Gonneke,
Just yesterday, my colleage and I were looking in the drawer at our "closed case" files. We have been collecting stats on babies with tongue mobility restriction and keep those files separately. Well, the folder of closed non-tongue mobility problem files was much thinner than the other. So many of the babies who present to us with breastfeeding problems seem to be affected. That, or we are crazy.

Isabella Knox was the first person to notice a difference in gender distribution between anterior and posterior tongue ties. Anteriors occur at the rate of about 2 or 2.5 boys for every girl, while posteriors occur equally with both genders. Data from my own institution and others confirmed her observation. This suggests to me that perhaps there are different etiologies involved. I personally am leaning towards environmental factors, especially after reading an article about an increased incidence of tongue-tie among babies born to mothers who ingested cocaine during pregnancy. What other substances might have the same effect? Tongue-tie and resultant tongue mobility restriction represents a failure of the tongue to separate normally during fetal development.

I do also think that genetics may play a role in overall vulnerability to such environmental factors, as might the overall burden and timing of exposure. Different populations may have different exposure rates and/or genetic susceptibilities.  

I don't think we are crazy and I don't think that it is "just" that we are identifying more that used to slip by. I think there is more than should be occurring in nature, and that we need to be asking these questions and looking for answers.

Lisa Marasco, MA, IBCLC, FILCA

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