A recent report published by the American Academy of Pediatrics (AAP) highlights concerns regarding the increasing use of surgery to treat tongue-tie in infants who have difficulty breastfeeding. This condition, known as ankyloglossia, is characterized by tissue connecting the tongue to the floor of the mouth that is too short, limiting the tongue’s movement. While the exact prevalence of tongue-tie is unknown, the Canadian Paediatric Society estimates that between 4.2% and 10.7% of infants are born with the condition. Despite its common occurrence, the medical community remains divided on its impact on lactation problems, speech disorders, and other oral motor issues.
The AAP report attributes the rise in tongue-tie diagnoses to a lack of uniform diagnostic criteria and a lack of consensus on treatment approaches. Although cutting the tissue is considered a minor procedure, it can lead to complications such as bleeding, infection, or injury. There are two types of frenotomy procedures available, with the most common involving a simple incision or snipping of the tissue connecting the tongue to the floor of the mouth. Some clinics now offer laser ablation for frenotomy, but there is limited data on its safety and effectiveness compared to traditional methods.
Pediatricians may consider a diagnosis of tongue-tie based on criteria such as an ineffective latch and poor weight gain. With a growing emphasis on the benefits of breastfeeding, there is increasing pressure to diagnose ankyloglossia as a barrier to successful breastfeeding, leading to a higher demand for frenotomy. Dr. Jack Newman, a Toronto-based pediatrician, advocates for early correction of tongue-tie in infants to facilitate breastfeeding and potentially prevent future speech difficulties. He believes that tongue-tie can be a common cause of breastfeeding pain and subsequently affect milk supply, necessitating intervention.
While acknowledging that some infants may benefit from tongue-tie surgery, lead author Dr. Maya Bunik views it as a “quick fix” for underlying issues that may not be related to tongue-tie. Breastfeeding can be challenging in the early days, but not all difficulties are due to tongue-tie; other factors may be at play. This leads to over-diagnosis and potential delays in addressing the true underlying issues contributing to breastfeeding problems. Bunik encourages collaboration among dentists, lactation specialists, primary care doctors, and pediatricians to determine the best approach for addressing breastfeeding challenges on a case-by-case basis.
Bunik warns against the trend of blaming breastfeeding difficulties solely on tongue-tie without considering other potential contributing factors. She urges families to make informed decisions about surgery, whether using a laser or scissors, in consultation with their healthcare providers. With the prevalence of misinformation online and financial considerations, such as out-of-pocket costs for surgeries not typically covered by insurance, it is important for families to weigh the potential benefits and risks of tongue-tie procedures carefully. Ultimately, individualized care and a thorough evaluation of breastfeeding issues are crucial in determining the most appropriate and effective treatment approach for infants with tongue-tie.
