Reasons for cutting tongue-ties

Should I have my baby’s tongue-tie clipped?

Cutting tongue-ties is controversial as there is little good research on the topic. Some studies say cutting an anterior tongue-tie may reduce nipple pain, allow more tongue movement, and improve breastfeeding, but others have found little or no improvement in breastfeeding and little reduction in pain. Cutting may not help a baby who can’t latch or stay latched as there are many other possible causes. There is not enough evidence to predict whether it will lower the risk of speech, dental, or gum problems, but some reports show children with these problems and obvious tongue-ties respond to surgery. Some studies conclude it is generally reasonable to cut an obvious anterior tongue-tie. Posterior tongue-tie is currently a popular diagnosis, but there is limited proof of its effect on breastfeeding and cutting should only occur after other problems are addressed.

A) The lack of good research supporting tongue-tie cutting

There is very little good research to guide families and health-care providers on the diagnosis and the need for the surgical treatment (cutting) of tongue-ties (Bin-Nun 2017; Patel 2018). Until there is, tongue-ties will be controversial.

B) Anterior tongue-ties

1) Benefits of cutting

There are several tools to identify an anterior tongue-tie. If a tongue-tie is present, cutting it may:

  • Decrease nipple pain (do Rêgo Barros de Andrade Fraga 2020; Francis 2015; Visconti 2021).
  • Increase breastfeeding rates (Bundogji 2020; McGoldrick 2016; Messner 2020; Ricke 2005; Todd 2015).
  • Allow for more effective breastfeeding (Buryk 2011; Campanha 2019; Geddes 2008; Miranda 2010).
  • Allow the child’s tongue to (Daggumati 2019; Francis 2015):
    • Move around the mouth to clean food bits out of the teeth.
    • Extend out of the mouth to lick the lips or foods.
  • Improve the tongue’s appearance (Francis 2015).

2) What cutting will not change

a) Some breastfeeding problems

Having a baby diagnosed with a tongue-tie does not mean there will be breastfeeding problems (Araujo 2019; Brandão 2018; Caloway 2019; Ramoser 2019).

In 2017, the Cochrane Group, an independent organization that reviews research, reported that (O’Shea 2017):

“Investigators did not find a consistent positive effect of tongue-tie cutting on infant breastfeeding.”

A study (Miller 2017) of 226 mothers who went to a breastfeeding clinic in the U.K. found that about 40% of the babies who had a tongue-tie cut had little or no improvement in breastfeeding. Other studies have found that cutting did not significantly affect breastfeeding rates (Dixon 2018; Illing 2019) or reduce pain (Emond 2014).

Tongue-tie is often blamed for latching problems but we have not found that cutting a tongue-tie consistently helps latching. There are many causes of latching problems and these should be considered before blaming a tongue-tie. 

b) Speech, language, dental, and gum problems

There is not enough information to predict whether cutting a tongue-tie will decrease the risk of speech and language, dental, or gum problems (Chinnadurai 2015; Francis 2015; Walsh 2017; Visconti 2021).

However, there are reports that children who have had obvious tongue-ties and who have had these problems have responded to surgery (Bahadure 2016; Baxter 2020; Bhattad 2013; Dollberg 2011; Lalakea 2003; Puthussery 2011).

c) Sleep apnea

There is not enough evidence to promote the cutting of tongue-ties to prevent sleep apnea (Messner 2020).

d) Normal behaviour

Based on our observations, cutting a tongue-tie will not generally help a healthy baby who:

C) Posterior tongue-ties

While the diagnosis of a posterior tongue-tie is extremely popular at present, there is no good test to identify posterior tongue-ties (Walker 2018). There is even less evidence supporting cutting posterior tongue-ties (Srinivasan 2018).

Posterior tongue ties may cause swallowing difficulties (Brooks 2020) but ultrasound studies have shown little evidence that they cause breastfeeding problems (Douglas 2018).

There is a pressing need for more research in this area to guide parents and health-care providers.

D) The risk of overlooking other problems

While cutting tongue-ties has helped some babies in our clinic, others were referred to us when surgery did not benefit them or caused new problems. Some of these babies:

  • Were underfed or otherwise ill when the procedure was done.
  • Had more trouble feeding after the surgery.
  • Refused to breastfeed temporarily or permanently after surgery.
  • Were in significant pain.
  • Experienced significant pain when mothers did the prescribed stretching exercises.
  • Had other breastfeeding challenges that were not dealt with.
  • Had the diagnosis of their illness delayed.
  • Underwent a second and even a third cutting, when the first did not help.  
  • Had mothers who had other reasons for nipple pain and their treatment was delayed.

We are not alone in this experience and such concerns have been reported by others (Hale 2019).

E) Conclusions

Breastfeeding problems can be complex and have many causes. It is unwise to assume that most problems will be fixed by cutting the bottom of the baby’s tongue or the lip. Mothers experiencing difficulties should be seen by a breastfeeding specialist before having their baby's tongue cut. Families should understand there is little high-quality research on the subject. 

Since cutting an anterior tongue-tie may prevent or treat breastfeeding problems, improve the appearance and mobility of the tongue-tip, and is relatively easy and safe to do within the first few months after birth, it is generally reasonable to clip an obvious anterior tongue-tie (Brookes 2014; Francis 2015; Ito 2014).

Cutting a posterior tongue-tie to solve breastfeeding problems should be considered only when other approaches have clearly failed. 

References

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