To Improve Breastfeeding, Babies Get Their Tongues Clipped. Is It Necessary?

Published July 2, 2019 at 9:00 AM CDT

A week-old baby lies in a neonatal intensive care unit bay at the Norton Children's Hospital in Louisville, Ky. (Timothy D. Easley/AP)

This show originally aired March 19, 2019.

Find our buildout from this hour, featuring a partial transcription, here.

Snipping an infant’s tongue can improve breastfeeding. But is the surgery overused or even medically necessary?

Guests

Rachel Morgan Cautero, journalist and author of The Atlantic piece “Why So Many Babies Are Getting Their Tongues Clipped.” ( @RachelMorganCau)

Dr. Jonathan Walsh, pediatric ENT at Johns Hopkins. ( @HopkinsMedicine)

Robin Kaplan, international board-certified lactation consultant and owner of the San Diego Breastfeeding Center. Author of “ Latch: A Handbook for Breastfeeding with Confidence at Every Stage.” ( @SanDiegoBFC)

From The Reading List

The Atlantic: “ Why So Many Babies Are Getting Their Tongues Clipped” — “It’s uttered in hushed tones during mommy-and-me yoga classes and at Montessori-school drop-offs, discussed ad nauseam in breastfeeding support groups and on parenting message boards.

“It’s called tongue tie, and it’s everywhere. In online mom groups, it’s blamed for all sorts of parenting woes. Baby isn’t gaining weight, or won’t take a bottle? Have you tried checking for ties? Kid won’t nap? It’s probably related to tongue tie. Baby have a rash? Check under the tongue!

“Tongue tie, or ankyloglossia, is characterized by an overly tight lingual frenulum, the cord of tissue that anchors the tongue to the bottom of the mouth. It occurs in 4 to 11 percent of newborns. A lip tie—a related condition—is an unusually tight labial frenulum, the piece of tissue that keeps the upper lip tethered close to the gum line. Tongue and lip ties often occur in tandem.”

Journal of American Medicine: “ Diagnosis and Treatment of Ankyloglossia in Newborns and Infants: A Review” — “The influence of tongue tie, or ankyloglossia, on breastfeeding is the subject of growing debate. Restriction of tongue mobility from the frenulum varies greatly among newborns and infants (hereinafter referred to as infants). Controversies about whether an infant has ankyloglossia and which infants need treatment are evident with wide variations in medical practice and a lack of high-quality clinical studies that provide guidance.

“Observations Diagnosis and management of ankyloglossia in infants can be a source of confusion and frustration for clinicians and families. Frenotomy is a low-risk procedure that is likely to be beneficial with careful patient selection, but the natural history of untreated ankyloglossia is not well documented. The variability in presentation and treatment outcomes of ankyloglossia indicate that the complexity of infant feeding and tongue development is not fully encapsulated in a simplistic ankyloglossia etiologic framework.

“Conclusions and Relevance Consistent terminology with emphasis on symptomatic ankyloglossia and a uniform grading system, such as the Hazelbaker Assessment Tool for Lingual Frenulum Function and Coryllos grading, are needed to improve the quality of research in the future. The ability to make definitive practice guidelines is limited with our current understanding of ankyloglossia. Additional research is needed to better understand the complexity of infant feeding and the role of ankyloglossia.”

Philadelphia Inquirer: “ Snipping an infant’s ‘tongue tie’ can improve breastfeeding. But is the surgery being overused?” — “Like most new mothers, Lisa Treilman really wanted to breastfeed.

“But like many women, Treilman had difficulty. After two months, her nipple pain was intense, despite wearing a protective silicone nipple shield while nursing. Each feeding took an hour, yet Treilman often supplemented it with a bottle of pumped milk because daughter Shoshana still seemed hungry.

“What happened next is also increasingly common — and part of a medical controversy that Treilman couldn’t have imagined. Shoshana was diagnosed with a tongue tie: The tissue tethering the infant’s tongue to the floor of her mouth was too tight, so she couldn’t properly latch on and suck.

“A pediatric dentist used a laser to clip the thin membrane, called the lingual frenulum, enabling freer tongue movement. A few weeks later, Treilman recalls, breastfeeding became a breeze, efficient and effective.”

Slate: “ The Tongue Tie Conundrum” — “Just when you thought you’d heard of every parenting controversy, another comes along to reaffirm your belief that there’s no end to the angst of having kids. (Of course, the joy is boundless, too!) The latest conundrum I’ve discovered involves tongue ties, a hugely trendy but controversial diagnosis. Tongue-tied infants have a particularly short, thick, or tight piece of tissue connecting the underside of the tongue to the floor of the mouth, which can restrict tongue movement and hinder breastfeeding. Tongue tie diagnoses have skyrocketed in recent years, and pediatricians, lactation consultants, and ear, nose, and throat doctors vehemently argue over whether it’s better to ‘snip’ them in the hopes of making nursing easier and less painful for Mom—a procedure that costs between $400 and $1,200 and isn’t always covered by insurance—or leave them be and try to improve breastfeeding in other ways.

“I started asking around on Facebook to get a sense for what parents have been going through. The variety of experiences was mind-boggling: ‘Within days, he was nursing better,’ reported a friend who had her baby’s tongue tie snipped, while another said that the same procedure ‘didn’t help with breastfeeding—at all.’ Friends got no clarity from medical providers, either. ‘Our pediatrician was like, it might help, it might not. The ENT said the same,’ one recalls. Another friend saw an ENT who said her daughter didn’t have a tongue tie, two lactation consultants who said she did, and a pediatrician who essentially shrugged and suggested that she formula feed. A couple of friends were told to perform mouth exercises on their babies to prevent their snipped tongue ties from reattaching, while another had to get her baby’s tie snipped twice because the first wasn’t ‘aggressive’ enough.

“How can such an increasingly common diagnosis—in-hospital diagnoses of newborns increased more than sevenfold between 1997 and 2012—be mired in this much confusion and angst? Is there research on tongue ties, I wondered, and can it address any of this uncertainty?”

Anna Bauman produced this hour for broadcast.

This article was originally published on WBUR.org.