Tongue-ties: To clip or not to clip?

You may have seen a recent article in the New York Times that suggested profit may be a main motivation in performing laser tongue-tie releases. That’s concerning to many of us medical professionals who specialize in pediatric care.

For centuries, tongue-tie releases have been used to correct an abnormal variation in an infant’s tongue, helping it to move more freely. This procedure is now more in demand than ever. Data shows tongue-tie procedures increased 800-fold between 1997-2012. At Children’s Wisconsin, tongue-ties are the No. 1 reason families seek out urgent appointments at our Ear, Nose and Throat Program.

But the spike in interest isn’t due to a sudden increase in kids born with tethered tongues. Instead, we believe the trend is fueled by heightened expectations around breastfeeding, and the peer pressure of social media and other parenting networks. 

Sadly, tongue-ties can be misdiagnosed, leading to an unnecessary and sometimes harmful procedure when there’s actually another reason for a baby’s feeding troubles. In severe cases, we have even seen infants require feeding tubes after complications from laser tongue-tie procedures.

Here’s what parents need to know before making the decision to cut the tie.

What is a tongue-tie?

The frenulum, a band of tissue that connects the underside of the tongue to the floor of the mouth, is a normal part of everyone’s anatomy. In infants with tongue-ties (also known as ankyloglossia), the frenulum is especially short or tight, which makes it more difficult for the tongue to have a full range of motion. Tongue-ties can be mild, moderate, severe or complete. Sometimes the condition doesn’t cause any issues, but more severe cases can lead to problems with feeding movements (sucking and swallowing), speech articulation and more.

It’s difficult to say how common this condition is, but the scientific literature suggests that it affects anywhere from .1 to 12.8 percent of kids. It occurs in boys more often than girls, and family history can make a tongue-tie more likely.

Even less common are lip-ties, which are a tighter-than-usual connection between the lip and gums, and buccal-ties, which connect the inside of the cheeks to the gums.

Are corrective procedures ever needed

A tongue-tie release, also known as a frenotomy, is sometimes warranted. Reduced tongue mobility can make it difficult for a baby to get enough to eat. Research shows that the greatest benefit of a tongue-tie release is relief of a mother’s pain during breastfeeding, and there is also evidence that the procedure can improve speech outcomes in children with moderate or severe tongue-ties. Contrary to some claims, there’s no scientific evidence that tongue-tie procedures improve sleep apnea.

With lip-ties, reduced upper lip mobility can also cause feeding problems, maternal breastfeeding pain and cavities because it’s more difficult for a child to properly brush their teeth. There’s no scientific evidence that buccal-ties cause any issues at all.

Should you use a laser procedure?

There is no evidence that a laser procedure is better than the standard lingual frenotomy, which involves first giving Sweet-ease, or sugar water, to decrease pain, and then simply snipping the tissue with surgical scissors. Laser procedures in a dentist’s office are also more expensive — usually around $500 — and are typically an out-of-pocket cost for families. Sometimes dentists or lactation consultants also recommend the additional expense of an oral myofunctional therapist, even though their recommended stretching exercises have not been scientifically proven to reduce scarring, improve eating or breathing.

With a standard tongue-tie release done at an Ear, Nose and Throat (ENT) clinic, the office visit and procedure are often covered by insurance because the feeding problem has been medically diagnosed by a physician. Babies who undergo the standard procedure also typically have fewer complications.

What are the downsides of a tongue-tie release?

Stretching exercises could delay a baby’s healing by reopening the wound. Pain from a laser surgery and stretching afterward can cause babies to develop an aversion to eating, which can be serious during the critical early months for growth and development. Sometimes, an untethered tongue can also slip backward and block a child’s airway, particularly when a child has another condition such as Down syndrome. These can also be risks with a standard frenotomy, but the risks are lower when the procedure is done by a pediatric physician who has the full picture of your child’s health.

What do you do when your baby has a feeding concern?

It’s always a good idea to start with your pediatrician for a comprehensive evaluation. Tongue-ties aren’t the only cause of breastfeeding troubles. Other variations in anatomy (the baby’s or mother’s), lack of skin-to-skin contact, poor position and latch, and oral thrush are just some of the other factors that can hinder breastfeeding. Your pediatrician can refer you to a multidisciplinary team at Children’s Wisconsin that combines the expertise of lactation consultants, speech therapists and ENT specialists. We also see patients on an urgent basis.

Remember: Be kind to yourself

When your new baby has difficulty feeding, the anxiety, frustration and disappointment can feel overwhelming. It can be easy to be swayed by the strong opinions of others or the promise of a “quick fix.” But know that there are many nonsurgical ways to make your breastfeeding experience positive and successful, and the experts at Children’s Wisconsin are here to help.

Also, it’s okay if breastfeeding doesn’t work out for your family. What’s most important is that your baby is healthy and thriving.

Cecille Sulman, MD Medical Director Ear, Nose and Throat Program

Children's Wisconsin specialty care providers have advanced training and expertise in many areas of pediatric medical care, including allergies, dental, dermatology, emergency medicine, ENT, gastroenterology, neonatology, pulmonology, surgery and more.