New Cochrane Review shows that cutting tongue-ties does not improve breastfeeding


I’ve written before that we’re in the midst of a curious epidemic of “broken” baby tongues.

Lactivists insist that women are mammals and mammals are “designed” for breastfeeding. They insist that breastmilk is the perfect food. They appear to believe that there is no such thing as not enough breastmilk. Simply put, no woman’s breasts are ever “broken”; if there’s a problem with breastfeeding it must be because … the baby’s tongue is broken (tongue-tie or ankyloglossia).

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Should you really cut your baby’s tongue when bottles of pumped breastmilk or formula may solve the problem with far less pain?[/pullquote]

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.

That has been confirmed in a variety of papers, but now The Cochrane Review has weighed in and they find that cutting babies’ tongues does not improve their ability to breastfeed.

Randomised, quasi-randomised controlled trials or cluster-randomised trials that compared frenotomy versus no frenotomy or freno- tomy versus sham procedure in newborn infants.

What did they find?

Five randomised trials met our inclusion criteria (n = 302). Three studies objectively measured infant breastfeeding using standardised assessment tools. Pooled analysis of two studies (n = 155) showed no change on a 10-point feeding scale following frenotomy (mean difference (MD) -0.1, 95% confidence interval (CI) -0.6 to 0.5 units on a 10-point feeding scale). A third study (n = 58) showed objective improvement on a 12-point feeding scale (MD 3.5, 95% CI 3.1 to 4.0 units of a 12-point feeding scale)… No study was able to report whether frenotomy led to long-term successful breastfeeding.

Yet frenotomy has become a big business.

Consider this study in British Columbia, Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004-2013: a population-based study.

The population incidence of ankyloglossia increased by 70% (rate ratio 1.70, 95% confidence interval [CI] 1.44-2.01), from 5.0 per 1000 live births in 2004 to 8.4 per 1000 in 2013. During the same period, the population rate of frenotomy increased by 89% (95% CI 52%-134%), from 2.8 per 1000 live births in 2004 to 5.3 per 1000 in 2013. The 2 regional health authorities with the lowest population rates of frenotomy (1.5 and 1.8 per 1000 live births) had the lowest rates of ankyloglossia and the lowest rates of frenotomy among cases with ankyloglossia, whereas the 2 regional health authorities with the highest population rates of frenotomy (5.2 and 5.3 per 1000 live births) had high rates of ankyloglossia and the highest rates of frenotomy among cases of ankyloglossia.

They concluded:

Population rates of frenotomy in British Columbia exhibited a substantial spatial variation by regional health authority, as did rates of frenotomy among cases of ankyloglossia. This is concerning insofar as it reflects arbitrariness with regard to the diagnosis of ankyloglossia and in the use of a potentially unnecessary surgical procedure among newborns. The controversy with regard to the use of frenotomy has been framed as a conflict between lactation nurses, breastfeeding support groups and mothers who have experienced difficulties in breastfeeding versus pediatricians who are focused on the evidence for the efficacy of frenotomy. The latter position is also informed by a culture that has increasingly rejected minor surgical intervention (e.g., tonsillectomy, ear tubes) for babies and children with the understanding that most conditions improve spontaneously.

In other words, breastfeeding advocates are increasingly insisting that breastfeeding difficulties are due to tongue-tie and can be cured with painful surgery on babies while pediatricians can’t find evidence that such surgery actually works.

Mothers should be extremely dubious about any surgery recommended by the lactation industry. Instead of acknowledging that pain in breastfeeding is distressingly common and that breastfeeding may not be right for every mother and every infant, babies are being cut on the theory that breastfeeding is always perfect and, therefore, it is babies who are “broken.”

Only further research will answer these questions definitively, but until then mothers should seek second opinions on tongue tie surgery from someone other than lactation consultants and the doctors who perform the surgery.

Mothers should ask themselves if the benefits of breastfeeding outweigh the risks of surgery:

Should you really cut your baby’s tongue when bottles of pumped breastmilk or formula may solve the problem with far less pain?