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.

Few topics are more debated in health than the value of the humble bathroom scale. Some experts advocate daily self-weigh-ins to promote accountability for weight management, particularly when we’re following a diet and exercise program to lose weight.

Others suggest ditching self-weigh-ins altogether, arguing they can trigger negative psychological responses and unhealthy behaviours when we don’t like, or understand, the number we see on the scale.

Many, like me, recommend using scales to weigh yourself weekly, even when we’re not trying to lose weight. Here’s why.

1. Weighing weekly helps you manage your weight

Research confirms regular self-weighing is an effective weight loss and management strategy, primarily because it helps increase awareness of our current weight and any changes.

A systematic review of 12 studies found participants who weighed themselves weekly or daily over several months lost 1–3 BMI (body mass index) units more and regained less weight than participants who didn’t weight themselves frequently. The weight-loss benefit was evident with weekly weighing; there was no added benefit with daily weighing.

Self-weigh-ins are an essential tool for weight management as we age. Adults tend to gain weight progressively through middle age. While the average weight gain is typically between 0.5–1kg per year, this modest accumulation of weight can lead to obesity over time. Weekly weighing and keeping track of the results helps avoid unnecessary weight gain.

Tracking our weight can also help identify medical issues early. Dramatic changes in weight can be an early sign of some conditions, including problems with our thyroid, digestion and diabetes.

2. Weekly weighing accounts for normal fluctuations

Our body weight can fluctuate within a single day and across the days of the week. Studies show body weight fluctuates by 0.35% within the week and it’s typically higher after the weekend.

Daily and day-to-day body weight fluctuations have several causes, many linked to our body’s water content. The more common causes include:

The type of food we’ve consumed

When we’ve eaten a dinner higher in carbohydrates, we’ll weigh more the next day. This change is a result of our bodies temporarily carrying more water. We retain 3–4 grams of water per gram of carbohydrate consumed to store the energy we take from carbs.

Our water content also increases when we consume foods higher in salt. Our bodies try to maintain a balance of sodium and water. When the concentration of salt in our bloodstream increases, a mechanism is triggered to restore balance by retaining water to dilute the excess salt.

Our food intake

Whether it’s 30 grams of nuts or 65 grams of lean meat, everything we eat and drink has weight, which increases our body weight temporarily while we digest and metabolise what we’ve consumed.

Our weight also tends to be lower first thing in the morning after our food intake has been restricted overnight and higher in the evening after our daily intake of food and drinks.

Exercise

If we weigh ourselves at the gym after a workout, there’s a good chance we’ll weigh less due to sweat-induced fluid loss. The amount of water lost varies depending on things like our workout intensity and duration, the temperature and humidity, along with our sweat rate and hydration level. On average, we lose 1 litre of sweat during an hour of moderate-intensity exercise.

Hormonal changes

Fluctuations in hormones within your menstrual cycle can also affect fluid balance. Women may experience fluid retention and temporarily gain 0.5–2kg of weight at this time. Specifically, the luteal phase, which represents the second half of a woman’s cycle, results in a shift of fluid from your blood plasma to your cells, and bloating.

Bowel movements

Going to the bathroom can lead to small but immediate weight loss as waste is eliminated from the body. While the amount lost will vary, we generally eliminate around 100 grams of weight through our daily bowel movements.

All of these fluctuations are normal, and they’re not indicative of significant changes in our body fat or muscle mass. However, seeing these fluctuations can lead to unnecessary stress and a fixation with our weight.

3. Weekly weighing avoids scale obsession and weight-loss sabotage

Weighing too frequently can create an obsession with the number on the scales and do more harm than good.

Often, our reaction when we see this number not moving in the direction we want or expect is to further restrict our food intake or embark on fad dieting. Along with not being enjoyable or sustainable, fad diets also ultimately increase our weight gain rather than reversing it.

This was confirmed in a long-term study comparing intentional weight loss among more than 4,000 twins. The researchers found the likelihood of becoming overweight by the age of 25 was significantly greater for a twin who dieted to lose 5kg or more. This suggests frequent dieting makes us more susceptible to weight gain and prone to future weight gain.

So what should you do?

Weighing ourselves weekly gives a more accurate measure of our weight trends over time.

Aim to weigh yourself on the same day, at the same time and in the same environment each week – for example, first thing every Friday morning when you’re getting ready to take a shower, after you’ve gone to the bathroom, but before you’ve drunk or eaten anything.

Use the best quality scales you can afford. Change the batteries regularly and check their accuracy by using a “known” weight – for example, a 10kg weight plate. Place the “known” weight on the scale and check the measurement aligns with the “known” weight.

Remember, the number on the scale is just one part of health and weight management. Focusing solely on it can overshadow other indicators, such as how your clothes fit. It’s also essential to pay equal attention to how we’re feeling, physically and emotionally.

Stop weighing yourself – at any time interval – if it’s triggering anxiety or stress, and get in touch with a health-care professional to discuss this.

At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.

Nick Fuller, Charles Perkins Centre Research Program Leader, University of Sydney

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