Tongue

In the first few visits, if not the first visit for newborns, I often get asked about tongue ties.  Everyone is born with a piece of tissue connecting their tongue to the lower part of their mouth of frenulum.  Very rarely, kiddos are born with such a thick bit of tissue that it actually prevents movement of the tongue.  What is not rare is for kids with perfectly normal tongues to get labeled as having a tongue tie if there is any slight hiccup when starting or maintaining breastfeeding.  I am constantly looking for new reports and studies about tongue ties and the treatment for tongue ties which is called a frenectomy (or frenulectomy) and when we should and should not recommend it. 

The best studies over the last 10 years have left us with this:  If a parent is still saying that breastfeeding is very painful 1 month in, then 50% of parents say after a frenectomy the pain improves.  That is it.  There is no actual reproducible data showing that babies who get frenectomy actually feed better over time in relation to those who do not get a frenectomy.  Meaning that most of the time, with practice and the natural stretching that occurs as babies learn to breastfeed, there is minimal difference between babies who receive treatment for a tongue tie and those who do don’t.   With sometimes 50-75% of new babies coming into my practice with a tongue tie report in their chart and a referral for clipping, I’m a bit skeptical.  

Now, there are some kiddos who have actual tongue restriction due to this rare physical abnormality.  These kiddos are the ones that I see in clinic who can’t get their tongue to their lips.  And, yes, we often need to release that tight tongue tie to allow for proper feeding.  But, again, this is super rare and usually addressed by a specialist looking for other disorders of the mouth, jaw, and palate. 

So before rushing off to clip the tongue tie, have a good discussion with your kid’s doc to see if it is truly necessary or if we are better off allowing baby more time to figure out the best mechanics for feeding slowly, growing stronger and nimbler in their ability to feed.