Is Tongue Tie in Breastfeeding Moms Being Overdiagnosed?

Tongue-tie sounds like something that happens when you can’t find the right words to say, but for new Boone mothers having trouble breastfeeding, tongue-tie refers to a condition in which the band of tissue connecting the tongue to the floor of the mouth is too short or tight. Nationwide diagnoses have increased dramatically in the past few years, but research indicates doctors may be acting too quickly in determining the reasons for breastfeeding struggles.

A Surge in Frenotomies

heart shaped knot in rope

Data indicates that 11 percent of newborns in North Carolina and nationwide are diagnosed with tongue-tie (known medically as anklyoglossia). Not surprisingly, this has led to a corresponding surge in the number of frenotomies – surgical tongue-tie revisions – that are performed. Nationwide, that number increased from a little over 1,200 in 1997 to more than 12,400 in 2012. It’s unlikely that the number of babies being born with tongue-tie has increased by 1,000 percent, so the obvious conclusion is that the condition is being over-diagnosed.

Mothers of babies with tongue-tie experience pain when trying to nurse their newborns. The short or tight tissue limits the infant’s range of motion, making it difficult to latch onto the nipple and swallow. If left untreated, tongue-tie can lead to problems with speech and other oral activities.

A frenotomy resolves the issue by cutting the tissue of the frenulum to improve movement. The inpatient procedure is quick, requires no anesthesia, and normally results in no more than a drop or two of blood. But experts believe it is often unnecessary, especially in milder cases of tongue-tie.

Is the Procedure Really Necessary?

A new study, led by Dr. Christopher Hartnick of Massachusetts Eye and Ear and published in JAMA Otolaryngology-Head & Neck Surgery, found that 63 percent of babies referred to a specialist for surgery to correct a tongue-tie ended up not needing the procedure after a comprehensive evaluation with a speech-language pathologist. These same babies eventually were able to breastfeed successfully without undergoing a surgical procedure.

Dr. Hartnick is quick to admit that the small sample size of his study – only 115 babies were examined – means additional research into the issue is needed. But he feels it’s an important topic to look into, given the uptick in the number of referrals he and his colleagues see on a weekly basis. While the frenotomy is simple and straightforward, there is always some risk with any surgery – not to mention costs associated with the procedure, fees that might strain some Portland parents’ budgets.

Tongue-tie has been a hot, and increasingly controversial, topic in the medical community for several years now. Skepticism over the validity of the diagnoses is countered by data showing a significant increase in the number of women breastfeeding nowadays. Jumping to conclusions either way is risky; a 2017 Cochrane review  concluded that there simply haven’t been enough studies to make a strong case for or against frenotomy or to establish guidelines for the procedure.

Still, given its ability to provide nursing moms with immediate relief from breastfeeding pain, it’s little wonder the procedure has become so popular.

Your Boone ear, nose and throat specialist recommends seeing a lactation consultant if you are experiencing pain while breastfeeding. It’s a good idea to get a second opinion before opting for a surgery that might not even be necessary.


Posted in ENT