If you’ve attended a mommy group, or perhaps a breastfeeding support group, or even popped into a parenting facebook group, then you are probably well acquainted with the medical term “tongue-tie” already. Because, at least in my experience, whenever nursing concerns come into play, tongue-tie almost always comes up as something to be looked into.
Tongue-tie, also referred to as ankyloglossia, is where the strip of skin connecting the baby’s tongue to the bottom of their mouth is shorter than usual. A good portion of babies diagnosed with tongue-tie have no symptoms, while others have restricted access to their tongue’s movement, making it difficult (and sometimes painful) to breastfeed.
The diagnosis of tongue-tie often comes hand-in-hand with lip-tie. Similar to tongue-tie, this is where the strip of skin connecting the baby’s lip(s) to their gums is shorter than usual.
Babies presenting with tongue- or lip-tie may have difficulty forming a good latch with negative pressure (much like a vacuum), which is needed in order to receive a sufficient amount of milk from their mother. Among many other breastfeeding-related symptoms, babies with tongue or lip-ties often make a “clicking” noise while nursing.
When my son was around a month or two old, he was one among 4-11% of newborns diagnosed with tongue-tie. My lactation consultant was the first one to notice, as he always made that incredibly distinctive “clicking” noise while nursing during appointments. Because I had already addressed breastfeeding concerns with my son’s pediatrician and the lactation consultant was now taking notes about them as well, my son’s doctor suggested clipping his minor tongue-tie in office in an effort to make our nursing experience smoother (and less painful) for both of us.
The procedure was done within the walls of the pediatrician’s office, and it was incredibly simple. My son cried for a moment or two due to being restrained for the clipping (and not the pain itself). Then he received much-needed baby snuggles, and was fine (pain-wise) from there on out.
But here’s the thing… breastfeeding still didn’t work for us. I’m not saying we made the wrong decision by clipping my son’s tie, because there were no consequences to his health, but I didn’t see a drastic change in any of his nursing habits thereafter. Granted, we hadn’t been nursing much before the in-office procedure was done due to his latch issues, but, for us, the tongue clip didn’t have the impact we had hoped. Like everything, each baby and breastfeeding relationship is different. Tongue clipping definitely has a marked, positive impact for many babies and moms.
For us, we decided to switch to formula once my stored breastmilk had run out, and he never had issues taking a bottle or feeding after that. That is not everyone’s story. It’s just ours.
The question keeps coming up: why the (seemingly) sudden push for clipping tongue-ties?
For one, severe cases of tongue-tie have been linked with failure to gain weight. And aside from multiple breastfeeding issues and concerns, tongue and/or lip-tie can be associated with eating concerns later in life as well as speaking issues too. And, as mentioned previously, it can be painful for mom while nursing as it makes getting a proper latch more difficult.
But over the years, tongue-tie revision procedures (otherwise known as a frenotomy or frenulotomy) are becoming increasingly popular. In-office procedures are done for minor ties, much-like my son’s, but every procedure differs per patient. Children undergoing a frenotomy need to be restrained — usually swaddled — during the procedure, but there is no need for general anesthesia (only topical numbing) while clipping. The risk for potential complications such as bleeding, infection, damage to the salivary glands or tongue, reattachment, or airway compression, are incredibly low.
For more extreme cases of tongue-tie, such as when the frenulum (skin between the tongue and floor of the mouth) is too thick for a quick fix, a doctor may choose a frenulotomy as the method of treatment. While this procedure comes with added risks, due to drugs being used for sleep and the need of dissolvable stitches for a deeper cut or laser incision, it’s still considered very safe with little risk of potential complications.
Perhaps the low-risks associated with these procedures, the potential to extend breastfeeding, and the possibility of reducing future speech and eating concerns, is partially why we are continuing to see the number of tongue-tie revision surgeries go up today.
According to a study headed by Johns Hopkins pediatric otalaryngolist-head and neck surgeon Jonathon Walsh, there were a mere 3,934 cases diagnosed in 1997. But by 2012, there were 33,000 diagnosed. And tongue-tie revision surgeries increased from 1,279 procedures in 1997 to more than 12,000 in 2012.
It’s because of this increase in numbers that doctors are beginning to wonder whether tongue-tie is being over-diagnosed, and consequently unnecessary revision surgeries are being used, or if we really are better at recognizing babies with tongue-ties that need treatment in order to prevent short and long-term issues.
There’s no conclusive data backing whether or not these revisions will help with breastfeeding, eating, or speaking. It seems the success of the procedure varies greatly from child to child.
“We’re seeing [tongue tie diagnoses and revisions] more now because of the stress woman are putting on themselves to breastfeed,” says Adva Buzi, an attending physician in the division of otolaryngology at Children’s Hospital of Philadelphia.
Women are faced with the pressure to breastfeed from the moment they give birth. And many women are committed to trying everything (and more) in our power to make it work. Or, at least, to exhaust all of our options before we make that final decision. Tongue- and lip-ties are now part of that larger conversation. As breastfeeding support and resources increase, awareness of these potential issues increase, and we are provided more options for potential solutions.
“Today, people are trying to find reasons why [breastfeeding] isn’t working, whereas in the past, if it didn’t work, people just went to formula and it was fine,” Buzi explains.
If you’re having difficulty or pain while breastfeeding, it’s not uncommon to hear that tongue-tie could be an underlying cause to the issue. If you wish to explore the option with your child’s healthcare provider(s), you absolutely should. I have no regrets about my son’s revision.
It’s also important to remember that only a small number of patients require a correction, as not all babies with tongue and/or lip ties will have issues nursing. And, having a revision done does not automatically resolve breastfeeding issues. As with everything regarding parenting, the choice to breastfeed or not, to opt into procedures or not, etc., it’s your choice and yours alone. Luckily, there seems to be a move toward more research, more information and more resources in this area, to help us feel secure in our choice.