More monitoring and studying is needed to provide more information on the benefits and potential risks, some studies say, while others say it has been associated with improved breastfeeding for the baby and reduced pain for mothers.
Local specialists have weighed in on the topic, most saying this procedure can be “life changing” for babies and moms struggling with breastfeeding.
“The biggest reason I see is they can’t feed,” said Dr. Greg Notestine, a pediatric dentist in the Dayton region who specializes correcting tethered oral tissues.
What is a tongue tie?
A tongue tie is a condition in which the tongue’s range of motion is restricted by a short, thick or tight band of tissue, called a lingual frenulum, according to the Mayo Clinic. The tongue’s tip is tied to the floor of the mouth, which can affect breastfeeding by preventing the infant from latching properly.
A tongue tie also can affect the way a child eats, speaks and swallows, the Mayo Clinic says.
Frenotomies can address a tongue tie. This procedure involves an incision that is made in the tissue of the frenulum to release the tongue from the bottom of the mouth.
“It’s kind of like, when a child tries to lift their tongue, it’s like a tight rubber band under the midline of their tongue, and we just cut through it the same way you would cut through a tight rubber band,” Notestine said.
A team approach
If an infant’s care team finds a restriction in the infant’s mouth like a tongue tie, they typically try to address it with non-surgical options first.
Tongue and lip ties can vary in severity, said Katie Dunlap, who has been a lactation consultant for more than eight years and was a NICU nurse prior to that.
“If I observe a restriction, then I start with non-invasive management,” said Dunlap. “We do oral exercises that are playful and pleasant for the baby and that can help to increase the baby’s tongue mobility and strength.”
Dayton Children’s sees babies with tongue ties frequently, said Dr. Elizabeth Knecht, a pediatric ENT physician at Dayton Children’s.
The treatment depends on the clinical situation, she said.
“We do many frenotomies in young babies to help improve the success of the breastfeeding relationship, and I do always recommend that they also work with a lactation consultant in addition to the procedure,” Knecht said.
Complications are rare
Negative outcomes are infrequent, but Knecht said they happen.
“If we run into problems, which in my personal experience has been very minimal, it would be bleeding or damaging a nerve,” Notestine said.
It’s also possible to have scarring or the frenulum reattach to the base of the tongue, the Mayo Clinic says.
“In my own personal experience, I need to re-treat about 5% of kids I see because the wound developed a scar that was too thick and dense, it wouldn’t be flexible,” Notestine said.
Doctors have since learned that parents need to rub the wound every day for a month after the procedure to keep the tissue stretched and flexible, he said.
Linda J. Smith, who has been a lactation consultant for more than 50 years, and Dunlap both said they have not seen negative outcomes.
“The fix was almost instantaneous. The incision would be done. There was almost never any bleeding,” Smith said.
The worst case scenario Dunlap said she saw was a family who wasn’t sure if it really helped.
“And for the vast majority, I have seen families that felt the procedure was so beneficial it was life-changing, and for a lot of those babies, they were losing weight previously or struggling to gain weight,” Dunlap said.
Tongue ties in older children
Older kids with tongue ties may have trouble eating solid food or trouble speaking, Notestine said.
Kids with tongue ties also may get cuts under the tongue when the frenulum gets caught between the lower front teeth or have tooth decay because they can’t clear food from their teeth with their tongue.
Speech therapists can teach the child and their parents techniques to do once the child has the frenotomy to help the child adapt more quickly after the procedure.
“You train the parent, you train the child, or you train the adult as they’re getting ready for the procedure in certain movements, exercises … Then they have their procedure, and then those same exercises are the ones that you can use as they’re recovering to help them recover more precisely and easily,” said Patricia K. Fisher, an orofacial myologist and speech pathologist.
Increased procedures
The number of frenotomies increased tenfold from 1997 to 2012 in the U.S., according to researchers affiliated with Stanford University and the Mayo Clinic.
The increased treatments are not due to overuse, Notestine said. Doctors, lactation consultants and speech therapists are learning the signs more and also working in tandem, he said.
“We’re just finding more,” Notestine said about tongue ties.
Smith found out about her own tongue tie as an adult. Smith also dealt with a lisp and difficulty speaking for long periods of time.
“I used to lecture all day long as a teacher, and by noon, I was getting fumble-mouth, and I couldn’t have a salad at lunchtime because my mouth would get so tired just talking all day, because my tongue was working so hard to make my sounds, and even then, I had a lisp. And so did my brother,” Smith said.
Smith eventually had a frenotomy when she was 60, which improved her sleep apnea and her speech differed.
What should parents ask
For parents who are having their child evaluated for a potential frenotomy, Dunlap recommended asking, “What does that provider see as the potential benefits versus the potential risk?”
Parents can also ask the provider how the do the procedure, such as with a laser or with surgical scissors, along with what they, the parents, should do after the procedure to manage the site.
“I would ask what kinds of exercises or after care would help, and not only to help the wound so it doesn’t scar back down, but also to help increase tongue strength and mobility,” Dunlap said.
When this a child is recommended for an evaluation of a potential tongue tie, those interviewed said it is done out of those hopes of improving the child’s quality of life.
“We do it out of a profound desire to directly help people,” Dunlap said.
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