There is increasing media interest about surgical procedures on new babies for tongue tie. Some hail it as a miracle cure, others view it as barbaric treatment, though adverse outcomes are rare.

Tongue tie occurs when the tissue under the tongue is attached to the lower gum or floor of the mouth in a way that can restrict the movement or range of the tongue. This can impact early breastfeeding in babies. It affects an estimated 8% of children under one year of age.

While there has been an increase in tongue tie releases (also called division or frenotomy), it’s important to keep this in perspective relative to the increase in breastfeeding rates.

The World Health Organization recommends exclusive breastfeeding for the first six months of life, with breastfeeding recommended into the second year of life and beyond for the health of mother and baby as well as optimal growth. Global rates of breastfeeding infants for the first six months have increased from 38% to 48% over the past decade. So, it is not surprising there is also an increase in the number of babies being referred globally with breastfeeding challenges and potential tongue tie.

An Australian study published in 2023 showed that despite a 25% increase in referrals for tongue tie division between 2014 and 2018, there was no increase in the number of tongue tie divisions performed. Tongue tie surgery rates increased in Australia in the decade from 2006 to 2016 (from 1.22 per 1,000 population to 6.35) for 0 to 4 year olds. There is no data on surgery rates in Australia over the last eight years.

Tongue tie division isn’t always appropriate but it can make a big difference to the babies who need it. More referrals doesn’t necessarily mean more procedures are performed.

How tongue tie can affect babies

When tongue tie (ankyloglossia) restricts the movement of the tongue, it can make it more difficult for a baby to latch onto the mother’s breast and painlessly breastfeed.

Earlier this month, the International Consortium of oral Ankylofrenula Professionals released a tongue tie position statement and practice guideline. Written by a range of health professionals, the guidelines define tongue tie as a functional diagnosis that can impact breastfeeding, eating, drinking and speech. The guidelines provide health professionals and families with information on the assessment and management of tongue tie.

Tongue tie release has been shown to improve latch during breastfeeding, reduce nipple pain and improve breast and bottle feeding. Early assessment and treatment are important to help mothers breastfeed for longer and address any potential functional problems.

Where to get advice

If feeding isn’t going well, it may cause pain for the mother or there may be signs the baby isn’t attaching properly to the breast or not getting enough milk. Parents can seek skilled help and assessment from a certified lactation consultant or International Board-Certified Lactation Consultant who can be found via online registry.

Alternatively, a health professional with training and skills in tongue tie assessment and division can assist families. This may include a doctor, midwife, speech pathologist or dentist with extended skills, training and experience in treating babies with tongue tie.

When access to advice or treatment is delayed, it can lead to unnecessary supplementation with bottle feeds, early weaning from breastfeeding and increased parental anxiety.

Getting a tongue tie assessment

During assessment, a qualified health professional will collect a thorough case history, including pregnancy and birth details, do a structural and functional assessment, and conduct a comprehensive breastfeeding or feeding assessment.

They will view and thoroughly examine the mouth, including the tongue’s movement and lift. The appearance of where the tissue attaches to the underside of the tongue, the ability of the tongue to move and how the baby can suck also needs to be properly assessed.

Treatment decisions should focus on the concerns of the mother and baby and the impact of current feeding issues. Tongue tie division as a baby is not recommended for the sole purpose of avoiding speech problems in later life if there are no feeding concerns for the baby.

Treatment options

The Australian Dental Association’s 2020 guidelines provide a management pathway for babies diagnosed with tongue tie.

Once feeding issues are identified and if a tongue tie is diagnosed, non-surgical management to optimise positioning, latch and education for parents should be the first-line approach.

If feeding issues persist during follow-up assessment after non-surgical management, a tongue tie division may be considered. Tongue tie release may be one option to address functional challenges associated with breastfeeding problems in babies.

There are risks associated with any procedure, including tongue tie release, such as bleeding. These risks should be discussed with the treating practitioner before conducting any laser, scissor or scalpel tongue tie procedure.

Post-release support by a certified lactation consultant or feeding specialist is necessary after a tongue tie division. A post-release treatment plan should be developed by a team of health professionals including advice and support for breastfeeding to address both the mother and baby’s individual needs.

We would like to acknowledge the contribution of Raymond J. Tseng, DDS, PhD, (Paediatric Dentist) to the writing of this article.

Sharon Smart, Lecturer and Researcher (Speech Pathology) – School of Allied Health, Curtin University; David Todd, Associate Professor, Neonatology, ANU Medical School, Australian National University, and Monica J. Hogan, PhD student, ANU School of Medicine and Psychology, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The death of a chess player in the middle of a match at the world’s most prestigious competition may have shocked those who view the game as a relaxing pastime. Kurt Meier, 67, collapsed during his final match in the tournament and died in hospital later that day. But chess, like any other game or sport, can lead to an immense amount of stress, which can be bad for a competitor’s physical health too.

We tend to associate playing sport or games with good health and well-being. And there are a countless number of studies showing playing games has an association with feeling happier. While this argument is true for recreational players, the story can be different for the elite, where success and failure are won and lost by the finest margins and where winning can mean funding and a future, and losing can mean poverty and unemployment. If this is the case, can being successful at a sport or game actually be bad for you?

Competitive anxiety

Elite competition can be stressful because the outcome is so important to the competitors. We can measure stress using a whole range of physiological indicators such as heart rate and temperature, and responses such as changes in the intensity of our emotions.

Emotions provide a warning of threat. So if you feel that achieving your goal is going to be difficult, then expect to feel intense emotions. The leading candidate that signals we are experiencing stress is anxiety, characterised by thoughts of worry, fears of dread about performance, along with accompanying physiological responses such as increased heart rate and sweaty palms. If these symptoms are experienced regularly or chronically, then this is clearly detrimental to health.

This stress response is probably not restricted to elite athletes. Intense emotions are linked to trying to achieve important goals and while it isn’t the only situation where it occurs, it is just very noticeable in sport.

The causes of stress

It makes more sense to focus on what the causes of stress are rather than where we experience it. The principle is that the more important the goal is to achieve, then the greater the propensity for the situation to intensify emotions.

Emotions intensify also by the degree of uncertainty and competing, at whatever level of a sport, is uncertain when the opposition is trying its hardest to win the contest and also has a motivation to succeed. The key point is that almost all athletes at any level can suffer bouts of stress, partly due to high levels of motivation.

A stress response is also linked to how performance is judged and reported. Potentially stressful tasks tend to be ones where performance is public and feedback is immediate. In chess – as with most sporting contests – we see who the winner is and can start celebrating success or commiserating failure as soon as the game is over.

There are many tasks which have similar features. Giving a speech in public, taking an academic examination, or taking your driving test are all examples of tasks that can illicit stress. Stress is not restricted to formal tasks but can also include social tasks. Asking a potential partner for a date, hand in marriage, and meeting the in-laws for the first time can be equally stressful.

Winning a contest or going on a date relate to higher-order goals about how we see ourselves. If we define ourselves as “being a good player” or “being attractive or likeable” then contrasting information is likely to associate with unpleasant emotions. You will feel devastated if you are turned down when asking someone out on a date, for instance, and if this was repeated, it could lead to reduced self-esteem and depression.

The key message here is to recognise what your goals are and think about how important they are. If you want to achieve them with a passion and if the act of achieving them leads to intense and sometimes unwanted emotions, then it’s worth thinking about doing some work to manage these emotions.

Andrew Lane, Professor in Sport and Learning, University of Wolverhampton

This article is republished from The Conversation under a Creative Commons license. Read the original article.