procedure, there is a risk of bleeding, infection, and in the case of tongue-tie surgery, damage to the tongue or salivary glands. As such, Walsh said that although many children are being diagnosed with tongue-tie, it “doesn’t mean you have to have a surgical procedure.”

For some, tongue-tie can be the cause of poor breastfeeding and maternal nipple pain and the procedure can correct the restriction to tongue movement and allow more effective breastfeeding for baby, and comfort for mum.

However, parents need good breastfeeding support and advice before considering surgery because, as this study shows, it can sometimes be avoided with the right support.

While this new study sheds some light on this issue, as yet, we do not have enough data from good quality trials to know what is best for breastfeeding outcomes.

Professor Mary Fewtrell, The Royal College of Pediatrics and Child Health

The study concludes by stating that the “majority of patients referred for ankyloglossia may benefit from alternative intervention strategies,” and that the formation of and collaboration between multidisciplinary teams for treating children with tongue-tie is “imperative”.

Journal reference:

Caloway C, et al. (2019). Association of Feeding Evaluation With Frenotomy Rates in Infants With Breastfeeding Difficulties. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2019.1696.

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