Debate over tongue tie procedures in babies continues. Here’s why it can be beneficial for some infants

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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.

chomplearn/Shutterstock

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.

baby with open mouth shows tongue tie under tongue
The frenulum is a band of tissue under the tongue that is attached to the gumline base of the mouth. Akkalak Aiempradit/Shutterstock

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.

baby breastfeeding and holding mother's finger
A properly qualified lactation consultant can help with positioning and attachment. HarryKiiM Stock/Shutterstock

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.

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    Head-to-head

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    • Wide-tooth combs should not be used for detangling as they can cause breakage; instead, use a proper detangling brush. Speaking of detangling…
    • Detangling brushes are essential for daily use. Whichever you use, start brushing from the bottom to prevent tangles from stacking and worsening. As for kinds of detangling brush:
      • The “Tangle Teaser” is a good beginner option, but it may not detangle well for thicker hair.
      • Wet Brush (this is a brand name, and is not about any inherent wetness) is the recommended detangling brush for most people. It can be used on wet or dry hair.
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    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

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    Take care!

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  • Can You Get Addicted To MSG, Like With Sugar?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small 😎

    ❝Hello, I love your newsletter 🙂 Can I have a question? While browsing through your recepies, I realised many contained MSG. As someone based in Europe, I am not used to using MSG while cooking (of course I know that processed food bought in supermarket containes MSG). There is a stigma, that MSG is not particulary healthy, but rather it should be really bad and cause negative effects like headaches. Is this true? Also, can you get addicted to MSG, just like you get addicted to sugar? Thank you :)❞

    Thank you for the kind words, and the interesting questions!

    Short answer: no and no 🙂

    Longer answer: most of the negative reputation about MSG comes from a single piece of satire written in the US in the 1960s, which the popular press then misrepresented as a genuine concern, and the public then ran with, mostly due to racism/xenophobia/sinophobia specifically, given the US’s historically not fabulous relations with China, and the moniker of “Chinese restaurant syndrome”, notwithstanding that MSG was first isolated in Japan, not China, more than 100 years ago.

    The silver lining that comes out of this is that because of the above, MSG has been one of the most-studied food additives in recent decades, with many teams of scientists in many countries trying to determine its risks and not finding any (except insofar as anything in extreme quantities can kill you, including water or oxygen).

    You can read more about this and other* myths about MSG, here:

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    *such as pertaining to gluten sensitivity, which in reality MSG has no bearing on whatsoever as it does not contain gluten and is not even made of the same basic stuff; gluten being a protein made of (amongst other things) the amino acid glutamine, not a glutamate salt. Glutamate is as closely related to gluten as cyanocobalamin (vitamin B12) is to cyanide (the famous poison).

    PS: if you didn’t click the above link to read that article, then 1) we really do recommend it 2) we did some LD50 calculations there and looked at available research, and found that for someone of this writer’s (very medium) size, eating 1kg of MSG at once is sufficient to cause toxicity, and injecting >250g of MSG may cause heart problems. So we don’t recommend doing that.

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    (2 tsp of cassia cinnamon, however, is enough to cause coumarin toxicity; for this reason we recommend Ceylon (or “True” or “Sweet”) cinnamon in our recipes, as it has almost undetectable levels of coumarin)

    With regard to your interesting question about addiction, first of all let’s speak briefly about sugar addiction:

    Sugar addiction is, by broad scientific consensus, agreed-upon as an extant thing that does exist, and contemporary research is more looking into the “hows” and “whys” and “whats” rather than the “whether”. It is a somewhat complicated topic, because it’s halfway between what science would usually consider a chemical addiction, and what science would usually consider a behavioral addiction:

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    People can crave salt, especially when deficient in it, and MSG does contain sodium (it’s what the “S” stands for), but it contains a little under ⅓ of the sodium that table salt does (sodium chloride in whatever form, be it sea salt, rock salt, or such):

    MSG vs. Salt: Sodium Comparison ← we do molecular calculations here!

    Sea Salt vs MSG – Which is Healthier? ← this one for a head-to-head

    However, even craving salt does not constitute an addiction; nobody is shamefully hiding their rock salt crystals under their bed and getting a fix when they feel low, and nor does withdrawal cause adverse side effects, except insofar as (once again) a person deficient in salt will crave salt.

    Finally, the only other way we know of that one might wonder if MSG could be addictive, is about glutamate and glutamate receptors. The glutamate in MSG is the same glutamate (down to the atoms) as the glutamate formed if one consumes tomatoes in the presence of salt, and triggers the same glutamate receptors in the same way. We have the same number of receptors either way, and uptake is exactly the same (because again, it’s exactly the same chemical) so there is a maximum to how strong this effect can be, and that maximum is the same whatever the source of the glutamate was.

    In this respect, if MSG is addictive, then so is a tomato salad with a pinch of salt: it’s not—it’s just tasty.

    We haven’t cited papers in today’s article, but it’s just because we cited them already in the articles we linked, and so we avoided doubling up. Most of them are in that first link we gave 🙂

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    Technically anyone can develop a sensitivity to anything, so in theory someone could develop a sensitivity to MSG, just like they could for any other ingredient. Our usual legal/medical disclaimer applies.

    However, it’s certainly not a common trigger, putting it well below common allergens like nuts (or less common allergens like, say, bananas), not even in the same league as common intolerances such as gluten, and less worthy of health risk warnings than, say, spinach (high in oxalates; fine for most people but best avoided if you have kidney problems).

    The reason we use it in the recipes we use it in, is simply because it’s a lower-sodium alternative to salt, and while it contains a (very) tiny bit less sodium than low-sodium salt (which itself has about ⅓ the sodium of regular salt), it has more of a flavor-enhancing effect, such that one can use half as much, for a more than sixfold total sodium reduction. Which for most of us in the industrialized world, is beneficial.

    Want to try some?

    If today’s article has inspired you to give MSG a try, here’s an example product on Amazon 😎

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