Tongue Tie and other Oral Ties

Over the past few years in Australia there has been an alarming increase in the numbers of infants having surgery for tongue tie release, and also what have been called lip ties and buccal ties. Many of these procedures have involved deep cuts under the tongue with laser performed by a dentist. These babies are often referred without an adequate specialised medical or breastfeeding assessment and the treatment involves laser cuts under the tongue and potentially to other parts of the mouth. Laser  surgeries in the mouth are painful procedures and may lead to oral aversion (not wanting to have anything in their mouths and difficulty with feeding) in infants. In addition there is a risk of serious complications with bleeding and infection and there has been an increase in the number of babies presenting to emergency departments with these complications. These laser procedures are also very expensive, costing in the hundreds of dollars. There is a large amount of information on the internet that promotes and supports division of "oral ties" with laser but in general the internet is not a reliable place to find accurate medical information. Much of the information promoting laser procedures is sourced originally from websites that have a financial interest.

At Mother Baby Clinic we do not support or promote the use of laser cuts in babies mouths.

While tongue tie does exist and can cause breastfeeding problems, the vast majority of babies that we see for second opinions (who have been told that their baby has a tongue tie or other oral ties) do not in fact have these problems. If babies do have a tight tongue tie causing difficulties with feeding it can be easily divided with a pair of sterile scissors. As long as this is done by a suitably trained GP, Paediatrician or Oral Surgeon there is minimal risk of complications. It should be noted that there is no good evidence to support surgery on infants to release "lip ties" or "buccal ties". Many labial frenulums (what have been called lip ties) in infants appear to be very thick and tight but are within the range of normal, and there is no evidence that dividing these improves breastfeeding no matter what their appearance. In addition some babies are said to have a “posterior tongue tie”, a tongue tie which is not obvious, and where there is strong debate between health professionals as to whether this is a condition which exists at all.

Difficulties with nipple pain and trauma, poor feeding and poor infant weight gain may be attributed to tongue tie or "oral ties" when it is in fact related to positional issues with latch and hold or other factors in the woman or her baby. Other concerns with small infants such as cry fuss problems, reflux, unsettled behaviours and gassiness are sometimes said to be caused by  tongue tie but these issues are very common in small infants under 12 weeks (for example, 90% of newborns have reflux) and are not caused by the presence or absence of tongue tie.

Tongue tie may be associated with speech difficulties in early childhood but it is difficult to assess the later impact on speech from the appearance of a tongue tie in a small baby.  To make an accurate diagnosis of tongue tie and in particular to assess if tongue tie release is necessary, the appearance and function of the tongue must be assessed, as well as infant suck, infant feeding, and the woman’s nipple pain and trauma. This assessment requires a highly specialized range of skills.

If it has been suggested to you that your baby has lip ties or buccal ties that require release please be aware that there is no evidence that these procedures are necessary and no evidence that they result in any benefit for your baby in breastfeeding or in any other way. Some babies are diagnosed with a significant tongue tie at birth and the release is done in hospital by a paediatrician. However if tongue tie is diagnosed by another health worker please seek a second opinion.  Mother Baby Clinic can provide a second opinion by a Medical Breastfeeding Specialist and assess any breastfeeding issues as well. If there is a tongue tie that needs release and your baby is under 12 weeks this can be done with sterile scissors either at the time of the appointment or shortly afterwards. If your baby is over 12 weeks or if you prefer it, your baby can be referred to an oral surgeon for the procedure.

If your baby has had a laser procedure and is now experiencing a feeding problem, we can assess and offer a plan of management at Mother Baby Clinic.

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