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On Tongue Tie- The American Academy of Pediatrics Calls out a Scam

By Dr. Arthur Lavin

This post comes to you from the Academy Leadership Forum of the American Academy of Pediatrics.  As many of you know, I am going to be chairing a Committee of the AAP starting this summer, and this opened the door to me participating in this Forum, which gathers the senior leadership of the Academy, including the chairs of its various councils, sections, and committees, the presidents of all state chapters from every state in the US and provinces of Canada, and of course the president of the Academy.

At this Forum, a series of resolutions are brought forward for consideration by the leadership.

Several have caught my eye, and I will be reporting them as they either pass or fail to be adopted by the AAP.

The first, which just now passed, calls for pediatricians across the country to respond to the dramatic rise in the number of newborns having their lip and tongue frenulum cut in the nursery.   The trend is being sold as a way to improve the performance of the newborn in latching for breast-feeding.

Discussion on the resolution revealed that the AAP has taken a close look at the practice of cutting newborn’s lip and tongue frenulum to improve breast-feeding, and found no evidence that doing this cutting helps.

The discussion went on to reveal that most of the cutting has been the result of the promotion of this practice by some dentists and ENT doctors in locales around the country, and their proposition that such cutting helps a baby to nurse widely taken up by lactation counselors.

On voting, the leadership of the Academy made clear there was nearly universal agreement that cutting a newborn’s lip or tongue frenulum does not help a baby to nurse.

Of course, as with any intervention, there will be families who experience the intervention and find that a problem got better after the intervention occurs.  Just so here.  Many babies in the US now have had their tongue or lip frenulums cut, and many report a dramatic improvement in nursing.   But when a careful look at the actual nursing experience in those with frenulums left alone and those cut, the evidence is very clear that both newborns do just as well as nursing.

The rise in cutting in the newborn nursery has always been very curious to me.   We simply never saw a baby’s frenulum’s cut prior to even a few years ago, and now it is a nearly constant topic in the nursery.  How was it that newborns nursed so well for decades and longer prior to the rise of this question, how did the need to cut the frenulum of a baby suddenly become such an urgent medical need so recently?

According to the discussion at the Leadership Forum today, there turns out to be no evidence that there really is any such emergence of a problem, there is simply no evidence these cuts help.

I support my Academy’s stance on this issue.  I don’t think newborns are born with abnormal tongues or lips, except in very rare instances in which those structures are actually anomalous.   Healthy, well-formed infants should not have any part of their mouth cut.  I am very concerned that underlying the sudden appearance of this procedure is driven by the allure of a new source of income.

I am once again grateful to the Academy for their advocacy on behalf of all our babies, and welcome the support to get the word out to all families that if a lactation counselor, dentist, ENT doctor, or other professional tells a family that a healthy, well-formed newborn has a condition, such as “tongue-tie,” that the family first speak to their pediatrician.   It is extremely likely your newborn is fine and the cut is not necessary.

For families who have undergone such a procedure, I am also very pleased to pass along the understanding that having this done is a minor procedure, and we have seen no complications to it.  So even though it likely does not, based on objective evidence help, it fortunately appears to do no harm.

BOTTOM LINES

  1. Prior to just a few years ago, newborns came to nurse with no worries about the little strip of tissue that anchors their tongue and lips, their frenulums.   Tongue-tie was an idea rarely if ever talked about until very recently.
  2. Suddenly, with no actual data to support the proposition, in nurseries around the country, a flurry of concern arose that large numbers of newborns were born with abnormal mouths, and many newborns got the frenulum to their tongue or lip cut.
  3. Now comes the leadership of the American Academy of Pediatrics today, and adopts a resolution that calls on the Academy to respond to this sudden surge of cutting.  In the discussion the evidence was presented and soundly concludes that cutting offers no benefit.
  4.  My own read of the emergence of this cutting is that it is indeed promoted for commercial reasons by the professionals doing the procedure.   
  5. Lactation counselors and families are acting in very good faith and with deep care for newborns in recommending and proceeding with this procedure, after all, the ENT doctors and dentists who have created the demand for this procedure are casting the rationale in the context of correcting a problem standing in the way of good nursing with a simple, safe action.   And many families, do experience improvements in nursing after the cut.
  6. Given that careful review of the evidence finds the improvements are the same for newborns cut and not cut, even with the same shape of frenulums, the benefits seen are clearly apparent.
  7. Putting it all together, I stand with the AAP and urge all families, if they hear from someone in the nursery that their newborn has an abnormality of their tongue or lip that will impede nursing, to first talk to us, chances are very high that their newborn’s mouth is normal and no procedure should be done.

To your health,
Dr. Arthur Lavin

 

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