Tongue-Tie Surgery In Babies Isn’t Always The Answer

You're not alone if your child is having breastfeeding problems.

For a small number of babies born each year, their tongues cannot move around normally. This condition is called tongue tie, meaning some children have a lingual frenulum that is too short and tight at birth and may attach to the tip of the tongue instead of attaching farther back.

A social media trend suggests moms struggling to breastfeed put their baby through a tongue tie surgery, but most breastfeeding problems can be managed without resorting to the surgery, according to a new report from the American Academy of Pediatrics (AAP).

Key Takeaways: Tongue-Tie Surgery

• Tongue-tie surgery (frenectomy) is a trend on social media but is not always necessary; evaluation by a clinician helps determine whether it will benefit the child.

• Tongue-tie may impact feeding, speech development and oral function, but not all cases require surgical intervention.

• Decisions about surgery should be based on careful clinical assessment of symptoms and functional limitations rather than social media pressure.

• A multidisciplinary approach including pediatric specialists and therapists may help guide families through evaluation and treatment options.

How Can I Tell If My Baby Has Tongue Tie?

So how can you tell if your baby has a tongue tie? Franciscan Health Dyer's Lead Lactation Consultant Abbey Cusimano-Imhof explains.

"Tongue tie, also known as ankyloglossia, is present when the lingual frenulum hinders the proper movement of the tongue," Cusimano-Imhof said.

The frenulum is the thin band of tissue that connects a baby's tongue to the bottom of the mouth or the upper lip to the gum.

It's thought that a too-tight connection in either spot can interfere with or even prevent breastfeeding. Later, it can cause speech and eating problems in some children.

Cusimano-Imhof shares these signs of a possible tongue restriction in your baby:

• A heart shape at the tip of the tongue when extended.
• Inability to extend the tongue past the lips.
• The lingual frenulum under the tongue is thick and located further up on the tongue.
• The infant cannot bring the tongue to the roof of the mouth.

How Does Tongue Tie Affect Breastfeeding?

Tongue tie, which may impact as many as 10 percent of babies, may result in ineffective latch and poor weight gain in an infant.

"Breastfeeding is a way to encourage the tongue to move and stretch as an infant grows," Cusimano-Imhof said. "Tongue tie can affect how the baby latches to the breast and remove milk from the breast. Due to difficulty latching this can cause pain and trauma to the mother's nipples."

These feeding complications can quickly lead to choking, slow weight gain or frequent crying by the baby. As for the mother, she's likely to experience breast pain due to damage and engorgement, alongside milk supply changes.

How Is Tongue Tie Treated?

In some children, many or all symptoms of tongue tie go away with time. Between ages 6 months and 6 years, the lingual frenulum naturally moves backward. This may solve the problem if the tongue-tie was only mild.

The AAP recommends that doctors approach cases of tongue tie by first collaborating with lactation consultants, speech-language pathologists and other specialists. If that doesn't work, your child may need to have a surgical procedure to treat tongue-tie.

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

When Should Tongue-Tie Surgery Be Considered?

Tongue-tie surgery is a reasonably quick procedure, but when's the right time to have it done?

"It is important for mothers to reach out to their pediatricians to ensure infant weight gain is appropriate and to reach out to lactation to assist the patient with proper latching to avoid breakdown and pain." Cusimano-Imhof said.

A recent study on newborns with breastfeeding trouble showed that around 63% of newborns initially referred for tongue-tie surgery ultimately did not have the surgery. This is because the mothers and their newborns were directed to breastfeeding and speech-language evaluation specialists who were able to assist the problem without surgery.

The results from the study emphasize that more comprehensive clinical evaluation can help families avoid unnecessary tongue-tie surgeries. Of course, if a medical evaluation suggests a tongue-tie surgery is needed, it should effectively solve your breastfeeding concerns. Talk with your child's provider about the risks and benefits of a procedure.

Tongue-tie surgeries include:

• Frenotomy: A frenotomy is a simple surgery and an effective treatment for many children. Professionals usually perform this procedure for babies in the office. Older children may need anesthesia. The provider makes a cut in the frenulum. This lets the tongue move normally.
• Frenectomy: A frenectomy can be more complex than a frenotomy since the procedure completely removes the lingual frenulum.
• Frenuloplasty: A frenuloplasty uses other methods to correct the tongue-tie restrictions. This procedure is usually suggested after a frenotomy fails to solve tongue movement or if the procedure is avoided due to the thickness of the lingual frenulum.

Your child may be required to see a speech therapist after a frenotomy for assistance with retraining tongue muscles.

What Is The Tongue-Tie Surgery Trend?

It's no surprise that tongue-tie surgery has become a sought-out trend across social media. Breastfeeding can be complicated, and mothers want their babies to be as happy and healthy as possible.

"We believe that social media has aided in the increase of these procedures," Cusimano-Imhof said. "Parents continue to take their infants to get these procedures even before discussing it with their pediatricians."

The United States has seen a ten-times increase in tongue-tie surgeries from 1997 to 2012. Today's rates are expected to be much higher.

Studies have shown that less than 50% of infants with tongue-tie complications actually need surgery.

"In northern Indiana, we have seen an increase in these procedures for the infant population, which raises concerns for local pediatricians," Cusimano-Imhof said.

She emphasizes that their patients receive the best care when all care teams work together to guide parents in making the best decision for their infants.

"Procedures such as a frenotomy should only be performed when all other resources are exhausted, and it is the best choice for the infant's health and safety," Cusimano-Imhof said.

Does Tongue-tie Surgery Have Side Effects?

There are very few and rare cases where a tongue-tie surgery caused any additional problems, but potential side effects of tongue-tie surgery include the following:

• Bleeding
• Infection
• Scarring
• Saliva gland dysfunction
• Tongue damage
• Frenulum reattachment