Surgery to snip the bit of muscle joining the tong to the bottom of the mouth has become a popular fix when babies struggle to breastfeed - but it may not be necessary, a new study suggests.
The procedure, often referred to as tongue-tie surgery has became 10 times more common between 1997 and 2012.
Obstetricians, pediatricians and mommy bloggers are all fond of the mantra, 'breast is best,' but only about a quarter of mother-baby pairs manage to exclusively breastfeed for the first six months of the infant's life.
But new Massachusetts Eye and Ear Infirmary research suggests that babies may be able to learn to breastfeed with training just as well as via surgery.
Breastfeeding confers health advantages like immunity, gut bacteria and growth factors as well as containing a naturally well-balanced set of nutrients.
The Centers for Disease Control and Prevention (CDC) and just about every other major relevant health organization recommends that mothers exclusively breastfeed their babies through the first six months of their lives if at all possible.
However, there are a host of reasons that, in spite of a mother's best efforts, her baby may struggle to breastfeed.
One of those is a condition called ankyloglossia.
More commonly referred to as a 'tongue tie,' between four and 11 percent of newborns in the US come into the world with an unusually short or tight bit of tissue, called the a lingual frenulum, joining their tongues to the floors of their mouths.
This overly-tight connection means the tongue is less mobile, which may make it more difficult for the baby to latch on and suck milk from the mother's breast and may impair speech later in life.
But it doesn't always cause any problems at all.
In addition to a notched or heart-shaped tongue, trouble breastfeeding may be one of the first signs of tongue-tie.
Surgery to fix a tongue tie is simple brief and noninvasive. All it requires is a quick snip to the extra frenulum tissue.
The procedure, called a frenulectomy, just involves a few drops of blood, about 15 seconds of crying (according to previous studies) and no complications to speak of.
But it's undoubtedly painful and unpleasant for an infant and for their family to see.
Still, frenulectomies have become far more common in the last decade.
In 1997, fewer than 1,300 such surgeries were performed.
By 2012, there were 12,406, even though the number of infants born every year was effectively unchanged.
That 10-fold increase raised some eyebrows at the Eye and Ear Infirmary at Massachusetts General Hospital.
Researchers there recruited 115 babies who'd been referred to a specialist for frenulectomy, and first gave them sessions with a pediatric speech and language pathologists to evaluate and work with the mothers and babies.
After working with the specialists, nearly 63 percent of the infants were better able to breastfeed and put on weight and their families opted out of surgery.
Some children have these tissue attachments holding their upper lips too close to their upper gums too, and about 28 percent of the recruited babies had surgery to correct both this and the tongue-tie.
Another 8.7 percent had surgery just to fix the tongue-tie.
Tongue-tie surgeries are often usually considered 'medically necessary' for infants that struggle to breastfeed and are therefore covered by insurance.
They cost about $850 at baseline, if done in a doctor's office without anesthesia, but up to $8,000 or $9,000 to perform in a hospital, under anesthesia.
Rates for pediatric speech pathologists vary widely and may or may not be covered by insurance, but the specialists' rates may run anywhere between $100 per half hour session to $250 an hour.
In the new study, mothers and babies went to the pathologists for between three and 14 days.
And it didn't work for every baby, but for a majority, therapy meant they didn't need the surgery at all.
'We don't have a crystal ball that can tell us which infants might benefit most from the tongue-tie or upper lip release,' said lead study author, Dr Christopher Hartnick.
'But this preliminary study provides concrete evidence that this pathway of a multidisciplinary feeding evaluation is helping prevent babies from getting this procedure.'
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