Perhaps this is what he is referring to. It is from the Agency for
Healthcare Research and Quality.
Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-
reports/?productid=2073
<http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and
-reports/?productid=2073&pageaction=displayproduct>
&pageaction=displayproduct
The conclusion of this study is:
"A small body of evidence suggests that frenotomy may be associated with
improvements in breastfeeding as reported by mothers, and potentially in
nipple pain. However, with small, inconsistently conducted studies, strength
of evidence is low to insufficient, preventing us from drawing firm
conclusions at this time. Research is lacking on nonsurgical interventions,
as well as on outcomes other than breastfeeding, particularly speech and
dental outcomes. In particular, there is a lack of evidence on significant
long-term outcomes, such as exclusive breastfeeding at 6 months of age or at
1 year of age, growth, and other measures of health outcomes. Harms are
minimal and rare; the most commonly reported harm is self-limited bleeding.
Future research is needed on a range of issues, including prevalence and
incidence of ankyloglossia and problems with the condition. The field is
currently challenged by a lack of standardized approaches to assessing and
studying the problems of infants with ankyloglossia."
This study DOES NOT say that treatment is not recommended for of tongue tie,
but that the evidence for its effectiveness is lacking. The reason is that
in the U.S. we don't bother measuring what we don't value!!! "GOOD" studies
have evaluating the effectiveness of Frenotomy on infant feeding and
maternal pain versus not treating it have not been done.
Typical primary care providers who encounter this in mothers and infants
don't know enough tongue function or breastfeeding management to assess
it, unless they have closely worked with an IBCLC experienced in the area.
Many physicians, as cited in the study (90% of pediatricians and 70% of
otolaryngologists), flatly don't "believe" feeding problems in infants are
caused by tongue tie. It is not real to them. The article actually cites
many studies finding improved outcomes for breastfeeding infants and nipple
pain improved. They also found that the procedure hard minimal risk of harm.
The REASON we don't have studies on this is because breastfeeding is not
that important in healthcare.
This research was done by a group from Vanderbilt University one quoted as
stating, ""This is a call to action for people to think of this as an
opportunity to do research. One purpose of the literature review is to point
out limitations in the evidence base and encourage people to fill those
gaps."
http://news.vanderbilt.edu/2015/05/surgery-for-tongue-tie-shows-some-benefit
s-more-research-needed/
The beginning of this report states...
"The information in this report is intended to help health care decision
makers-patients and clinicians, health system leaders, and policymakers,
among others-make well-informed decisions and thereby improve the quality of
health care services. This report is not intended to be a substitute for the
application of clinical judgment. Anyone who makes decisions concerning the
provision of clinical care should consider this report in the same way as
any medical reference and in conjunction with all other pertinent
information, i.e., in the context of available resources and circumstances
presented by individual patients."
Sadly, we have one insurer in my area that has already used this to
discontinue payments for infant Frenotomy. Colleagues, no what shall we
do??? As usual the good intentions to investigate this issue have resulted
in unintended consequences.
Judith L. Gutowski, BA, IBCLC, RLC
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