It’s an all-too-common situation facing new mothers across the country: A lactation consultant examines their newborn and suggests that cutting a “tongue tie” might ease their difficulty breastfeeding.
The quick procedure, known as a tongue release, involves a dentist or doctor removing a tight band of tissue that connects the tongue to the bottom of the mouth. In recent years, lactation consultants and dentists have aggressively promoted the procedures, even for babies with no signs of a true tongue and despite the modest risk of complications, a New York investigation recently found Times.
Many parents, anxious and tired, agonize over whether to go ahead with the procedure, which is often done with a dental laser. Dentists, lactation consultants and pediatricians often disagree on whether it helps.
The Times spent months investigating the evidence behind the tongue-tie leaks and talking to dozens of experts. Here’s what parents considering the procedure should know.
Breastfeeding a newborn can be difficult, even if it’s fine.
The first few days of nursing can be rough. A recent survey of more than 1,400 women found that nearly 40 percent struggled with at least one complication, such as pelvic pain, cracked nipples or sore breasts.
Those early hurdles can be discouraging, especially for new moms who survive on little sleep. The good news: Many mothers report that breastfeeding often gets easier over time, as they and their babies become more experienced.
Lactation consultants can provide support in the early days of nursing by suggesting ways to position the baby that will reduce a mother’s pain. Consultants have become more accessible since Obamacare mandated that health insurers cover their services. Hospitals and nonprofits like La Leche League offer support groups also for nursing mothers.
A small proportion of babies are born with a tongue tie, which can make breastfeeding difficult.
Pediatricians say that true tongue-tie is easy to recognize. When the baby tries to lift the tongue, it forms a heart shape as the center is pulled down. Other babies with tongue-tie cannot extend their tongues past their lower teeth.
Different studies have estimated that 4 to 11 percent of babies have tongue-tie. If you suspect a tie and are having trouble nursing, a pediatrician or ear, nose and throat specialist can weigh you after a physical examination of your baby. (Certified lactation consultants are should not diagnose tongue-ties who don’t have medical degrees, but can refer babies to specialists.)
Doctors stressed to The Times that multiple tongues are not harmful. The procedure is only warranted, they say, when tongue-tie is pronounced and the mother has difficulty breastfeeding.
Small studies have shown that sticking out the tongue can reduce nipple pain.
Some providers tout tongue-tie releases as a cure for everything from sleep apnea and speech delays to cavities and constipation.
Little evidence supports those claims.
In 2017, after reviewing the medical literature for the best studies on tongue-tie discharges, researchers found five high-quality studies that included a total of 302 infants.
Studies have shown that sticking out the tongue can reduce nipple pain. But the data showed no effect on a baby’s ability to eat.
A 2015 study of researchers at Vanderbilt University came to a similar conclusion: Tongue-tie releases led to “mother-reported improvements in breastfeeding, and possibly in nipple soreness.”
No thorough studies have shown that the methods affect a baby’s sleep or future issues such as speech.
A big challenge for those learning the techniques is that breastfeeding often gets easier over time. While many moms report a better nursing experience after the procedure, it can be hard to tell if that’s the result of getting rid of the tongue-tie.
Bring a skeptical eye to the cheek and lip-ties.
In the past decade, some dentists and lactation consultants have begun to recommend cutting “oral ties” in other parts of the mouth. Those include lip-tie — when tissue ties the lip to the gum — and buccal-tie, named for the webbing that connects the cheeks to the upper gums.
Some also recommend a detailed care regimen, telling parents to periodically sweep their fingers under their baby’s tongue and around their mouth to prevent tissue reattachment.
Children’s ear, nose and throat specialists say they rarely, if ever, clip lips or cheek-ties on babies because there is no strong evidence that ties prevent breastfeeding.
These doctors strongly recommend seeking a second opinion if a medical provider recommends this type of care. The American Academy of Otolaryngology issued a consensus statement in 2020 stating that “surgery to release a ‘buccal tie’ should not be performed” and that “there is no evidence” to support stretching or massaging the wound after discharge.
Complications are rare, but they can happen.
Most dentists and doctors interviewed by The Times agreed that tongue-tie removal, which only takes a minute or two, carries a low risk of injury.
But complications do occur, and they can be serious. It is difficult to estimate an accurate rate of problems because no one systematically tracks them. Some pediatric ear, nose and throat specialists who work in children’s hospitals say they see two or three complications of tongue tie each year.
Doctors say the most common problem is oral aversion, where the disease causes babies to be sensitive to anything that goes into their mouths. In serious cases, babies will refuse to eat and will require hospitalization.
While some dentists and doctors often highlight the benefits of tongue-tie release, Dr. Soham Roy, chairman of the pediatric ear, nose and throat practice at Children’s Hospital Colorado, says he encourages parents to ask about the risks as well.
“No surgical procedure is without risk, and parents deserve that information before they sign up,” she said.
