• Posted July 29, 2024

Surgery Overused for 'Tongue Tie' Issue That Stops Babies From Breastfeeding, Experts Say

Surgery is being overused to correct breastfeeding difficulties in infants, a new report says.

A growing number of newborns are being diagnosed with ankyloglossia, also called “tongue-tie.”

Tongue-tie restricts the tongue’s range of motion in a baby. An unusually short or tight band of tissue holds the tip of their tongue close to the bottom of their mouth, making it difficult for them to latch on or suckle during breastfeeding.

The condition can be treated through a simple surgery that snips the band of tissue, a procedure called a frenotomy.

But most breastfeeding problems can be managed without resorting to the surgery, according to a new clinical report from the American Academy of Pediatrics (AAP).

The AAP is encouraging doctors to first consider nonsurgical options to address breastfeeding problems rather than going straight to a frenotomy.

“Surgery is often unnecessary for breastfeeding concerns, and there is limited research on its effectiveness,” said lead report author Dr. Jennifer Thomas, a Wisconsin pediatrician and executive board member with the AAP Section on Breastfeeding.

“Lactation specialists and other experts are often helpful when working within a team to help support parents,” Thomas added in an AAP news release.

The rate of tongue-tie in newborns ranges from about 2% to nearly 11%, according to three different studies conducted in the United States, Canada and England.

One study found an almost 10-fold increase in tongue-tie diagnosis between 1997 and 2012, and a further doubling between 2012 and 2016, the AAP report says.

An ineffective latch and poor weight gain in an infant are the main considerations for a pediatrician diagnosing tongue-tie, the report says.

Tongue-tie also can cause painful breastfeeding in a new mother, if the infant’s tongue cannot extend and elevate enough to latch on properly, experts said.

Yet, “most difficulties with breastfeeding, including pain, are not due to ankyloglossia,” said Dr. Maya Bunik, chair of the AAP Section on Breastfeeding.

“We are seeing some health care providers and clinics promoting this diagnosis and frenotomies, but they are not always in the patient’s best interest,” Bunik said. “Parents may also feel pressure from what they learn on social media about ankyloglossia when breastfeeding difficulties arise, as the awareness has grown within online communities.” 

The procedure is safe, and poor outcomes are rare, the AAP noted.

However, evidence reviews have found an inconsistent positive effect on breastfeeding and only a short-term reduction in nipple pain for breastfeeding moms, the report says.

The AAP recommends that doctors approach cases of tongue-tie by first collaborating with lactation consultants, speech-language pathologists and other specialists.

Surgery should be reserved for cases with significant functional impairment caused by tongue-tie, where other possible interventions haven’t worked.

“It’s easy to understand why a breastfeeding parent would be eager for solutions to feeding concerns, especially when it’s touted on social media as an option,” Thomas said. “We just encourage families to first work with their pediatrician who can help them understand what is known and unknown about a diagnosis of ankyloglossia and treatment."

More information

The Cleveland Clinic has more on tongue-tie.

SOURCE: American Academy of Pediatrics, news release, July 29, 2024