Are We Overdiagnosing Tongue-Tie In Breastfeeding Newborns?

Moms rave about the transformative impact of surgery. But experts say more research on the frenotomy option is needed.
miodrag ignjatovic via Getty Images

When a new mom struggles with breastfeeding, doctors, lactation consultants and well-meaning (if overbearing) loved ones tend to have a lot to say. “How’s the latch?” “What positions have you tried?” And increasingly: “Have you checked for a tongue-tie?”

Diagnoses of tongue-tie — which basically means the band of tissue connecting the front of the tongue to the floor of the mouth is short or tight — have soared recently, and it is now said that up to 11% of newborn babies have the condition. Likewise, the number of frenotomies or tongue-tie revisions ― basically “clipping” the tissue in question ― has gone way up. One study found that inpatient frenotomies nationally jumped from just over 1,200 in 1997 to more than 12,400 in 2012.

A tongue-tie can make breastfeeding a painful-for-mom slog because the tongue doesn’t have enough range of motion to allow the baby to latch onto the nipple and swallow effectively. In dedicated tongue-tie Facebook groups, which boast thousands of members, moms rave about the transformative impact that a frenotomy can have ― and indeed in some instances, they can help.

Tongue-tie may also cause problems with speech and other oral activities. But overall, there is not a lot of good data looking at who should get treated, particularly in milder cases, and what impact that treatment has.

Now, a small study published Thursday wades into these murky waters, finding that 63% of babies who were referred to a specialist for surgery to treat a tongue-tie or an upper lip tether were ultimately determined to not need the procedure after a comprehensive evaluation with a speech language pathologist, and those same babies were able to breastfeed successfully without surgical intervention.

“It’s been surprising to see such an uptick over the last decade, to see people sent in for something they weren’t sent in for before,” study author Dr. Christopher Hartnick, director of pediatric otolaryngology at Massachusetts Eye and Ear, told HuffPost. “We wondered, ‘Is the indication proper? Are all of these procedures necessary?’” As an ear, nose, and throat surgeon, Hartnick said he now gets referrals for such procedures for up to five newborns a week.

Hartnick believes his study raises questions about whether babies are getting a procedure they may not need, but he was also frank about the limitations of the research, which was published in JAMA Otolaryngology-Head & Neck Surgery. The study included only 115 babies, most about 1 month old. And he and his team were looking only at patients at his institution.

Above all else, he said it’s a study that begs for more research. While the procedure to correct a tongue-tie is brief and not thought to be particularly painful, Hartnick said, there are risks with any surgery. According to figures cited in the study, basic surgical fees for a frenotomy can run around $850. More complex procedures performed under general anesthesia can generate costs for medication as well as extensive hospital fees.

“To me, what it says is that it’s OK for parents to be asking not just for an opinion from a surgeon, but to be looking for a multidisciplinary look at [what’s happening],” said Hartnick.

“There are really two questions at play here,” echoed Dr. Casey Rosen-Carole, a pediatrician and medical director of lactation services and programs at the University of Rochester Medical Center, who did not work on the study. “One is the individual question of how parents should be making this decision. And the second is the public health issue and the ‘hotness’ of this debate, which I take issue with.”

Over the past few years, there has been growing skepticism in the medical community and media over the utility of tongue-tie intervention, as evident in stories labeling it a “fad.” But Rosen-Carole noted that although it’s true that more frenotomies are being performed, it’s also true that significantly more women are breastfeeding now than in past decades.

She also pointed to a 2017 Cochrane review that concluded there have not been enough strong studies to make a case for or against frenotomy or to provide clear guidelines around it, but that did find it reduced short-term breastfeeding pain for moms. And that, of course, to a woman who is struggling through one excruciating feeding after the next is no small thing.

“The knee jerk reaction to a study like this is, ‘Uh oh!’ Whereas I think we’re probably going in the right direction ― we just need far more education on how to properly diagnose and treat [tongue-tie],” she said. “And there is a huge gap in research.”

Hartnick and Rosen-Carole agree that the best approach is a multidisciplinary one, where some combination of pediatricians, lactation consultants, speech pathologists, and ear, nose and throat specialists come together to make a diagnosis and settle on a course of treatment.

But in many parts of the country, that’s just not possible.

“I would tell moms, if you can get to a lactation consultant, start there,” Rosen-Carole said. “And ask your pediatrician, too. Then you’ve got to find the people in your local community who deal with this and get a second opinion. See people who you trust, and make a decision from there.”

Before You Go

Public Breastfeeding Awareness Project