Ashley’s case is mild — she can easily stick out her tongue — and she lives with it. But Emersyn’s was severe. She couldn’t freely move her tongue. Doctors predicted that she could have speech problems later if not corrected.
So, in March, when Emersyn was 9 days old, she underwent a simple “clipping” procedure using sterile scissors performed by an ear, nose and throat specialist that released the band and freed the tongue. It’s quick and usually doesn’t require anesthesia. “It was definitely a relief to get it done, and she’ll never remember it,” says Ashley, a nursing student from Rockmart, Ga.
Tongue-tie — or ankyloglossia — occurs in up to 10 percent of newborns, according to the Mayo Clinic. When the band, called the frenulum, is too short or too tight, it can limit the tongue’s range of motion, making breastfeeding difficult for the infant and painful for the mother. It can be familial, although the genetics are unknown, according to experts.
Left untreated, “if it is tight enough, it can cause difficulty pronouncing certain sounds, and later in life such simple pleasures as licking an ice cream cone, kissing and other activities,” said Rebekah Huppert, a registered nurse and lactation consultant at the Mayo Clinic Children’s Center in Rochester, Minn.
“It’s not the same as a speech delay,” says Joanna Dolgoff, a pediatrician with Wellstar Health System in Marietta, Ga., and a spokesperson for the American Academy of Pediatrics. Toddlers with the condition “usually have the words, but it’s hard for them to pronounce them. Their sounds are off.”
Some health-care providers urge quick treatment, while others suggest a wait-and-see attitude. Although the surgery is low-risk, experts point out that it’s not always necessary in mild cases and that, with time, the band can stretch. Also, some experts think the procedure is overused, in part because of growing discussions about the condition and treatments on social media. It’s unclear how many tongue-tie procedures are performed annually, but research suggests that they have been rapidly increasing in recent years.
“If you can avoid surgery, that would be best,” says Dolgoff, who estimates that she sees several dozen cases every year in her practice. Everyone “has some connection between the tongue and the bottom of the oral cavity,” she says, although this is not considered tongue-tie, nor does it cause problems. “We don’t fix tongue-tie unless a child is having some functional issue as a result of it.”
If you aren’t sure whether your baby has tongue-tie, watch how the tongue moves. “If your baby can stick his or her tongue fully out of their mouth, it’s less likely they have tongue-tie, although not impossible,” Dolgoff says.
Pediatricians don’t routinely check for it when examining a newborn, but the condition can quickly become apparent once the mother tries to breastfeed.
“The tongue needs to scoop around the nipple and hold it in place,” Huppert says, adding that breastfeeding becomes challenging “if the tongue can’t extend out over that lower lip, or if the tongue can’t roll properly around the nipple to hold it.”
This often causes discomfort, or even pain, for the mother, and, if the baby can’t eat, failure for the child to gain weight or weight loss. Before considering surgery, known as a frenotomy, experts often suggest first consulting a lactation specialist to be sure that tongue-tie is the cause of the breast latch-on problems. They may also have nonsurgical ideas for solving the issues.
Among other things, lactation experts might suggest a change of position for mother and baby that could make it easier for the tongue to reach the nipple. But if their recommendations still don’t work, they often encourage a frenotomy.
“We want to make a move quickly if we can to encourage the mothers to continue breastfeeding,” Huppert says. “The gold standard is the scissors clip. That’s what we do here at Mayo. We call it a procedure rather than a surgery. It takes five seconds. There’s very little blood, no anesthesia and no downtime afterwards.”
Most experts recommend the clipping be done by a trained ear, nose and throat specialist, which is usually covered by insurance. In recent years, however, some dentists have begun to offer laser treatment to cut the tongue-tie band, as well as other procedures — such as lasering under the upper lip or inside the mouth — which many experts discourage, saying they aren’t needed, nor is there evidence that they help. Also, health insurance generally doesn’t cover a tongue-tie procedure performed by a dentist, experts say.
Maya Bunik, a professor of pediatrics at the University of Colorado School of Medicine and chair of the section on breastfeeding for the American Academy of Pediatrics, worries that parents may be too quick to opt for surgery, and thinks the procedure may be overused — understandable, she adds, because “everybody wants to do whatever they can for their babies, and breastfeeding is a challenging part of babyhood.”
“There has to be a happy medium,” adds Bunik, who co-authored a soon-to-be-published clinical report on ankyloglossia for the American Academy of Pediatrics. She says it’s important to rule out other causes of breastfeeding problems before considering surgery, and she encourages patience.
“You need to evaluate both the mom and the baby,” she says. “I do think some babies just need more time. But if feeding is not going well, the baby is not gaining weight, and the mom is having nipple or breast pain, it’s probably worth doing the surgery.”
That was the situation for Ashley, who initially found breastfeeding Emersyn to be painful. But now, with Emersyn post-procedure and nearly 3 months old, she says it’s comfortable. “I didn’t want to wait until she got older to have the surgery,” she says. “At first, I was apprehensive. But I am definitely glad we had it done.”