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In order to avoid re-healing of the surfaces, parents are often instructed to pull the wounds apart multiple times a day for two or three weeks afterwards, causing further pain and discomfort.
But there is little evidence to support the practice. Classic tongue tie can usually be treated relatively painlessly with a simple snip, without the need for deep surgical cuts.
Classic tongue tie is treated with a non-invasive snip, called a frenotomy. What is tongue tie? A frenulum is any connective tissue fold that tethers or anchors mobile organs in the body.
The frenula of the tongue or upper lip in babies have a wonderful diversity of thicknesses, lengths, points of insertion, and elasticity. They tether the tongue to the floor of the mouth, and the upper lip to the gum. Midwives have long recognised that infant tongue tie can result in nipple pain for the mother and breastfeeding failure unless promptly snipped.
But from the s, with the medicalisation of birth and the breakdown of traditional breastfeeding support, classic tongue tie was often left untreated.
In some circles, only pointy tongues that extend to beyond the lower lip are deemed as safe. This unusual degree of tongue mobility has become the new gold standard, and shorter, squarer tongues with less elastic frenula are viewed as failures.
What does the research say? Two recent systematic reviews have examined the effectiveness of frentomies and frenectomies. The firstfromconcludes that half of breastfeeding babies with tongue-tie will not have problems. If there are difficulties, mothers report improvements after frenotomies or frenectomies.
The other review, published inconcludes there is a small body of evidence to suggest frenotomies or frenectomies may be associated with the mother reporting improvements in breastfeeding and nipple pain.
But researchers say the strength of this evidence is low to insufficient. Level D evidence is of very low quality, based on no direct research evidence or with very uncertain estimate of effect. The nature of the tongue tie, associated breastfeeding difficulties and type of surgical intervention are poorly defined, as is the kind of breastfeeding support offered alongside the surgery.
We need long-term follow-up studies, including research that compares the effects of these procedures with high-quality breastfeeding support over time.
My clinical practice In the absence of workable guidelines, clinicians such as myself have to fall back on theoretical frames and clinical experience.
I do a simple frenotomy on any who have a classic tongue tie. There are very occasionally babies with an unusual kind of classic tongue tie, best referred on to oral surgeons.
Mostly, I observe normal, if highly variable, tongue and upper lip frenula, attached to adequately mobile tongues and springy upper lips, all perfectly suitable for breastfeeding.
Occasionally, I find other unexpected side-effects of frenectomies: Parents are told the stitches were because the tie was so bad. But stitches are only put in to control excessive bleeding. In our experience, with the right help, the feeding difficulties and unmanageable fussiness usually resolve.
Support for breastfeeding women Breastfeeding offers substantial short- and long-term health benefits to both mother and child.
Yet clinical breastfeeding support is not prioritised within the overcrowded primary health care agenda, and primary health care research is not prioritised within the national health research agenda. In the meantime, parents can feel comfortable that a simple frenotomy for a classic tongue tie just as soon as possible after birth is likely to protect breastfeeding and, if severe, speech and oral hygiene down the track.
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