I have decided to write what might be a controversial blog about Tongue Tie.
I have thought long and hard about this but decided that to be true to my ethos, I need to raise this issue. I really think it needs more discussion and research.
I really believe ‘Knowledge is Power” and it is so important that when we make decisions we make informed ones so that we know in our heart that we made the right decision for US in OUR unique circumstances.
So here goes…(*deep breath and last deep dig for courage).
I am really concerned about what seems to be an epidemic of tongue and lip tie at the moment.
I do know Tongue Tie is a very real issue for a small percentage of babies.
I have been a midwife for over 20 years and I have never heard of Tongue Tie in the numbers I am now hearing about them. They are discussed (and diagnosed) on facebook forums. I do realise Facebook is a relatively new forum and maybe this is why we are hearing about them more. But Midwives, Childbirth educators, GPs and ENT surgeons are telling me they are hearing about them in greater numbers than ever before.
I would love some recent clinical statistic on the prevalence in Australia, but I haven’t been able to find any. Please send me a link if you do have these.
So I am left wondering:
Are we really seeing more tongue ties or have we just found a quick fix to a multitude of breastfeeding problems?
Is there anything wrong with a quick fix?
If there truly is a rise in this congenital abnormality, shouldn’t we be trying to find out why?
I know tongue tie has been linked with MTHFR mutations and folic acid but the evidence is really scant and so we should we be looking further?
The research around the prevalence of tongue tie suggests it is not that common.
One recent study said the prevalence in newborn infants is between 0.3-12%, which seems like quite a wide discrepancy, and they also looked at how tongue tie was being diagnosed. They devised the Coryllos Tongue-Tie Classification System, which defines four types, including posterior tongue tie. They made sure everyone was using the same definitions and began visually examining the tongues of 200 healthy babies during their first 3 days. Interestingly, the researchers were blinded to any breastfeeding problems.
They found that 199 of the 200 babies were identified with 1 of the 4 types of tongue tie. However, only 7 babies had breastfeeding problems related to tongue restriction. And a tongue tie revision solved the breastfeeding problem in 5 of these 7 babies.
From this study, the researchers suggested that the term “Short frenulum,” should be abolished because the frenulum can’t be accurately measured. And they suggested we use the terms “asymptomatic tongue tie” for the babies (192 out of 199) who had an identified tongue tie and no breastfeeding problems and “symptomatic tongue tie” for the few babies (7 of 199) who had the tongue restrictions affected breastfeeding. I think this is a fantastic suggestion because I am hearing of babies being diagnosed with tongue tie at birth before the first breastfeed. I think this is just setting Mums up to fail. We know being relaxed, so your oxytocin can flow, is a big part of breastfeeding, but how can you relax if you have just been told your baby has a tongue tie?
Another thing to remember as a parent is that the frenulum (lingual frenum) may stretch as your baby grows. This is because your baby’s oral cavity is still developing in shape and size. So is their tongue, it will grow and narrow at the tip.
Other literature on tongue tie and potential difficulty with breastfeeding (Nicholson, 1991; Jain, 1995; Fitz-Desorgher, 2003; Ricke et al., 2003) finds that approximately 25% of newborns with tongue-tie will have some trouble latching on to a nipple for sucking, but the majority have no early feeding problems. And that babies with mild to moderate tongue tie, or ankyloglossia, are likely to breastfeed successfully and usually require no treatment (Cho et al 2010)
But Mums are reporting real improvement in breastfeeding once their baby has had the revision surgery?
It is true that mums whose babies have had the surgery overwhelmingly report an improvement in attachment and breastfeeding.
The Australian Breastfeeding association (ABA) has had a look at this and concluded that:
“ Improvement in breastfeeding appears to have two components: a placebo response of 47% and a real response of 31%.
Overall, mothers’ experiences of tongue-tie division appear to be positive, but just why is not clear-cut since, in the studies presented here, some mothers notice differences and improvements even when:
- objective observers cannot detect any differences in breastfeeding measures after tongue-tie division and
- their babies had not had their tongue-ties divided.”
So is the surgery just a quick fix for a multitude of breastfeeding difficulties and what’s wrong with that?
I actually think there is nothing wrong with a good placebo in most cases but I have a couple of worries here.
Firstly, I think we should have a much more holistic approach to breastfeeding problems and that this over-medicalising of breastfeeding allows care providers to gloss over other issues that may lead to attachment and breastfeeding problems.
We constantly interfere with babies’ natural instinct to breastfeed in many ways.
Perhaps if we let these instincts play out, particularly in the first hour or so after birth, we would see far fewer feeding problems
A 2014 study by Hannah Dahlen, found that babies born in private hospitals, in Australia, were more likely to be readmitted for , among other things, breastfeeding problems in their first 28 days of life. It would be interesting to see how many of these were diagnosed wth tongue tie, rather than looking at the impact of interventions, medication, and separation of mum and baby.
As I said at the beginning, I am really not saying tongue tie isn’t a real thing but please get a thorough feeding assessment by qualified practitioners to make sure that your babies feeding issues cannot be solved in ways other that surgery.
On a personal note.
My eldest son did have a true tongue tie but I had no feeding problems, dental issues or speech difficulties.
He finally had it lasered at 21years of age because he wanted his tongue pierced and they wouldn’t do it with his degree of tongue tie.
But hey, his body his decision at 21.