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.

Summer is nearly here. But rather than getting out the sunscreen, some TikTokers are urging followers to chuck it out and go sunscreen-free.

They claim it’s healthier to forgo sunscreen to get the full benefits of sunshine.

Here’s the science really says.

How does sunscreen work?

Because of Australia’s extreme UV environment, most people with pale to olive skin or other risk factors for skin cancer need to protect themselves. Applying sunscreen is a key method of protecting areas not easily covered by clothes.

Sunscreen works by absorbing or scattering UV rays before they can enter your skin and damage DNA or supportive structures such as collagen.

When UV particles hit DNA, the excess energy can damage our DNA. This damage can be repaired, but if the cell divides before the mistake is fixed, it causes a mutation that can lead to skin cancers.

The most common skin cancers are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Melanoma is less common, but is the most likely to spread around the body; this process is called metastasis.

Two in three Australians will have at least one skin cancer in their lifetime, and they make up 80% of all cancers in Australia.

Around 99% of skin cancers in Australia are caused by excessive exposure to UV radiation.

Excessive exposure to UV radiation also affects the appearance of your skin. UVA rays are able to penetrate deep into the skin, where they break down supportive structures such as elastin and collagen.

This causes signs of premature ageing, such as deep wrinkling, brown or white blotches, and broken capillaries.

Sunscreen can help prevent skin cancers

Used consistently, sunscreen reduces your risk of skin cancer and slows skin ageing.

In a Queensland study, participants either used sunscreen daily for almost five years, or continued their usual use.

At the end of five years, the daily-use group had reduced their risk of squamous cell carcinoma by 40% compared to the other group.

Ten years later, the daily use group had reduced their risk of invasive melanoma by 73%

Does sunscreen block the health-promoting properties of sunlight?

The answer is a bit more complicated, and involves personalised risk versus benefit trade-offs.

First, the good news: there are many health benefits of spending time in the sun that don’t rely on exposure to UV radiation and aren’t affected by sunscreen use.

Sunscreen only filters UV rays, not visible light or infrared light (which we feel as heat). And importantly, some of the benefits of sunlight are obtained via the eyes.

Visible light improves mood and regulates circadian rhythm (which influences your sleep-wake cycle), and probably reduces myopia (short-sightedness) in children.

Infrared light is being investigated as a treatment for several skin, neurological, psychiatric and autoimmune disorders.

So what is the benefit of exposing skin to UV radiation?

Exposing the skin to the sun produces vitamin D, which is critical for healthy bones and muscles.

Vitamin D deficiency is surprisingly common among Australians, peaking in Victoria at 49% in winter and being lowest in Queensland at 6% in summer.

Luckily, people who are careful about sun protection can avoid vitamin D deficiency by taking a supplement.

Exposing the skin to UV radiation might have benefits independent of vitamin D production, but these are not proven. It might reduce the risk of autoimmune diseases such as multiple sclerosis or cause release of a chemical that could reduce blood pressure. However, there is not enough detail about these benefits to know whether sunscreen would be a problem.

What does this mean for you?

There are some benefits of exposing the skin to UV radiation that might be blunted by sunscreen. Whether it’s worth foregoing those benefits to avoid skin cancer depends on how susceptible you are to skin cancer.

If you have pale skin or other factors that increase you risk of skin cancer, you should aim to apply sunscreen daily on all days when the UV index is forecast to reach 3.

If you have darker skin that rarely or never burns, you can go without daily sunscreen – although you will still need protection during extended times outdoors.

For now, the balance of evidence suggests it’s better for people who are susceptible to skin cancer to continue with sun protection practices, with vitamin D supplementation if needed.

Katie Lee, PhD Candidate, Dermatology Research Centre, The University of Queensland and Rachel Neale, Principal research fellow, QIMR Berghofer Medical Research Institute

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