Tongue-tie controversy: Experts caution against unnecessary surgery
A 420 per cent increase in controversial procedures to snip "tongue-tie" in babies has prompted a coalition of professional dental and medical groups to warn parents against unnecessary and potentially life-threatening surgery.
About two to 10 per cent of babies are born with a congenital anomaly called ankyloglossia, or tongue-tie, which can make it difficult for a baby to breastfeed because the membrane (the lingual frenum) connecting the tongue with the floor of the mouth is tight or short.
A child with a tongue tie.
In a joint statement to be released on Friday, the Australian College of Midwives, the Australian Dental Association and 12 other medical associations urge families to seek professional advice to "ensure a restricted frenum is actually causing a baby's problems".
They warn that these surgeries can sometimes result in dangerous complications, including reports of large amounts of blood loss in newborns.
Dr Mihiri Silva, a paediatric dentist who chaired the multidisciplinary working group, said it was important to remember feeding problems could be due to problems other than tongue-tie. And she warned it could not be diagnosed by appearance alone.
"Sometimes while the [lingual] frenum looks restricted, it may not be causing any issues,” she said.
Discussion of tongue-tie has taken off on social media, but some parents say it hadn't worked as well as expected.
Lois Wattis, a representative of the Australian College of Midwives, said it was important that mothers have access to expert perinatal care - including seeing an international board-certified lactation consultant - if they were struggling with breastfeeding.
"Non-surgical management such as advice on positioning, latch optimisation and ongoing support can avoid surgery for many infants," she said.
According to Medicare data, there were nearly 53,000 frenectomies in Australia from 2006 to 2016, with the rate rising from 1.22 per 1000 to 6.35 per 1000 children in that decade. The real number is likely higher because these figures don't include procedures in public hospitals or those by dentists.
A frenectomy involves the cutting, sometimes by laser surgery, of skin that connects the tongue to the mouth.
While there is some evidence to support surgery for lingual frenum when non-surgical treatment has been unsuccessful, the group warns there is no evidence to back surgery for other oral ties including those on the side of the mouth or the upper lip.
Dr Silva was alarmed by discussions on social media where laypeople urged others to get their child snipped with "absolute certainty using pseudoscience".
Although some breastfeeding groups welcome increased awareness of the condition, they say it is "highly controversial" and charged on social media.
"There are definitely some cowboys [offering the surgery]," said a woman who didn't want to be identified. "I have seen children go in for a tongue-tie, and come out with all four done," she said, referring to snipping the ties on the side of the mouth and top lip.
Many parents say on social media that the surgery didn't provide the results they wanted. "Straight after the laser, he was able to latch so much better but since then it has been hit and miss," said a Sydney mother.
In the United States, which has seen an 866 per cent increase in frenectomies, the Atlantic magazine reported on "tongue tie madness".
They said tongue-ties were being blamed in online mothers groups for all sorts of parenting woes on online forums. "Baby isn’t gaining weight, or won’t take a bottle? Have you tried checking for ties? Kid won’t nap? It’s probably related to tongue tie. Baby have a rash? Check under the tongue!"