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.

It’s Saturday afternoon and the kids are all connected to separate devices. So are the parents. Sounds familiar?

Many families want to set ground rules to help them reduce their screen time – and have time to connect with each other, without devices.

But it can be difficult to know where to start and how to make a plan that suits your family.

First, look at your own screen time

Before telling children to “hop off the tech”, it’s important parents understand how much they are using screens themselves.

Globally, the average person spends an average of six hours and 58 minutes on screens each day. This has increased by 13%, or 49 minutes, since 2013.

Parents who report high screen time use tend to see this filtering down to the children in their family too. Two-thirds of primary school-aged children in Australia have their own mobile screen-based device.

Australia’s screen time guidelines recommended children aged five to 17 years have no more than two hours of sedentary screen time (excluding homework) each day. For those aged two to five years, it’s no more than one hour a day. And the guidelines recommend no screen time at all for children under two.

Yet the majority of children, across age groups, exceed these maximums. A new Australian study released this week found the average three-year-old is exposed to two hours and 52 minutes of screen time a day.

Some screen time is OK, too much increases risks

Technology has profoundly impacted children’s lives, offering both opportunities and challenges.

On one hand, it provides access to educational resources, can develop creativity, facilitates communication with peers and family members, and allows students to seek out new information.

On the other hand, excessive screen use can result in too much time being sedentary, delays in developmental milestones, disrupted sleep and daytime drowsiness.

Too much screen time can affect social skills, as it replaces time spent in face-to-face social interactions. This is where children learn verbal and non-verbal communication, develop empathy, learn patience and how to take turns.

Many families also worry about how to maintain a positive relationship with their children when so much of their time is spent glued to screens.

What about when we’re all on devices?

When families are all using devices simultaneously, it results in less face-to-face interactions, reducing communication and resulting in a shift in family dynamics.

The increased use of wireless technology enables families to easily tune out from each other by putting in earphones, reducing the opportunity for conversation. Family members wearing earphones during shared activities or meals creates a physical barrier and encourages people to retreat into their own digital worlds.

Wearing earphones for long periods may also reduce connection to, and closeness with, family members. Research from video gaming, for instance, found excessing gaming increases feelings of isolation, loneliness and the displacement of real-world social interactions, alongside weakened relationships with peers and family members.

How can I set screen time limits?

Start by sitting down as a family and discussing what limits you all feel would be appropriate when using TVs, phones and gaming – and when is an appropriate time to use them.

Have set rules around family time – for example, no devices at the dinner table – so you can connect through face-to-face interactions.

Consider locking your phone or devices away at certain periods throughout the week, such as after 9pm (or within an hour of bedtime for younger children) and seek out opportunities to balance your days with physical activities, such kicking a footy at the park or going on a family bush walk.

Parents can model healthy behaviour by regulating and setting limits on their own screen time. This might mean limiting your social media scrolling to 15 or 30 minutes a day and keeping your phone in the next room when you’re not using it.

When establishing appropriate boundaries and ensuring children’s safety, it is crucial for parents and guardians to engage in open communication about technology use. This includes teaching critical thinking skills to navigate online content safely and employing parental control tools and privacy settings.

Parents can foster a supportive and trusting relationship with children from an early age so children feel comfortable discussing their online experiences and sharing their fears or concerns.

For resources to help you develop your own family’s screen time plan, visit the Raising Children Network.

Elise Waghorn, Lecturer, School of Education, RMIT University

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