Is tongue-tie being overdiagnosed in infants?

Introduction

NEW YORK — Tongue-tie, a condition in infants that can affect breastfeeding, may be overdiagnosed in the U.S. and too often treated with unnecessary surgery, according to a prominent doctors’ group.

Concerns Raised

The American Academy of Pediatrics is the latest and largest medical society to express alarm about the increasing use of scissors or lasers to cut away some infants’ tongue tissue when breastfeeding proves difficult.

Dr. Maya Bunik, a Colorado-based co-author of the report, stated, “It’s almost an epidemic.” Experts believe that the annual tally of infants treated for tongue-tie with surgery may exceed 100,000, with many of those treatments deemed unnecessary.

Understanding Ankyloglossia

Ankyloglossia, or tongue-tie, occurs when an infant is born with a tight or short band of tissue that tethers the bottom of the tongue’s tip to the floor of the mouth. This condition can hinder the infant’s ability to extend and lift their tongue to grasp a nipple and draw milk, which can be painful for the mother.

Need for Timely Intervention

Doctors emphasize the importance of getting breastfeeding on track within the first three to four weeks. Surveys indicate that most parents desire to breastfeed, leading them to seek quick solutions to breastfeeding challenges.

Increasing Diagnoses

Diagnoses of ankyloglossia have been rising globally, yet there is no uniform diagnostic criteria or consensus on treatment methods. While some practitioners use scissors to cut the tissue, others are employing lasers, with costs sometimes exceeding $800.

Potential Risks

However, these procedures can cause pain and sore mouths, which may deter infants from breastfeeding. Dr. Jennifer Thomas, a Wisconsin pediatrician and co-author of the report, remarked, “The practice of treating tongue-tie became very common without sufficient data to support it.”

Recommendations

The report encourages collaboration among lactation experts, pediatricians, surgeons, and parents to evaluate potential reasons for breastfeeding challenges and to make informed treatment decisions.

Statements from Medical Groups

At least two other medical organizations have addressed tongue-tie concerns. In 2020, the American Academy of Otolaryngology-Head and Neck Surgery issued a consensus statement indicating that tongue-tie is overdiagnosed in some areas and that there is insufficient evidence to claim that lasers are superior to other techniques.

In 2021, the Academy of Breastfeeding Medicine called for more research into tongue-tie treatment, emphasizing that decisions require a high level of clinical skill and judgment.

Parental Experiences

Haley Brown sought help from a lactation consultant after her son Shiloh, born prematurely, struggled with nursing. After consulting a dentist who diagnosed Shiloh with tongue-tie, he underwent a laser procedure costing $750, which improved breastfeeding immediately.

Brown later learned from another lactation consultant that a scissors snip could have been less invasive and equally effective. She reflected, “I probably should have consulted with my pediatrician before I went straight to the dentist.”

Conclusion

The American Dental Association has not directly responded to inquiries about the new report but stated that they agree with a 2022 policy statement from the American Academy of Pediatric Dentistry, which noted that not all children with ankyloglossia require surgical intervention.

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