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


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!