Web address:
     http://www.sciencedaily.com/releases/2010/07/
     100701183603.htm  
Treating Tongue Tie Could Help More Babies Breastfeed
ScienceDaily (July 5, 2010) — Doctors advise new mothers to breastfeed for at 
least the first six months of a baby's life, but a simple yet often untreated 
problem can sabotage their efforts, University of Florida researchers say.
Called a tongue tie, the problem occurs when the connective tissue under the 
tongue is too tight. A tongue tie can hinder some newborns from being able to 
breastfeed properly and painlessly, and this struggle can lead many new mothers 
to give up breastfeeding.
A simple snip can fix the problem, but many doctors still do not perform the 
procedure despite the effects a tongue tie can have on breastfeeding, writes UF 
neonatologist Sandra Sullivan, M.D., in an article published online this month 
in the journal Pediatrics.
"It is called a frenotomy, and it is far simpler than a circumcision, which we 
do fairly routinely," said Sullivan, an assistant professor of pediatrics and 
the lead author of the report. "It literally takes longer to fill out the 
consent form for the procedure than to do the actual procedure itself."
The problem is many practicing doctors were taught that the procedure is not 
medically necessary, Sullivan says.
But for babies to breastfeed effectively, their tiny tongues have to be able to 
perform a more complex type of sucking than what it takes to drink from a 
bottle. A tongue tie can hinder baby's efforts to move his tongue up, down and 
out, which he would need to do in order to nurse.
"If you take a bottle with an artificial nipple, there is not a lot a baby has 
to do to get milk," Sullivan said. "To get milk out of the breast, they have to 
make a vacuum and if they cannot get their tongue to the roof of their mouth, 
they cannot do this. They also need to use their jaw and tongue to move the milk 
along through the milk ducts in the breast.
"If they just bite on the nipple (like a bottle), first, it hurts (the baby's 
mother) a lot and second, it blocks off all those little tubes, which keeps the 
milk stuck in the breast."
Studies show about 2 percent to 5 percent of babies have constrictive tissue 
under the tongue and about half of those babies have problems with 
breastfeeding, said Isabella Knox, M.D., Ed.M, an associate professor of 
pediatrics at the University of Washington. About 4 million babies are born in 
the United States annually, meaning that between 40,000 and 100,000 babies are 
born each year with a tongue tie problem.
"That's a lot of babies," Knox said. "I don't think general pediatrics training 
gives us a lot of skills in supporting breastfeeding. A lot of pediatricians 
have lactation consultants, but we don't really know how to help somebody and 
for some people it is not always a priority."
In Sullivan's report in Pediatrics, she describes a patient who ended up in the 
hospital with feeding and growth problems, which could have been avoided if his 
tongue tie had been corrected as a newborn.
The baby's mother was following expert advice and exclusively breastfeeding. She 
had noticed the problem when her child was born, but doctors told her not to 
worry about it. Eventually, she was referred to an oral surgeon, but was told no 
one would operate on the baby until he was at least 6 months old.
To his parents, whose eldest child had been premature and small, the baby seemed 
to be growing. But by the time he was 6 months old, he weighed less than he did 
at birth, Sullivan says. "He gained about 2 pounds in a matter of 36 hours in 
the hospital, and all we really did was fix his tongue," Sullivan said. "This is 
just one example, an extreme example, of what happens when you do not fix this 
problem."
According to the American Academy of Pediatrics, breast milk is considered the 
optimal food for babies. Studies have shown that exclusive breastfeeding offers 
infants some protection against diseases and common childhood illnesses, such as 
ear infections.
"Breastfeeding is best for babies, and we want to encourage mothers to 
breastfeed and do it successfully for as long as they would like," said Jerry 
Isaac, M.D., a pediatrician and past president of the Florida chapter of the 
American Academy of Pediatrics. "This (paper) is an important piece of 
information adding to the body of knowledge that this may be a significant 
problem in some babies."
Sullivan is part of an international organization focused on issues related to 
tongue ties. She and other members of the group's screening committee are 
working to develop a screening tool that would help nurses quickly screen for a 
tongue tie while assessing the baby after birth.
"There is not a lot of literature about frenotomy, and there are still a lot of 
doctors who say, 'Is this really necessary?'" Sullivan said. "Whether or not 
there is an epidemic or whether we ignored tongue ties and are looking for them 
now, this is something that is coming up more often in nurseries."
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The above story is reprinted (with editorial adaptations by ScienceDaily staff) 
from materials provided by University of Florida, via EurekAlert!, a service of 
AAAS.
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University of Florida (2010, July 5). Treating tongue tie could help more babies 
breastfeed. ScienceDaily. Retrieved July 6, 2010, from 
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