Tongue-tie — a condition in infants that can affect breastfeeding — may be overdiagnosed in the United States and too often treated with unnecessary surgery, a leading group of doctors said Monday.
The American Academy of Pediatrics is the latest major medical society to sound the alarm about the increasing use of scissors or lasers to cut babies’ tongue tissue when breastfeeding is difficult. “It’s almost an epidemic,” said Maya Bunik, a co-author of the report and a doctor in Colorado.
Pediatricians said there is no reliable count of the number of children who receive surgical treatment each year, but Bunik believes the annual figure may exceed 100,000. His research suggests that many of those treatments are unnecessary, he added.
The report encouraged pediatricians and other medical professionals to consider nonsurgical options for treating breastfeeding problems. The report cited a study suggesting that less than half of children with the characteristics of ankyloglossia actually have difficulty breastfeeding.
Ankyloglossia, or tongue-tie, occurs when a baby is born with a tight or short band of tissue that holds the underside of the tip of the tongue to the floor of the mouth. This condition can make it difficult for the baby to extend and lift the tongue to latch on to the nipple and extract milk, which can be painful for the mother.
Doctors say it’s critical to get breastfeeding on track in the first three to four weeks, and surveys show most parents want to breastfeed, so it’s natural they’d want a quick fix to a problem.
Diagnoses of ankyloglossia have been increasing worldwide, although there are no uniform diagnostic criteria for the condition and no consensus on how to treat it. One of the common methods is to cut away the tissue with scissors, but dentists are increasingly using lasers to vaporize the tissue (some charge $800).
But these procedures can cause pain and discomfort in the mouth, which can discourage babies from trying to feed themselves.
“The practice became very common without a lot of reliable data,” said Jennifer Thomas, a pediatrician in Wisconsin and co-author of the report.
The research also recommends that lactation experts, pediatricians, surgeons, and other medical professionals work with parents to assess possible reasons for breastfeeding problems and make the best treatment decision.
The American Academy of Pediatrics, which has 67,000 members who specialize in treating children, began working on the report in 2015 after some pediatricians began noticing that an increasing number of patients were going to dentists for treatment for tongue-tie. Pediatricians were hearing about it after the surgeries.
At least two other medical groups have issued opinions on tongue-tie. In 2020, the American Academy of Otolaryngology-Head and Neck Surgery issued a consensus statement in which member physicians noted that tongue-tie is overdiagnosed in some places and that there is insufficient evidence to support the claim that laser is superior to other techniques.
A year later, the Academy of Breastfeeding Medicine, an international group, issued a position paper calling for more research on the treatment and stressing that decisions “require a high level of clinical skill, judgment and discernment.”
The American Dental Association did not directly respond to questions from about the new report. It sent a statement saying the organization agrees with a 2022 statement from the American Academy of Pediatric Dentistry, which noted that not all children with ankyloglossia need surgical intervention and that a team-based approach with other specialists can help in treatment planning.
Haley Brown went to a lactation consultant two years ago after her son Shiloh, who was born prematurely, was having trouble breastfeeding. But as the months passed and things didn’t improve, Brown went to a Denver dentist she’d heard about on social media. The dentist diagnosed Shiloh with ankyloglossia and also labiocephaly, in which the tissue inside the upper lip is too tight. Shiloh underwent a brief laser procedure that cost $750.
Breastfeeding improved immediately. “Things seemed a little easier for her,” said Brown, 33, of Englewood, Colo. Brown had another baby, and another lactation consultant assured her that a snip might have been less messy and just as effective. Brown said the laser treatment worked for Shiloh, but added, “I probably should have checked with my pediatrician before going straight to the dentist.”
