In recent years, surging numbers of infants have gotten minor surgeries for "tongue tie," to help with breastfeeding or prevent potential health issues. But research suggests many of those procedures could be unnecessary.
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 , 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 . 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.
To breastfeed effectively, babies need to create negative pressure (in a word, a ) on the breast. This differs from the compression that some babies with limited tongue mobility use, effectively squeezing the milk out rather than sucking.
This compression can be painful for mothers, and breastfeeding pain can compound the stress of the exhausting first weeks of parenting. And cases of severe tongue tie have been linked to issues such as failure to gain weight.
But the tongue-tie madness in pediatricians' offices, lactation rooms, and online groups has some researchers wondering whether people are all twisted up over nothing.
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Moms might start worrying about tongue tie when breastfeeding fails to be the peaceful bonding experience they envisioned, when they're dealing with cracked nipples and the pain of trying to nurse a baby who can't latch properly.
They might call a local lactation consultant to help. If the consultant suspects a tongue tie, she'll typically refer mom and baby to a pediatric dentist or an otolaryngologist (an ear, nose, and throat doctor), who will perform a procedure to "clip" the stringlike piece of tissue underneath the tongue. In some cases, the child's pediatrician is not involved in the decision.
The procedure, called a frenotomy, frenulotomy, or tongue-tie revision, is a relatively straightforward one. A doctor or dentist holds the baby's tongue taut toward the roof of his mouth and cuts the lingual frenulum to "release" it, usually with a laser or sterile scissors. This allows for greater range of motion for the tongue, provided the frenulum doesn't reattach.
During the procedure, the baby will be restrained with a swaddle, but there's no need for general anesthesia (just a topical numbing), and the risk of possible complications—bleeding, infection, damage to the tongue or salivary glands, reattachment, or airway compromise—. Babies tend to be quite young when the procedure is performed, less than three months old. As medical procedures go, it's quick and easy. And the results can be immediate. After a frenotomy, some babies have an , which makes breastfeeding less painful for mothers.
While the popularity of frenotomies has exploded in recent years, many medical professionals and researchers say it's not totally clear whether they address the issues they're supposed to—or whether a lot of babies are having an unnecessary procedure.
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My son has both a tongue and lip tie, as diagnosed by a lactation consultant shortly after his birth. After helping my newborn son latch, she spent the next 20 minutes telling my husband and I that we needed to take him to a pediatric dentist immediately to have his tongue tie lasered, or he would never latch properly, would have trouble eating, would need braces and probably develop a speech impediment, and could develop craniofacial issues or sleep apnea.
