Tongue-tied babies: Procedure to help infants breastfeed may not be necessary, say some experts

Many parents across Canada struggle with breastfeeding, and in some cases, new mothers are being told to utilize a laser procedure to fix tongue issues in their infants -- a treatment that experts say can be unnecessary.

Six months ago, Shadi Toloui-Wallace became a new mother. And like many, she found breastfeeding difficult.

“He's not eating, he's losing weight,” Toloui-Wallace said. “And it's quite painful, and he's not taking my breast.”

A lactation consultant said her son Ezra had a condition called ankyloglossia or “tongue-tie.” Although everyone has a frenulum, which is a ribbon of skin connecting the tongue to the bottom of the mouth, sometimes infants are born with a frenulum that is too tight, or too far forward in the mouth, limiting the movement of the tongue and sometimes interfering with breastfeeding.

Anterior -- or classic – tongue-ties are where this ribbon of skin near the front of the tongue is snipped, often in a doctor’s office.

It’s a simple procedure, but in recent years, a more invasive laser treatment to treat something called "posterior tongue ties” has been recommended and promoted by some lactation consultants and dentists.

It was this procedure that the consultant recommended to Toloui-Wallace — a therapy that costs hundreds of dollars.

“We could hear him from the other side of the wall […] screeching, howling, and it's quite difficult to hear your baby in pain,” she said. “It was horrible.”

After the procedure, she was told to do exercises with her baby in order to exercise his tongue. But these proved painful for him, which added stress to the parents.

“Basically, there were […] massaging techniques, kind of like pushing the tongue from side to side, training them to use their tongue more because they hadn't used it like this before,” she explained.

“I was quite determined to breastfeed, as you can see, to go through all of this.”

She said they continued doing this for around three weeks until they consulted with another doctor, who recommended that they stop.

Women are strongly encouraged to breastfeed. The Canadian Paediatric Society website says “breast milk is the best food you can offer your new baby,” and recommends “exclusive breastfeeding for the first six months of life.”

But many women struggle, and some lactation consultants conclude the problem is a baby’s tongue tie.

The issue with this increasingly popular laser procedure is that studies say the definition of what constitutes a posterior tongue-tie is nebulous.

Parents also get encouragement on social media to do the laser procedure, with Facebook groups dedicated to supporting parents dealing with tongue-tie.

Increasingly, this once-rare procedure to cut under the tongue is now becoming big business in Canada.

One study describes "runaway rates" of tongue-tie procedures due to the “absence of standardized criteria for the diagnosis of ankyloglossia.”

And some experts warn it's unnecessary in most cases, and carries risks when performed by practitioners without the experience necessary.

Verity Livingstone, a clinical professor in the department of family practice at the University of British Columbia, is the founder of the Vancouver Breastfeeding Centre.

She believes that some consultants are making diagnoses they don’t have the expertise to make, and exhausted parents are simply accepting it.

“There are many lay people in our communities who have some expertise in breastfeeding management, and they set themselves up as private practitioners and make unusual diagnoses and make unusual recommendations, way outside that scope of expertise,” Livingstone told CTV News.

Livingstone says she has seen babies with wounds that take weeks to heal.

“If the cut is too big, then the muscles and the ligaments of the tongue get damaged, and they do not always heal the wound can become infected, and it can bleed,” she said. “So the problems can be short term, which would be the bleeding and the infection straightaway, [but] the long term could be damage to the way the tongue actually functions.”

Fatima Ladha says she felt pressured by a lactation specialist in B.C. to get the procedure done on her son Mykhail when he was only nine days old.

She said that within 10 minutes of a lactation consultant meeting with the parents and assessing the infant, she was telling the parents they needed to fix the baby’s tongue-tie.

“She basically stuck her fingers in his mouth […] and asked us to bottle feed him and then try to ask me to latch him, and she basically said, ‘Oh, he's got tongue-tie and lip-tie based on what I've seen, because the milk is pooling in his mouth, he's not able to open his mouth wide open. And so you'll probably want to get a revision done sooner rather than later in order to successfully breastfeed.’

“It was very overwhelming to hear all this information I mean, we're sleep deprived, we've got a new baby, it's a first baby,” Ladha said.

She hadn’t even started breastfeeding yet, and wondered how a problem could be diagnosed this early when other solutions hadn’t even been attempted.

“The lactation consultant had phone numbers ready to go right away, within a few minutes of her coming into our home,” Ladha said, adding that the consultant gave her specific oral surgeons and physiotherapists that she recommended Ladha go to.

Ladha declined, but said that she saw a lot of new mothers in groups she was in on social media discussing the surgery.

She is also a pharmacist, so she has some health expertise, which helped her with her decision, she says.

“It wasn't even a physician who [did the] diagnosis and so these were the thoughts running through my mind,” she said.

Ladha was eventually able to breastfeed successfully without taking the advice of the consultant

Other studies suggest the treatment do help babies feed better, with few complications, and some experts find them helpful.

Angela Grant Buechner is a registered nurse and an international board-certified lactation consultant expert based in Toronto who had her two children treated for tongue-tie -- her son when he was just 10 days old.

She said while it wasn’t an easy choice, it “made a huge difference” with her children.

“I think because I have that personal experience, it was easier for me to me to see that sometimes it is necessary,” Buechner said.

She said it’s important not to jump to it right away, and to see experts to see if there’s anything that can be done to help the baby latch on and breastfeed properly.

“But it really is true that some babies have restriction,” she said. “It really can be something that needs to go further and then we might need to look at a release of that tissue that is tethered.”

She said that some providers don’t have the extra training necessary to identify a posterior tongue-tie and assess the function of the tongue properly, adding that this can result in some parents being told that everything is fine with their infant, and then being confused when they’re still struggling weeks later.

“It's often just that the training isn't there to know when a tie is in fact causing problems for feeding or speech,” she said.

The Canadian Paediatric Society put out a paper dictating their position on the topic, written in 2015 and reaffirmed this summer, which suggests the issue is not clear cut.

“Based on available evidence, frenotomy cannot be recommended for all infants with ankyloglossia,” the paper states.

Frenotomy is the term for the surgery that cuts a tongue-tie.

The paper added that while there is an association for some babies between ankyloglossia and difficulty breastfeeding, that’s not true for all infants.

“If an association between significant tongue-tie and major breastfeeding problems is identified and surgical intervention is deemed to be necessary, frenotomy should be performed by a clinician experienced with the procedure, using appropriate analgesia,” the paper states.

“Consultation with a health care professional who has expertise in breastfeeding is recommended before referring a child for frenotomy.”

Dr. Anne Rowan-Legg, the author of the Canadian Pediatric Society Position paper, is also a full-time pediatrician at CHEO, a pediatric health-care and research centre in Ottawa.

“I think one of the main issues is that posterior tongue-tie doesn't have a clear or consistent definition,” Rowan-Legg told CTV News.

“And that's what makes this both very difficult for parents and mothers and also for studies.”

Because of the lack of a clear definition that is widely understood, “it leaves it up to interpretation,” Rowan-Legg said, causing issues for clinicians when counselling parents.

“We do know that many kids with tongue-ties can breastfeed successfully. That decision to get a tongue clipped should not be made in haste.”

More important than jumping to frenotomy, some experts say, is helping mothers learn how to properly breastfeed – support that is sometimes lacking.

Toloui-Wallace did get help to breastfeed after attending Livingston’s Vancouver breastfeeding clinic, with baby Ezra finally latching correctly.

Today Ezra is happy and healthy.

Toloui-Wallace said while she doesn’t regret getting the laser procedure, she doesn’t know if it was what helped or not.

But she stresses what parents need most is early support and connection to credible breast-feeding experts after they give birth, explaining that Livingstone’s expertise was essential to her.

“I just wish healthcare providers are better informed and knew all the resources out there to help parents make an informed decision for their child and for themselves,” she said.

She and Ladha are sharing their stories for parents who are in similar situations and to raise awareness about this contentious issue.

“I also feel it's my duty as a health care provider to inform people and let them know how to advocate and protect themselves from something like this,” Ladha said.

“Whatever anyone tells you, ask the questions, don't be afraid to ask the questions. You're doing everything that you can to protect your child and yourself.”

Doctors admit they have no idea how many of these procedures are being done in Canada because most are done privately.

Many are urging for more studies to be done in order to see if the procedure is a real solution, as well as for there to be more oversight of the people offering surgical solutions.