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Does My Baby Need Tongue-Tie Surgery for Breastfeeding?

Research Findings

A new study from the Pediatric Airway, Voice and Swallowing Center at Massachusetts Eye and Ear raises questions on the minds of parents struggling with breastfeeding.

Breastfeeding is a choice many parents make for their newborn. But it can be difficult,  as some newborns have trouble latching, getting enough milk, and as a result, gaining weight.

Struggling parents often seek consultations with pediatricians, lactation consultants, and other medical and dental providers. Occasionally, these providers may spot a piece of tissue some babies are born with that connects the tongue to the floor of the mouth, or the upper lip to the gum, both of which inhibit movement. If that’s the case, these professionals may recommend tongue-tie or upper lip-tether release surgeries (also called a frenulectomy).

Although these surgeries are considered minor and have increased in popularity, new research out of Mass. Eye and Ear suggests babies with tongue-ties may not need the procedure to breastfeed successfully.

Success for many children without surgery

In the study published in JAMA Otolaryngology—Head & Neck Surgery, researchers found that more than 60% of newborns referred for surgery did not need the procedure following an evaluation by a pediatric speech-language pathologist.

Tongue-tie surgery has become more popular as more public health initiatives support breastfeeding, despite a lack of evidence it might help, say the study’s authors. One database found U.S. surgeries increased from 1,279 in 1997 to 12,406 in 2012.

“Some babies really do benefit after surgery,” says senior study author Christopher Hartnick, MD, director of the Pediatric Airway, Voice and Swallowing Center, and chief of Pediatric Otolaryngology at Mass. Eye and Ear. “This study, however, suggests parents and providers should pause, and ask, is there an alternative solution?”

The surgery is considered safe, but Dr. Hartnick tells families “parental trauma” about having a procedure done to their child can be a side effect, on top of guilt that comes with breastfeeding challenges. Cost can also be expensive for some families as insurance coverage varies.

One family’s perspective

Amy and Seth were among the many parents who faced these decisions and feeding challenges with their newborn, Sophia, this past year. Shortly after birth, the hospital pediatrician saw a tongue-tie and the procedure was done immediately, but feeding difficulties persisted throughout their stay and once at home. They sought evaluations with a lactation consultant for a month as the many techniques they tried did not yield the results they had hoped. Amy had to nurse 10 times a day for 40 minutes, in addition to pumping, to try and help her daughter’s weight gain.

“And while you’re doing this around the clock, you’re constantly worried your baby is not getting enough milk,” Amy recalled to Focus.

Amy, a speech-language pathologist, had been describing these challenges to her lactation group, when she learned that Cheryl Hersh, MS, CCC-SLP, a pediatric speech-language pathologist at Mass General, was co-leading a study on children like Sophia at Mass. Eye and Ear.

During the group session, Cheryl observed Amy feed Sophia and was able to identify that a lip tether, which hadn’t been noticed by the first pediatrician, was affecting feeding. Unlike families who had been told they didn’t need surgery, Cheryl recommended Sophia receive lip-tether surgery, and referred her to Dr. Hartnick.

“This is a study that tells us the pattern we’re going on may better identify which babies need the procedure, and which babies can be spared the surgery,” explains Cheryl. “We’re not clipping the tissue just because we see it, we’re not sending parents away, and we’re not giving them weeks of trying techniques without a surgical consult,” she said.

The family met with Dr. Hartnick and Sophia got surgery one week later.

“During the first feed at home after the surgery, Sophia latched immediately,” said Amy. Now five-months-old, Sophia is doing terrific.

Following her family’s experience, Amy advises parents to educate themselves as it gave them the confidence to move forward with surgery. The study’s authors add that it is important to get medical opinions from different clinicians when it comes to getting the best diagnosis for a breastfeeding issue.

“When I look back, I feel beyond proud of Sophia, and proud that Seth and I persisted,” said Amy.

Authors of the JAMA Otolaryngology study include Christopher J. Hartnick, MD; Christen L. Caloway, MD; and Gillian R. Diercks, MD, at Massachusetts Eye and Ear/Harvard Medical School; and Cheryl J. Hersh, MS, CCC-SLP; Rebecca Baars, MS, CCC-SLP; and Sarah Sally, MS, CCC-SLP, at Massachusetts General Hospital.

Read more about the new study in:

The New York Times:  Is Tongue-Tie Surgery Necessary for Breastfeeding Success?

NBC News: More Babies Getting Their Tongues Clipped to Help Breastfeed. But is it Necessary?

HuffPost: Are We Overdiagnosing Tongue-Tie In Breastfeeding Newborns?

Reuters: Surgeries to Help Newborns Nurse May Have Become Too Common 

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