An article in The New York Times published in late 2023, Inside the Booming Business of Cutting Babies’ Tongues, has stirred up the controversial topic for feeding practitioners of when or when not to recommend frenectomy procedures (correction of lip-ties, buccal-ties and/or tongue-ties). As an occupational therapist and mother of a child who had a lip-tie correction, I have seen the benefits these procedures have had on nursing and eating solids, however; I have also been witness to the significant increase in these procedures, which are done when not always necessary. I have outlined some key information on the subject to help parents make the most informed decisions.
What Are Tongue-Ties?
A small percentage of babies have a tongue that is tied so tightly down, they cannot latch or nurse well or may cause pain to their mother when nursing. In addition to tongue-ties, a baby may have a frenulum that ties their top lip close to their gums or buccal ties that tie their cheeks close to their gums. This tightness in the mouth can also potentially negatively impact bottle feeding or eating solids, due to their limited motion in the mouth.
Who Treats Tongue-Ties?
Often a midwife or lactation consultant will identify a tongue-tie when they see a mother having difficulty nursing. Ties can also go unidentified for many months or may not show up until there are issues with feeding when a baby starts solids. A specialized dentist, oral surgeon or ENT (ear nose and throat specialists) can perform the procedures to clip the ties with scissors or a laser. The procedures can range from $200-$1250+.
There are bodywork specialists who can help with the stretching of the mouth to help avoid having a frenectomy or to help co-treat with a procedure for better outcomes. These specialists include chiropractors who specialize in ties or craniosacral facial therapists (who are typically a lactation consultant, occupational therapist, or speech therapist).
The Rise of More Frequently Performed Frenectomy Procedures:
Some versions of clippings have been done for centuries by pediatricians and midwives, which consisted of a quick snip under the tongue to increase movement. These clippings often naturally healed with breastfeeding and there was little follow-up. With an increase in mothers nursing with campaigns such as “Breast is Best,” there has been a recent steep increase in these procedures (up to 800%). The New York Times article cited above, identified three driven forces in healthcare that are harming patients by performing procedures that may be unnecessary:
- Doctors have financial incentives to perform the procedures. Doctors are not always paid a salary and part of their pay could be tied to the procedures they are performing.
- There is a push for the medical device companies (such as the laser companies used for frenectomies) that make these procedures possible. The medical device companies often provide loans to help practitioners buy the equipment or lend them the money they need to help set up the clinic to perform the procedures.
- There is a large information void for medical advice that many doctors take advantage of to perform these procedures.
Benefits and Risks of Frenectomies:
There is limited evidence-based research on the benefits of frenectomies on helping with babies nursing, but some evidence suggests they can help with the pain of the nursing mothers. However, every mother-baby dyad is unique and it is difficult to measure the benefits when there are so many factors involved in feeding. Personally and antidotally, I have seen babies’ latch for nursing and bottle feeding significantly improve after having a procedure. In addition, a mother’s soreness of nipples due to shallow latching could improve or the babies’ ability to explore and chew food could improve.
Risks involved include: babies developing oral aversions, malnourishment, or acquiring of a feeding tube. Some parents have reported the procedure leaving large sores in their baby’s mouth. A practitioner may also not explain pre-procedure or post0procedure stretches well, which could lead to re-attachment of the tissues and the procedure needing to be re-done.
In Conclusion:
If you are having difficulty nursing, schedule an appointment with a lactation specialist (IBCLC), occupational therapist or chiropractor, who could assess your unique situation. The main concern you should be treating is function (if your child is eating well and gaining the appropriate amount of weight). If the child is having difficulty feeding or the mother is in pain from nursing, try to have the practitioner help identify if a tie correction would be helpful.
Once you think you may be interested in a frenectomy, you can schedule a consult with a dentist, oral surgeon or ENT. Keep in mind the incentives the practitioner who performs the procedure may have and schedule a second opinion with a different practitioner if you would like to compare opinions. Knowledge is power, so gather all the information you can to make the best decision possible for you and your child.