Tongue tie or ankyloglossia is a condition present at birth. It is generally defined as "a short, tight band of tissue tethering the tongue's tip to the floor of the mouth. It can affect how the child eats and speaks and can interfere with breastfeeding." (Mayo Clinic).
An upper lip tie is also present at birth and is generally defined as: the labial frenulum being short, tight, and restrictive. Like tongue ties, lip ties can potentially affect eating, speaking, and breastfeeding.
Awareness surrounding this issue has grown exponentially in the last few years, especially in breastfeeding and alternative health support groups and communities. When women ask for breastfeeding help on social networking sites such as Facebook others almost unanimously ask if the baby has been checked for a lip or tongue tie. Some people will ask for a photo in order to diagnose a tie. Parents are urged to have these ties cut or "revised" at the earliest opportunity, not only to ensure breastfeeding success but also because leaving the tie intact is said to cause a myriad of short and long term health problems.
Following is a list of some of the issues said to be caused by ties that are not revised: colic, reflux, breastfeeding problems (shallow latch, mastitis, misshapen nipples, nipple pain and damage, clicking sound, oversupply/undersupply, unusual nursing patterns), slow weight gain, carseat discomfort, tooth decay, gaps between teeth, orthodontics required, high palate, sleep apnea, snoring, speech delay or difficulties, facial tension, headaches, mouth breathing, difficulty eating solids, food, intolerances, ADHD, autism, and more. Many of these claims are anecdotal at best and these issues may be caused by multiple things. Even if the mother reports no breastfeeding issues: no pain or sore nipples, ample milk supply, baby is gaining weight well, she is strongly advised to have the tie revised in order to prevent possible future breastfeeding problems or other health problems in the child. Revising ties is also commonly advised for older children and adults regardless of if they are currently experiencing problems from it. But in the absence of a clearly defined current medical need, does cutting a tie more closely resemble cosmetic surgery?
The two main ways to revise ties are by scissors or laser. The exact procedure can vary and varying amounts of pain medication may be used depending upon the practitioner. As with many other procedures, it is generally recommended to revise ties as soon as possible in order to breastfeed successfully, prevent future problems, and to have a minimal impact on the child. Newborns are thought to recover faster and to feel pain less than older babies and children as they don't always react in the way a parent might expect. Recent research suggests that "infants not only feel pain the way adults do, but also that they have a lower pain threshold." (
https://www.huffingtonpost.com/2015/04/23/babies-pain_n_7117812.html)
Anecdotal reports of newborns who have a tie revised show that the recovery sometimes takes longer than expected. Many parents report that their baby will not readily latch on to breastfeed after a tie revision and that they are fussy and seem to be in pain for hours and sometimes even days afterwards. Some mothers report that their babies go on a 'nursing strike,' refusing to breastfeed and screaming when breastfeeding is attempted. Refusing a pacifier and bottle is also common. Some babies reportedly never breastfeed again even when the mother seeks help from a lactation consultant. Post surgical stretches (such as here:
https://www.drghaheri.com/aftercare/) are often recommended for months after the procedure so the tissues do not reattach. Manipulating the wound site is likely to be painful for the baby and may lead to further oral aversions.
Most experts agree that revision is warranted in cases where the tie is very severe, the baby clearly cannot breastfeed well, and the mother is struggling with sore nipples due to a poor latch caused by the tie. Usually a recommendation to revise the tie is suggested by a provider, such as a pediatrician, dentist, or lactation consultant, after a visual exam of the baby's mouth. Some providers will also observe the breastfeeding dyad during a nursing session in order to see how the baby is able to function rather than routinely advising revision for all ties.
(Such as suggested by these IBCLC's:
http://mammaeblog.blogspot.com/2015/06/a-tongue-frenulum-vs-tongue-tie.html
http://www.theboobgeek.com/blog/tongue-tie.html
https://www.breastfeedingbasics.com/articles/tongue-tie)
It should also be noted that there is currently no standard of protocol for tie assessment or even a universally agreed upon definition of what constitutes a tie.
Amidst all the controversy, there is one question that is rarely being asked. If a tongue or lip tie is causing no current problems for the baby or the mother: baby is breastfeeding well, gaining weight well, and the mother is reporting no latching problems due to the tie, is it necessary to cut it? What about the option of waiting until, or even if, the ties do cause problems and revising it then? And if the breastfeeding dyad is experiencing nursing difficulties, what about first putting time and money into a consultation with an IBCLC who may be able to offer non-surgical solutions?
Is it ethical to perform a likely painful, prophylactic surgery on a newborn in order to prevent things that have not been proven in research to be caused by ties?
