Is Tongue-tie Surgery Necessary in Babies? Experts Divided – National

A growing chorus of medical experts is questioning the widespread use of surgery to treat tongue-tie, a condition in infants that can affect breastfeeding. The American Academy of Pediatrics (AAP) has raised concerns about potential overdiagnosis and unnecessary procedures.

Last month, the AAP warned about the increasing practice of using scissors or lasers to target tongue tissue in babies who have difficulty breastfeeding.

The report, published on July 29 in Pediatricsencourages pediatricians and other medical professionals to consider nonsurgical options to address breastfeeding issues. The report cites a study that suggested that less than half of infants with tongue-tie features have difficulty breastfeeding.

The study also found that there has been insufficient research into the effectiveness of tongue-tie surgery to improve breastfeeding outcomes.

“We all have a little bit of tissue under our tongue and in some people it’s a little tighter. For babies, that’s important because if it’s really tight, it’s hard to get the tongue past the gums. Babies have to move their tongue past their gums to get the milk out of the breast,” explained the report’s lead author, Dr. Maya Bunik, who is also a professor of pediatrics at the University of Colorado Denver School of Medicine.

“It also causes some pain for breastfeeding mothers and it also makes the baby less efficient. But overall, it usually doesn’t cause too many problems and it will also stretch over time. And unfortunately, it has become the be-all and end-all solution when there are breastfeeding problems.”

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Tongue-tie, or ankyloglossia, is a condition present at birth in which the tissue connecting a newborn’s tongue to the floor of the mouth is too short, restricting tongue movement. according to HealthLink BC.

The cause of a tongue-tie is not generally known, but the provincial health department says it can run in families or occur in babies who have other problems affecting the mouth or face, such as a cleft palate.

Although the exact prevalence of tongue-ties is unknown, the Canadian Pediatric Society (CPS) estimates that between 4.2 and 10.7 percent of babies are born with this condition.

While it is a common birth defect, the medical community remains divided over its links to lactation problems, speech disorders and other oral motor problems, CPS said, adding that the procedure is a “continuing source of controversy.”

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Diagnoses have also increased in Canada and worldwidethe AAP report said, attributing the trend to the lack of uniform diagnostic criteria for the condition and the lack of consensus on its treatment.

The condition known as tongue-tie can make it difficult for a baby to extend and lift his or her tongue to grasp a nipple and suck milk, which can be painful for the mother, the AAP reports.

Although cutting the tissue is a minor procedure, the AAP report noted that it can cause complications, such as bleeding, infection or injury. However, these incidents of minor complications appear to be rare.

There are two types of procedures known as frenotomy. The most common procedure involves making a simple incision or cutting the frenulum, the tissue that connects the tongue to the floor of the mouth, according to CPS.

Specialized private clinics now offer laser ablation frenotomy, which uses a laser to release the lingual frenulum. However, CPS noted that there is limited data on the safety and effectiveness of the laser technique compared to the conventional method.

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According to the AAP, ineffective latching and poor weight gain are the most important considerations a pediatrician will make when considering a diagnosis of tongue-tie.

With a renewed emphasis on the benefits of breastfeeding, CPS said, “There is increased pressure to diagnose ankyloglossia as a barrier to successful breastfeeding, increasing the demand for frenotomy.”

Dr. Jack Newman, a Toronto pediatrician, believes that tongue-tie in infants should be corrected immediately to facilitate breastfeeding and prevent future speech problems.

“Breastfeeding should not cause significant pain,” he told Global News. “And the most common cause of significant pain is a baby not latching on properly. One of the leading causes of a baby not latching on properly is a baby with a tongue-tie.”

“It’s such an easy procedure. It takes a second,” he said. “And I would say it’s rare that a mother doesn’t get relief.”

He said he has seen mothers who were still having problems breastfeeding four months after their baby was born, and after the tongue-tie procedure the mothers noticed an immediate improvement.

Another possible problem with a tongue-tie is what Newman calls “late-onset decreased milk production.”

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“So the baby is exclusively breastfed for two or three months, but then the mother starts to notice that the baby is more restless and not drinking as long as the baby is upset. And that late decrease in milk production, the cause is a tongue-tie. So it’s not just pain, it can affect production.”

Bunik acknowledges that tongue-tie surgery may be necessary for some babies, but she still views it as a “quick fix” for an underlying problem that may have nothing to do with the tongue-tie at all.

Breastfeeding can be challenging for new families and painful for the first few days. However, she noted that this doesn’t always mean it’s a tongue-tie; other issues can be at play.

This leads to overdiagnosis, she said.

“It’s become a popular kind of thing to throw,” Bunik said. “It could be that the mother has unusually large nipples or the baby is premature or very sleepy … but we blame the tongue-tie. And then time is lost and you can’t bring the milk back. You often postpone what’s really going on.”

In the report, Bunik and the other authors encourage dentists, lactation consultants, general practitioners and pediatricians to work together to find the best method for treating breastfeeding problems in each case.

“I think the family really needs to make decisions about these types of surgeries, whether it’s laser or scissors, with their doctor before they go in. There’s just so much information on the internet and unfortunately most people don’t have dental insurance for their babies, so they’re paying out of pocket,” she said.

— with files from the Associated Press