NEW YORK — Tongue-tie — a condition in babies that can affect breastfeeding — can be overdiagnosed in the U.S. and often treated with unnecessary surgery, a leading doctors’ group said Monday.
The American Academy of Pediatrics is the latest and largest medical society to sound the alarm about the increasing use of scissors or lasers to cut tissue from some babies’ tongues when breast-feeding it is difficult.
“It’s almost an epidemic,” said report co-author Dr. Maya Bunik, a Colorado resident.
Experts say there is no good count of how many children each year are treated for tongue-tie with surgery, although Bunik believes the annual number could exceed 100,000. Research suggests that many of these treatments are not necessary, she added.
The academy’s new report encourages pediatricians and other medical professionals to consider nonsurgical options to resolve breastfeeding problems. The report cites a study that suggests that less than half of children with tongue-tie characteristics actually have difficulty breastfeeding.
Ankyloglossia, or “tongue-tie,” occurs when a baby is born with a tight or short band of tissue that attaches the underside of the tip of the tongue to the floor of the mouth. The condition can make it difficult for a baby to extend and lift its tongue to latch onto a nipple and express milk – which in turn can be painful for the mother.
Doctors say it’s critical to start breastfeeding within the first three to four weeks, and research indicates that most parents want to breastfeed, so it’s natural for them to want a quick solution to a problem, Bunik said.
Diagnoses of ankyloglossia have been increasing worldwide, although there are no uniform diagnostic criteria for this condition and no consensus on how to treat it. A common approach is to cut the tissue with scissors, but dentists are increasingly using lasers to vaporize the tissue — some charging $800 or more.
But the procedures can cause pain and sores in the mouth, potentially preventing babies from trying to breastfeed, Bunik said.
“The practice (of treating tongue-tie) has become very common without a lot of good data,” said Wisconsin pediatrician Dr. Jennifer Thomas, who also co-authored the report.
The report also recommends that lactation specialists, pediatricians and surgeons and other medical professionals work with parents to evaluate possible reasons for breastfeeding challenges and make the best treatment decision.
The American Academy of Pediatrics, which has 67,000 members who specialize in treating children, began working on the report in 2015 after some pediatricians began noticing that a growing number of patients were seeing dentists for tongue-tie treatment, Thomas said. Pediatricians discovered it after the surgeries.
At least two other medical groups have issued statements about tongue-tie. In 2020, the American Academy of Otolaryngology-Head and Neck Surgery issued a consensus declaration in which member doctors said they believe tongue-tie is being overdiagnosed in some places and that there is not enough evidence to support claims that the use of lasers is superior to other techniques.
A year later, the Academy of Breastfeeding Medicine, an international group, issued a statement called to further research into the treatment of tongue-tie and emphasized that decisions “require a high level of clinical skill, judgment and discernment”.
The American Dental Association did not directly respond to questions from The Associated Press about the new report. It sent a statement saying that the organization agrees to a 2022 Policy Statement by the American Academy of Pediatric Dentistry, which noted that not all children with ankyloglossia require surgical intervention and that a team approach with other specialists can help with treatment planning.
Haley Brown consulted a lactation consultant two years ago after her son Shiloh, who was born prematurely, had trouble breastfeeding. But as the months passed and the situation didn’t improve, Brown reached out to a Denver dentist she heard about on social media. The dentist diagnosed Shiloh with tongue tie and also lip tie, where the tissue inside the upper lip is very tight. Shiloh underwent a minor laser procedure that cost $750.
Breastfeeding improved immediately. “Things seemed a little easier for him,” said Brown, 33, of Englewood, Colorado.
Brown later had another baby, and another lactation consultant told her that a scissor cut might have been less messy and just as effective. Brown said the laser treatment worked for Shiloh, but added, “I probably should have consulted my pediatrician before going straight to the dentist.”
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