'Every day we have patients that ask us to look at their babies' tongues'

According to a new report from the American Academy of Pediatrics, tongue-tie release, also known as frenotomy, a procedure that involves cutting tissue under babies’ tongues, is happening far too often.  

The goal of the procedure is to allow the tongue to move more easily to facilitate better breastfeeding. There is some evidence that tongue-tie release can reduce nipple pain and may enable babies to breastfeed more effectively. However, the AAP report makes it clear that “most breastfeeding difficulty is not related to symptomatic ankyloglossia [tongue-tie].” 

This new report resonates with Molly Gros, a registered nurse and International Board-Certified Lactation Consultant at the MUSC Shawn Jenkins Children’s Hospital. “Every day, we have patients that ask us to look at their baby's tongues. It's a very hot topic in the lactation world. It is overdiagnosed, and I do feel like a lot of babies are having procedures done that were not necessary.”

But she gets it. Women with painful, bleeding nipples from babies who are unable to latch well may become desperate for a quick solution. A visit to a pediatric dentist who advertises tongue-tie releases is inviting and accessible. 

The problem is that sometimes babies don’t need tongue-tie release. Instead, their mothers may need help from a lactation consultant to learn how to position babies better at the breast, Gros said. 

And not every baby with an improperly tethered tongue needs to have it fixed. Sometimes infants can feed just fine. It depends on both babies’ and mothers’ anatomies and how they work together. It is also possible that the breastfeeding issues may go away with good breastfeeding management without surgical intervention. 

“We don't want to put a baby through a procedure that we don't have to because even though it's a very minor procedure, and we do it at the bedside, any procedure that breaks the skin barrier puts a baby at risk for bleeding and infection. Anytime we can avoid a painful procedure, we would like to do so. So, we are not going to jump on that bandwagon and clip everything. We are going to be very conservative about it and treat accordingly,” Gros said.

 “We have a really big collaboration between our lactation team, our pediatric team and our pediatric ear, nose and throat group,” Gros said of the Shawn Jenkins Children’s Hospital. 

They work together to determine whether a tongue-tie release is needed. When the answer is yes, it can be done at the baby’s bedside. If a tongue-tie release is not indicated, they work to find other solutions to ensure a comfortable breastfeeding experience. Breastfeeding not only benefits babies. It also has great future benefits for mothers, including a reduced risk of reproductive cancers, heart disease and stroke.

In response to the American Association of Pediatrics report, Gros shared her thoughts. “I hope that having a tongue-tie release is accessible for those families who need it. And I hope that we stop making it a catchall for unsuccessful breastfeeding.”