One of the first indications that your baby has a tongue tie is you struggle to get a good latch and your nipples end up sore, cracked and maybe bleeding when you have breastfed your baby. A tongue tie is thought to restrict the tongue movement as a baby needs to be able to extend their tongue and pull the breast into their mouth to drain the milk from the breast effectively. Bottle fed babies are less likely to have problems with a tongue tie as formula feeding requires much less effort.
Maybe you have asked your health visitor, midwife or lactation consultant for their opinion? They may have recommended a frenectomy, also known as a frenotomy or frenulectomy.
There is an option of having a tongue tie cut on the NHS if you live in the UK but the waiting list can be long. Or you may opt to go private.
The procedure can be carried out surgically with or without local anaesthesia or it may be cut using laser treatment. It is normally done with a pair of sterile surgical scissors without anaesthetic. Current NICE guidelines (National Institute of Clinical Excellence) recommend that anaesthetic is generally only required after the first few months of infancy.
https://www.nice.org.uk/guidance/pg149
There is a huge amount of inconsistency as to whether a tongue tie should be cut or not. And with false and misleading information on social media and Dr Google it leaves this unregulated industry rife with over diagnosis. There are scare stories about children having behavioural problems in later life if these tongue ties are not cut, even in the absence of feeding issues.
A repost from the AAP, the American Academy of Paediatrics warned that tongue-tie may be over diagnosed and often treated with unnecessary surgery. Tongue tie procedures have increased by as much as ten times in the past fifteen years from 1,200 in 1997 to 12,400 in 2012. UK related stats are not currently being collated so we have no idea about the true incidence.
During 2006–2016, 52 473 Medicare frenotomy items for 0- to 4-year-old children in Australia were recorded; the rate increased from 1.22 per 1000 population in 2006 to 6.35 per 1000 in 2016. The highest rate was for the Australian Capital Territory in 2016 at 16.5 per thousand babies and children.
There is no universally accepted definition of tongue-tie or ankyloglossia, but it may be described as a congenital abnormality of the lingual frenulum that limits the range of movement of the tongue, interfering with feeding or speech. There is little consensus among health professionals about how tongue-ties should be managed, and little reliable evidence for the benefits of frenotomy.
In 2022-2023 there were 18, 729 frenectomies performed in NHS outpatient departments. These are up from just 2,550 in 2016 and just 31 in 2004. It is thought that the rise in breast feeding rates are partially behind this rise in incidence. However true cases of severe tongue-ties are actually quite rare. Having a frenectomy is seen as a cure-all for unsettled behaviour, reflux or sleep apnoea.
And according to many clients many procedures are being carried out on kitchen tables with no follow up care. In the olden days this procedure was often performed with a sharp fingernail courtesy of a midwife.
The Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) is a globally accepted method of assessing the frenulum and tongue tie to determine if a tongue-tie is present or not. Many paediatricians, lactation consultants and speech and language therapists use this assessment tool. However there is little consensus as to whether a tongue-tie is actually causing a feeding or latch problem. And there is little evidence if cutting them improves breast feeding and latch longterm.
One indicator of a poor latch is an audible click is heard when breastfeeding.
Dr Alison Hazelbaker, a renowned lactation consultant and craniosacral therapist, who developed the assessment tool, from Ohio believes we may be in the midst of an epidemic of misdiagnosis. In her expert opinion only 1-1.5 per cent is a true tongue-tie incidence. She says that people are over-diagnosing tongue-ties because thewy don't understand what the real problems are. In my long experience I have seen overtired babies, developmental leaps and temperament misconstrued as a need to cut a tongue-tie. It is seen as a quick answer just like the plethora of anti wind/gas and colic preparations are used as an answer for fussy bevaviour in babies.
Also forceps deliveries and torticollis can cause feeding problems and these often go undiagnosed.
And whilst some babies do have tongue-ties that need intervention, it doesn't address all these other reasons for feeding issues and fussy behaviour in babies.
https://www.pubmed.ncbi.nlm.nih.gov/37181430/
Professor Horowitz discovered that most babies who had tongue-ties cut were first borns suggesting that there are maternal and social factors at play. Its always good to ask advise from a lactation consultant or paediatrician who doesn't offer fenulectomy as a main part of their business. This way you've got more chance of a truly objective opinion.
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