Katherine, and all who responded

Firstly, thanks for asking this question, and for all the other 
thoughts that have been sent in. Mine may be the only dissenting 
voice, but I must say I'm becoming concerned with what I begin to 
suspect is over-diagnosis of tongue-tie problems.  I worked in 
private practice for 13 years, saw just over 3000 mother-baby pairs 
(doing an oral exam with every one) and because I had hospital 
privileges was able to identify tongue-tie in the first day or two of 
life, and then follow up with face to face consults as necessary once 
mothers were home.  I think I can safely say I saw a lot of 
non-problematic tongue ties, which I'd identify for the parents, 
assess the breastfeeding and give anticipatory care.  I'd always give 
mothers information about two potential difficulties associated with 
tongue-tie which had been identified - the possibility of on-going 
sore nipples for the mother, and/or the possibility of inadequate 
breastfeeding effectiveness (low intake, low weight gain) for the 
baby.  I asked parents to contact me again if either of these 
scenarios occurred so that we could review their individual circumstances.

In all those years I must have been lucky, to be sure, because I 
never saw a tie which tethered the tongue at the tip - the worst 
cases I've ever seen have been in pictures in our literature.  There 
were many cases of medium to mild tongue tie, and I made sure that I 
followed them all up as being somewhat at risk.   But not one 
interfered with attachment, caused nipple damage that couldn't be 
resolved by paying meticulous attention to good positioning and 
attachment, and there was not one case of inadequate intake due to 
tongue tie.  I did have _one_ case of a baby I'd seen at birth where 
the paediatrician suggested that the baby's tie be snipped at nine 
months of age, because he said it might interfere with speech.  I 
went scrabbling through my notes to see if I'd missed anything.  But 
no, the mother was breastfeeding just fine - there had never been any 
weight issues or undue nipple damage.

Could be I was influenced by my own experience.  My eldest son has a 
tongue tie (as does his father).  A clinic midwife who identified it 
told me that in the old days all ties were snipped, but that the 
recent thinking (this was in 1977) was to leave them because over 
time the tongue would grow and be less tied.  My dentist said if my 
little boy couldn't say "sausages" clearly by the age of 4, then it 
would need to be snipped, but also suggested the tie be left.  So 
that's what we did.  It's still a bit tied, but otherwise there are 
no problems.    I had sore nipples for the first week, but they 
resolved and he gained weight well on exclusive breastfeeding for 
five months, and happily continued breastfeeding for nearly a year - 
in retrospect I really wish it had been for longer, but I didn't have 
access to an LC then and the early weaning was not a result of tongue-tie.

What concerns me is how many latching difficulties, weight gain 
issues and sore nipples are attributed to tongue tie now.  I've just 
had a little browse around on the net, and I belong to other 
lists.  Seems that mothers diagnose each other, that tongue tie is 
diagnosed by counsellors and supporters over the phone and that 
sometimes ties are snipped twice, three or even four times, and still 
the original breastfeeding difficulty persists (the pain, the low 
gain ...)   It reminds me of when we used to see so much 
Lactose-Intolerance Colic, or so much nipple Thrush, until our 
knowledge evolved showing that block-feeding might be just as harmful 
to breastmilk synthesis as feeding 10 minutes a side, or 
that  bacterial infections might also cause ongoing damage and 
pain.  I realize that as LCs we are likely to be asked to help with a 
higher proportion of tongue-ties than occur in the general population 
(~2%??) but shouldn't we be moving from the most likely to the least 
likely cause of a particular difficulty - and how likely really is 
tongue-tie?  Are we starting to see Tongue Tie behind every bush, 
when we should really be looking for other causes??   Most 
especially, if a frenulotomy doesn't fix the problem, shouldn't we be 
reviewing _other_ causes of latching difficulty, inadequate milk 
transfer or ongoing nipple trauma rather than snipping again, and 
again and again???

This was the latest review article I could find:  J Periodontol. 2009 
Aug;80(8):1204-19. Ankyloglossia: facts and myths in diagnosis and 
treatment. Suter VG, Bornstein MM. 
http://www.ncbi.nlm.nih.gov/pubmed/19656020?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed

Just my 0.2ml - no flames please!

Pamela Morrison IBCLC
Rustington, England
----------------------------------------------

Date:    Sat, 9 Jan 2010 10:52:47 -0500
From:    Katherine Morrison <[log in to unmask]>
Subject: Tongue tie not a problem

How often are you all seeing non-problematic ankyloglossia?

I've always assumed it's always a problem to some degree but I realize that
could be because I *only* have contact with moms who are having problems -
generally major problems.   Many of you see moms routinely in the hospital
before problems have occured.

Just curious,
Katherine

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