Dear friends

There seems to be ever-growing support of the diagnosis of
tongue-tie, and the need for babies to have their ties snipped.  A
recent post describes how tongue-ties would have been snipped at
birth without ever telling the mother.  Others I've seen, either on
this list or another, describe ties that have been snipped two or
three times, because the first one didn't "work" and the
breastfeeding difficulty attributed to the tie didn't resolve after
the first procedure.

I confess to being concerned.  It seems that we are seeing tongue-tie
behind every bush (it reminds me of the way we used to ascribe every
case of sore nipples to Thrush a few years ago).  My question is
this:  what is the incidence of tongue-tie (posterior included) in
the babies that you see?  On the rationale that the human race has
survived for xxxx millions of years, and that breastfeeding has been
directly responsible for keeping our babies alive for long enough to
mature into little people capable of eating/thriving on other foods,
how can it be that such a "fault" as tongue-tie has not caused the
species to die out before now??

Please understand, I'm not discounting that tongue-tie exists;  it
does.  But it seems that we are attributing every breastfeeding
problem to it nowadays.  That worries me.

In my private practice (1991-2003) I saw over 3000 mother-baby
pairs.  Since I made a visual oral exam on every single baby, I also
saw a fair few tongue ties, but never one so serious that it
prevented, or turned out - in the end - to have materially impacted
successful breastfeeding in any way.  I realize that there could have
been an element of luck in this, ie I saw tongue-ties, and
heart-shaped tongues, but never one that was tethered to the tip, and
never one that prevented the baby's tongue being able to cover the
lower gum.   My standard of care was  1) to identify this for the
mother, 2) warn her that tongue-tie had been identified in the
literature as a possible cause of sore nipples and inadequate weight
gain, 3) that all tongue-ties used to be snipped, but that nowadays
(before 2003) it was no longer considered to be necessary UNLESS it
caused problems and 4) to suggest that if either of (2) happened she
might like to contact me again asap so that the situation could be
re-evaluated.   I'd then flag "tongue-tie" on my notes as a special
risk factor indicating the need follow them up closely and work to
facilitate good positioning etc. if any sore nipples developed or if
there was a problem with weight gain.  I never saw more extreme sore
nipples in mothers of tongue-tied babies, nor sore nipples that
persisted more than just a few days.  Importantly, not one of those
babies had any problem at all with normal weight gain on exclusive
breastfeeding.  In fact, one of them (only one!) had his tie snipped
at 8 months because the paediatrician was concerned that it might
impact his speech later; at that time he was chubby and still
breastfeeding and there had been no effect whatsoever of the tie on
his mother's ability to breastfeed.

Could be that I was influenced by my own experience.  When my first
baby was about 3 weeks old, a community nurse told me he had a tongue
tie. I was horrified, of course, to think that my perfect baby might
have something wrong, but she told me not to worry.  I learned that
tongues grow so that what seemed to be a noticeable tie at birth may
turn out not to be noticeable at all later.  By that time my sore
nipples had already resolved and my baby was gaining weight well on
nothing but breastfeeding.   Later our dentist told me it should be
left unless it interfered with his speech, and was satisfied with the
way he could say, "sausages".   Actually, now that he's all grown up
and because I know, I can identify the tiniest effect on 's' sounds,
compared to his non-tied brothers, but I doubt that anyone else
notices and no-one else has ever remarked on it.  It's only me,
because I'm looking!   But as to the effect of the tie on
breastfeeding, there was absolutely none.  Maybe my confidence about
breastfeeding a baby with a tongue-tie was conveyed to the mothers I
worked with?  If so, is that a placebo effect?

Nevertheless, instilling confidence aside, I'm still concerned about
what's happening with all the current focus on tongue-ties causing so
many problems?  What percentage of babies that you work with do you
consider need to have their ties snipped?  Is this a "problem" that
is being over-diagnosed?

Pamela Morrison IBCLC
Rustington, England

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