Infant tongue ties – should I have my baby’s tongue cut?

Tongue-tie, or ankyloglossia, is a condition whereby the lingual frenulum (stringy bit under your tongue) attaches near the tip of the tongue and may be short, tight and thick. It is potentially a concern if it limits the range of movement of the tongue, interfering with feeding or speech. Tongue-tie is present in ~4% to 11% of newborns and has been cited as a cause of poor breastfeeding and maternal nipple pain. Frenotomy (cutting/removal of the tongue tie) has been promoted to correct restriction of tongue movement and allow more effective breastfeeding with less maternal nipple pain. Recently there have been dramatic increases worldwide in performing this procedure. Canada has reported an 89% increase, the USA a 300% increase between 2006 – 2012 and in Australia a 420% increase has been reported. Frenotomy may seem like a logical solution but is it supported by evidence?

A Cochrane review based on older research found frenotomy reduced breastfeeding mothers' nipple pain in the short term but did not find a consistent positive effect on infant breastfeeding. However the evidence was based upon only a small number of studies with a small number of infants. More recent research in Australia has found an alarming increase in the number of frenotomies or tongue-tie releases being performed and in New Zealand it was found to be performed in 13% of newborn infants. With only 25-50% of babies with ankyloglossia having feeding problems, the target or suggested rate for tongue-tie release surgery is between 0.2-5%. This suggests many of these procedures are being performed without indication and potentially placing the child needlessly at risk of complications.

A recent study in Western Australia found instead of improving breastfeeding rates, the frenotomy was actually more likely to lead to early weaning! Their research revealed that the real problem in many cases was low milk production and not the baby’s tongue tie. Breastfeeding rates were NOT improving following surgery and some babies required hospitalisation for serious bleeding or infection. It therefore appears many may needlessly be receiving this procedure and being placed at harm. Frenotomy may seem like a ‘simple’ solution and for some it is appropriate but if you are unsure, then seek a second opinion from your Paediatrician.

Dr Peter Miles is the orthodontist at Newwave Orthodontics in Caloundra, Australia and has taught orthodontics part-time at the University of Queensland and Seton Hill University in the USA for over 10 years. Peter is one of the editors and authors of the orthodontic textbook, 'Evidence-Based Clinical Orthodontics'. Importantly, he has no financial interest in any products or techniques mentioned in these Blogs.