Surprise! 70% of babies referred for tongue-tie surgery DON’T need it!

Newborn

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

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

The same people who insist that women are perfectly designed to breastfeed can’t explain why so many babies supposedly aren’t equally perfectly designed.

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 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.

And the worst part? 70% of babies referred for tongue-tie surgery don’t need it!

That’s the conclusion of a new paper published in the International Journal of Pediatric Otorhinolaryngology. As Diercks et al. explain:

Despite growing popularity of the procedure, controversy remains surrounding the diagnosis of ankyloglossia, when to perform frenotomy, and whether frenotomy even improves feeding outcomes. A 2017 Cochrane review of lingual frenotomy concluded that lingual frenotomy reduces short term maternal nipple pain, but this did not translate to improvements in breastfeeding consistently and no data about long term breastfeeding success was available . This is further complicated by introduction of the concept of posterior ankyloglossia as well as consideration of the role of the maxillary lip frenulum in feeding.

The epidemic of tongue-tie has been driven by lactation consultants:

There is disagreement among health care professionals regarding the degree to which ankyloglossia impacts infant feeding patterns, with 69% of lactation consultants attributing breastfeeding problems to anatomic restriction vs. 10% of pediatricians and 30% of otolaryngologists.

Lactation consultants are grossly over diagnosing tongue tie. Up to 70% of patients they refer don’t actually need the surgery.

The authors studied all infants referred for surgery in their institution in a year. But before performing the surgery:

All mother-infant dyads were offered a formal feeding evaluation by a pediatric speech language pathologist specializing in infant feeding and swallowing disorders approximately 3 to 14 days prior to consultation with a pediatric otolaryngologist.

What happened?

Of the 153 participants referred for frenotomy, after multidisciplinary evaluation, a procedure was recommended for only 46 (30.1%) of patients. One patient had undergone lingual frenotomy prior to consultation elsewhere and a revision procedure was not recommended… Of the infants who underwent frenotomy, 11 (23.9%) underwent labial frenotomy alone, 5 (10.9%) underwent lingual frenotomy alone, and 30 (65.2%) underwent both labial and lingual frenotomies. 94 children (71.8%) had accessed lactation consultant services prior to assessment…

The authors note:

Rates of ankyloglossia diagnosis and frenotomy have increased sharply over the past decade, perhaps due to increased desire as well as pressure for new mothers to breastfeed.

They conclude:

The majority of patients referred for ankyloglossia may benefit from nonsurgical intervention strategies based on findings from comprehensive feeding evaluation. Frenotomy is associated with higher maternal feeding-related worry and reduced breastfeeding self- efficacy scores. While tongue appearance is associated with frenotomy, functional assessment is critical for identifying patients who may also benefit from lip frenotomy.

Why has the diagnosis of tongue-tie reached epidemic proportions followed by an explosion of unnecessary surgery?

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 supposedly AREN’T equally perfectly designed nor why those babies apparently need (mostly unnecessary) surgery to treat breastfeeding problems.

How ironic!

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  • demodocus

    *sigh* My nephew had a good solid tongue tie (my sister jokes about his forked tongue) so he did get it clipped.

    I did ask my kid’s ped about it, in part because I’d been reading some stupid bf’ing book, and nursing was still painful after several weeks. Nope. But he did have something of a lip tie. That he ripped it himself on an apple when he was a toddler. Poor little lad; that hurt. Not enough to stop eating the apple, mind. (This is my apple fiend)

  • rational thinker
    • rational thinker

      I have nothing against teen mothers, I AM/WAS one, but making a career out of it irks me.

  • Lisa Hayes

    Dr Amy, have you read this? http://velamag.com/superbabies-dont-cry

  • Sarah T.

    My baby had a tongue tie clipped at abt 2 weeks old, after consulting with LC and a pediatrician at my practice. I was pumping more than enough milk but baby was not transferring more than half an ounce per feed. Well I don’t think the frenotomy did anything, really. My baby did eventually learn to breastfeed by around 3 months. I don’t recommend “triple feeding” for three months to anyone. I was saved by the pandemic and having to stay home all day anyway.

    • PeggySue

      This sounds like a really difficult time. I hope things go much more smoothly from here on!

    • The Bofa on the Sofa

      I would agree there is no reason to think that clipping the tongue-tie in this case made any difference at all.

  • rational thinker

    I worked with a woman many years ago who got very angry with me because she learned that I had my son circumsized when he was born. A few years later she had a baby who was having trouble nursing so she had the ties cut (upper and lower). I didn’t think about it at the time but looking back on it I can see how messed up that actually was. She lectured me about how much pain the circumcision must have caused by son, but it was okay for her to put her baby though a probably more painful procedure so she could breastfeed. What a hypocrite. The baby ended up on formula anyway caused it turned out mom had mammary hypoplasia and was barely making anything.

    • Dunno. All my kids had tongue and/or lip ties as diagnosed by the neonatologist. I took one kid with a tongue-and-lip tie to an ENT. (He was the only one who could breastfeed directly from me.) Everybody said “Wait”; none of my kids had speech or other problems.

  • Poster Girl

    Wonder what the overlap is between tongue-tie-surgery-happy crunchy mamas and “all obstetric intervention is bad” crunchy mamas. Something tells me that Venn diagram is just a circle.

    • MaineJen

      Also a circle: the venn diagram showing people who are pro-tongue tie clipping but anti-circ

      • rational thinker

        I worked with a woman many years ago who got very angry with me because
        she learned that I had my son circumsized when he was born. A few years
        later she had a baby who was having trouble nursing so she had the ties
        cut (upper and lower). I didn’t think about it at the time but looking
        back on it I can see how messed up that actually was. She lectured me
        about how much pain the circumcision must have caused by son, but it was
        okay for her to put her baby though a probably more painful procedure
        so she could breastfeed. What a hypocrite. The baby ended up on formula
        anyway caused it turned out mom had mammary hypoplasia and was barely
        making anything.

  • The Bofa on the Sofa

    I just want to reiterate the silliness of the “your body was designed to breast feed” vs “lots of babies have tongue ties and that prevents them from breastfeeding properly” claims.

    • Obviously, GMOs cause tongue ties.

    • PeggySue

      and vaccinations. If the mother or any of the mother’s first-degree relatives has received vaccines, well…

    • Anna

      The latest claim is that pre-natal vitamins cause tongue ties!

      • PeggySue

        Good gravy.

  • CatCatCat

    My younger cousin actually was tongue-tied. We knew it because it interfered when she began to speak– she pronounced her own name as “Sodi” rather than “Jodi,” for example. She had it corrected at a fairly young age, but certainly not in early infancy. Let the record show that she did not starve as a baby. 🙂

  • rational thinker

    There needs to be a major change about this issue. I have heard more than one person with a new baby say that they know how to check for ties. When you ask them how they know how to check the most common answer is ” my LC taught me” or “the nurse at the hospital”. Those people are not qualified to diagnose ties and neither is some random Karen on facebook. Ties should only be diagnosed by a pediatrician or better yet a speech pathologist.

    The worst part may be that the baby is already starting to starve but someone tells mom ” you are producing enough milk almost everybody has enough milk the problem is the baby so no need to give him formula just wait a few more days to get an appointment for the ties to be cut”.

    Ties are just another excuse used by lactivists to support their stance of only 5% of moms dont make enough milk and it works.