Breastfeeding and the curious epidemic of “broken” baby tongues

Tint newborn baby crying after bath in a blue towel

Am I the only one to have noticed this irony?

Lactivists insist that women are mammals and mammals are “designed” for breastfeeding. They insist that breastmilk is the perfect food; in order for it to be the perfect food, it would have to be highly nutritious, always available in the amounts needed, and the baby always able to access it easily from the breast. They appear to believe that there is no such thing as not enough breastmilk (“nurse more! and pump when you’re not nursing!”) and no such thing as pain when breastfeeding (“it’s your fault; you’re not doing it right!”). Simply put, no woman’s breasts are ever “broken”; if there’s a problem with breastfeeding it must be because of the mother’s laziness.
[pullquote align=”right” color=”#c7dcef”]If pediatricians and ENT specialists think it’s a fad, who’s making the diagnoses? Mothers and lactation consultants.[/pullquote]

Yet at least 5% of women don’t produce enough breastmilk to completely nourish a baby; many women find breastfeeding painful, and they have raw bleeding nipples to show for it; and many babies are screaming with hunger because they can’t extract enough milk from the breast.

What’s the problem? It’s the baby’s fault! Their tongues are “broken”!

There appears to be a veritable epidemic of “broken” baby tongues, known colloquially as tongue-tie and scientifically as ankyloglossia.

According to lactation consultant Nancy Mohrbacher:

What started as a problem for a small percentage of babies seems now to be an epidemic. Health-care providers report increasing numbers of breastfeeding mothers self-diagnosing tongue and lip ties in their babies, often based on online information, and asking for a tongue- or lip-tie revision, a minor office procedure to release the tie…

What is tongue-tie?

If you look carefully at the photo above, you will see that underneath the infant’s tongue there is a small vertical membrane that connects the tongue to the floor of the mouth. Tongue tie occurs when the membrane (the frenulum) is abnormally shortened and or thickened, restricting the movement of the tongue itself. Since the motion of the infant tongue is critical in breastfeeding, it’s easy to see how tongue-tie can cause problems breastfeeding.

The epidemic of tongue tie is surprising since the natural incidence of tongue-tie has been estimated as 1.7-4.8%

But releasing (snipping) the tongue tie is big business. The surgical fee for frenectomy/frenotomy is $850. I presume that $850 is what the doctor bills; what he or she is actually paid probably varies by insurance company.

How effective is surgery for tongue-tie in reducing breastfeeding problems?

Not very.

A recent review of the literature published in the journal Pediatrics, Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review, found:

Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low. (my emphasis)


A minority of surveyed pediatricians (10%) and otolaryngologists (30%) believe ankyloglossia commonly affects feeding, whereas 69% of lactation consultants feel that it frequently causes breastfeeding problems.

So, according to the scientific literature, the incidence of tongue-tie is small (less than 5%), it does not necessarily lead to breastfeeding difficulties, and there is little evidence that surgical treatment of tongue tie improves breastfeeding difficulties.

Why has there been a dramatic increase in the diagnosis of tongue-tie and a dramatic increase in expensive surgery to correct it?

Dr. Bobby Ghaheri insists that Diagnosing Tongue-Tie In A Baby Is Not A Fad:

One of the most frequent things I hear is that primary care providers say something to the effect of “Oh, diagnosing tongue-tie is just a fad” or “This tongue-tie business is just something new that some people are doing”.

So if pediatricians and ENT specialists think it’s a fad, who’s making the diagnoses? Mothers and lactation consultants.


I have a theory:

Breastfeeding is supposed to be perfect, yet it is clear that many babies and mothers aren’t doing well with exclusive breastfeeding. The obvious conclusion is that breastfeeding is not perfect, and may not even be a healthy choice for some babies. That simple, obvious conclusion leads to cognitive dissonance in the lactation industry and among lactivists themselves. For them, breastfeeding must be perfect; therefore, it is babies who are “broken.”

Curiously, the same people who insist that women are perfectly designed to breastfeed can’t explain why so many babies aren’t perfectly designed to breastfeed, and why they apparently need surgery to treat with breastfeeding problems.

How ironic!