A recent report published by the American Academy of Pediatrics (AAP) has raised concerns about the over-diagnosis and unnecessary surgical treatment of tongue-tie in infants. Tongue-tie is a condition present at birth where the tissue connecting the tongue to the floor of the mouth is too short, affecting the movement of the tongue and potentially causing breastfeeding problems. The report suggests that less than half of infants with tongue-tie characteristics actually have difficulty breastfeeding and highlights the lack of research into the effectiveness of surgery for improving breastfeeding outcomes. Dr. Maya Bunik, the lead author of the report, emphasizes that while tongue-tie can cause pain and reduce breastfeeding efficiency, it often resolves with time and may not necessarily require surgical intervention.
The prevalence of tongue-tie in infants is estimated to be between 4.2% and 10.7% by the Canadian Paediatric Society (CPS). Despite its common occurrence, the medical community remains divided on the association between tongue-tie and lactation problems, speech disorders, and other oral motor issues. The AAP report attributes the increasing diagnoses of tongue-tie to the lack of uniform diagnostic criteria and treatment guidelines. Although cutting the tissue connecting the tongue is a minor procedure, there are potential complications such as bleeding, infection, or injury. Two types of procedures known as frenotomy are commonly used to address tongue-tie, with the traditional method involving an incision and the newer laser ablation technique being offered at specialized clinics.
Pediatricians often consider an ineffective latch and poor weight gain as main indicators for diagnosing tongue-tie in infants, as these issues can impact breastfeeding success. Dr. Jack Newman, a pediatrician, advocates for immediate correction of tongue-tie to facilitate breastfeeding and prevent future speech difficulties. He believes that tongue-tie is a common cause of breastfeeding pain and poor latch, and that correcting the condition can provide immediate relief to mothers and potentially address issues such as late-onset decreased milk supply. However, Dr. Bunik cautions against considering tongue-tie surgery as a quick fix for breastfeeding challenges, as other factors such as nipple size, prematurity, or sleepiness in infants can also contribute to breastfeeding difficulties.
Concerns have been raised about the potential over-diagnosis of tongue-tie in infants and the reliance on surgical intervention as a solution to breastfeeding problems. Dr. Bunik encourages healthcare providers to collaborate in determining the best approach to addressing breastfeeding challenges in each individual case, rather than resorting to surgery as a first-line treatment. She stresses the importance of involving families in decision-making regarding tongue-tie surgery and ensuring that a thorough evaluation of all potential contributing factors to breastfeeding difficulties is conducted before proceeding with the procedure. Additionally, the lack of insurance coverage for infant dental procedures may result in families incurring out-of-pocket costs for tongue-tie surgery, further underscoring the need for careful consideration and informed decision-making in these cases.
