Tongue-tie surgery to help in breastfeeding not always needed, study finds

A new study suggests tongue-tie surgery isn’t always necessary for infants who are having trouble breastfeeding.

According to the Canadian Paediatric Society, up to 10 per cent of infants were born with a piece of tissue – also known as a tongue-tie -- that too tightly connects the tongue to the floor of the mouth.

In some cases, this makes breastfeeding harder and, in even rarer cases, could affect dental health or speech later in childhood. Because of this, some children could be referred to a pediatric ear, nose and throat surgeon to clip the tissue.

But new research found a majority of infants (63 per cent) referred for tongue-tie surgery and lip tether surgery didn’t need it and went on to breastfeed with help from clinicians and speech-language pathologists.

The findings were published on Thursday in JAMA Otolaryngology.

The rates of these surgeries in the U.S. have been rapidly rising in recent years. But this study raises questions as to whether too many infants are getting the surgeries in an effort to improve breastfeeding -- despite there being limited medical evidence to support this practice, according to a university press release.

"We have seen the number of tongue-tie and upper lip tether release surgeries increase dramatically nationwide without any real strong data to show these are effective for breastfeeding," said Dr. Christopher J. Hartnick, director of the Division of Pediatric Otolaryngology of MassGeneral Hospital for Children.

According to the Kids' Inpatient Database in the United States, the number of surgeries has increased from 1,279 in 1997 to 12,406 in 2012.

"We don't have a crystal ball that can tell us which infants might benefit most from the tongue-tie or upper lip release,” Hartnick added. “But this preliminary study provides concrete evidence that this pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure."

The study involved researchers examining 115 newborns who were referred to Massachusetts Eye and Ear clinic for tongue-tie surgery. There, the team offered consultations with experts pediatric speech-language pathologist and breastfeeding specialists before any recommendations of surgery were made.

Following these “multidisciplinary feeding evaluations,” 62.6 per cent of newborns did not undergo surgeries. Further studies will examine the outcomes of those who did the surgery compared with those who didn’t.

Dr. Dina Kulik from the Kidcrew pediatric clinic in Toronto, who wasn’t involved in the study, said she’s also seen an uptick in the number of surgeries recently. But she similarly recommends other avenues before surgery.

“In my experience, working with a certified lactation consultant, often we’re able to get babies feeding well even with some tightness in their anatomy,” she told CTVNews.ca during a phone interview.

“So not every baby needs it done, no,” she said. But she also stressed that some infants will need some sort of surgical fix, despite them working with lactation consultants and pediatric speech-language pathologists.

Breastfeeding is widely seen as the preferred method to feed a newborn and ensure their growth and development, but when children have difficulty, parents go for a consultation that can end in a recommendation for surgery.