It’s an increasingly common scenario facing new mothers across the country: A lactation consultant examines their newborn and suggests that cutting a “tongue tie” might ease their breastfeeding difficulties.
The quick procedure, known as tongue tie release, involves a dentist or doctor cutting a narrow strip of tissue connecting the tongue to the back of the mouth. In recent years, lactation consultants and dentists have aggressively promoted these procedures, even for babies with no signs of a true tongue tie and despite a modest risk of complications, a New York Times investigation recently found.
Many parents, anxious and exhausted, wonder whether or not they should continue with the procedure, which is often done with a dental laser. Dentists, lactation consultants and pediatricians often disagree on whether such treatment is helpful.
The Times spent months investigating the evidence behind the language-free posts and speaking with dozens of experts. Here’s what parents considering this procedure should know.
Breastfeeding a newborn can be difficult, even if everything is going well.
The first days of breastfeeding can be difficult. A recent survey of more than 1,400 women found that nearly 40 percent suffered from at least one complication, such as pain when latching, cracked nipples or sore breasts.
These early hurdles can be daunting, especially for new mothers who are surviving on little sleep. The good news: Many mothers report that breastfeeding often gets easier over time, as they and their baby gain more experience.
Lactation consultants can provide support in the early days of breastfeeding by suggesting ways to position the baby that will decrease the mother’s pain. Consultants have become more accessible since Obamacare required health insurers to cover their services. Hospitals and associations like the La Leche League offer support groups also for breastfeeding mothers.
A small proportion of babies are born with a tongue tie, which can make breastfeeding more difficult.
Pediatricians say a true tongue tie is easy to identify. When the baby tries to raise his tongue, it forms a heart shape when the middle is pulled down. Other babies with tongue tie cannot extend their tongue past their lower teeth.
Various studies have estimated that 4 to 11 percent babies have a tongue tie. If you suspect a connection and are having difficulty breastfeeding, a pediatrician or ear, nose, and throat specialist may intervene after physically examining your baby. (Certified lactation consultants are not supposed to diagnose without a medical degree, but can refer babies to specialists.)
Doctors stressed to the Times that many tongue ties are harmless. The procedure is only justified, they say, when the tongue tie is pronounced and the mother has difficulty breastfeeding.
Small studies have shown that tongue relaxation can reduce nipple pain.
Some providers tout tongue releases as a panacea for everything from sleep apnea and speech delays to cavities and constipation.
Little evidence supports these claims.
In 2017, after scouring the medical literature for the best studies on tongue releases, researchers find five high-quality studies involving a total of 302 infants.
Studies have shown that tongue relaxation can reduce nipple pain. But the data showed no effect on the baby’s ability to eat.
From 2015 study Researchers at Vanderbilt University came to a similar conclusion: Tongue releases led to “mother-reported improvements in breastfeeding, and potentially in nipple pain.”
No rigorous studies have shown that the procedures affect a baby’s sleep or future problems like speech.
One of the major challenges for those studying these procedures is that breastfeeding often becomes easier over time. Although many mothers report a better breastfeeding experience after the procedure, it can be difficult to tell if this is the result of the tongue tie releasing.
Bring a skeptical eye to cheeks and lips.
Over the past decade, some dentists and lactation consultants have begun to recommend cutting “mouth ties” in other parts of the mouth. These include lip tie – when tissue attaches the lip to the gum – and buccal tie, so named because of the strap that connects the cheeks to the upper gums.
Some also recommend an elaborate aftercare schedule, telling parents to periodically run their fingers under their baby’s tongue and around his or her mouth to prevent the tissue from reattaching.
Pediatric ear, nose and throat specialists said they rarely, if ever, cut babies’ lip or cheek ties because there is no strong evidence that these ties interfere with breastfeeding.
These doctors strongly recommend seeking a second opinion if a medical provider has recommended this type of care. The American Academy of Otolaryngology issued a consensus statement in 2020 stating that “surgery to release an ‘oral tie’ should not be performed” and that there is “no evidence” for support stretching or massaging the wound after release.
Complications are rare, but they can occur.
The vast majority of dentists and doctors interviewed by The Times agreed that tongue releases, which take only a minute or two, pose a low risk of harm.
But complications can arise and they can be serious. It is difficult to estimate a precise rate of problems because no one tracks them systematically. Some pediatric ear, nose and throat specialists working at children’s hospitals report seeing two or three tongue-related complications each year.
Doctors said the most common problem was oral aversion, in which pain makes babies extremely sensitive to anything that goes into their mouths. In severe cases, babies will refuse to eat and will need to be hospitalized.
While some dentists and doctors often emphasize the benefits of tongue releases, Dr. Soham Roy, chairman of the pediatric ear, nose and throat practice at Children’s Hospital Colorado, says he also encourages parents to ask questions about risks.
“There is no safe surgery, and parents deserve to be informed before signing up,” he said.