It's so good to see this discussion about the prevalence of tongue 
tie.  I realize that a lot more has been learned about tongue tie in 
recent years, but I have to confess that I'm beginning to be really 
concerned about how very frequently this diagnosis is being 
made.  It's reminiscent, in many ways, of the frequency with which 
Thrush was cited as the cause of sore nipples several years ago, and 
endless treatments suggested, but still the pain and damage didn't 
resolve.  And then we discovered bacterial infections.....

This is only a sample of one, but as an LC who worked in private 
practice for 13 years, and who saw slightly over 3000 mothers and 
babies in that time (all races, many different nationalities) and 
babies from the first day of birth, sometimes the first hour (I had 
hospital privileges) up to nursing children of 6.5 years, I did not 
see even one tongue tie that required frenotomy in order that a 
non-latching baby could latch, or a sore nipple could heal or a 
non-thriving baby could start to gain weight.  In short, I didn't 
find it necessary, while facilitating and preserving effective, 
pain-free breastfeeding, to refer even one baby to another 
practitioner for tongue tie, although I did have one mother whose 
paediatrician recommended frenotomy at 9 months because he was 
concerned that the tongue-tie would impede normal speech.  I went 
frantically back to my notes for that baby, seen on the first day of 
life, and saw that I'd described the tie, advised the mother and 
given my usual spiel about possible risks;  that if  the mother 
experienced nipple pain/damage, or if the little one didn't gain 
weight well then please come back and see me again.  She hadn't 
needed to, and the baby grew fine, but the paediatrician now thought 
it was time to snip.  What I'm saying is that while working to help 
babies latch, to resolve sore nipples, to work with many, many 
low-gain babies, and while seeing a fair percentage of babies who had 
mild to medium degrees of tongue tie, I didn't see even one baby 
whose tie was so severe that it actually caused a breastfeeding difficulty.

I can't believe that of all the 20 000 or so LCs on the planet I'm 
the only one who has been so lucky.  Breastfeeding initiation rates 
were 99.6%, and while about 75% of the babies I saw were experiencing 
a wide range of breastfeeding difficulties, about 25% of my clients 
were mothers who requested LC consults because they wanted to do it 
right from the beginning (preventive rather than therapeutic 
care).  So there were varied races, varies ages, and a wide range of 
scenarios, but no very severe tongue-ties.  I belong to several 
lists, so LACTNET is not the only place I hear about perceived 
tongue-tie difficulties, but some of the case histories, and the 
sheer volume of them, are starting to bother me.  Please understand 
I'm not saying that I don't believe that tongue-tie doesn't 
exist;  it does.  But I do wonder if tongue-tie as a cause of 
breastfeeding difficulties and requiring intervention is being 
over-diagnosed?  When I hear about tongues being snipped and the tie 
growing back again and having to be separated two, three or four 
times (!!!) while still the problem of the sore nipples or the 
non-latching or the low gain persists, then I can't help wondering if 
the cause of the problem is not something _else_.  And whether the 
focus on the tie is not hindering further investigation?  Or being 
snipped as a first, instead of as a last resort?  If prevalence is 
about 4%, yet some 30-50% of babies' lingual frenula are being 
snipped nowadays, the maths doesn't add up.  Apart from anything 
else, one wonders how the human race survived to the present day if 
ankyloglossia is both so prevalent and so problematic.

More information about the stats and others' experience would be very 
welcome :-)

Pamela Morrison IBCLC
Rustington, England (formerly Harare, Zimbabwe)



   

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