Tongue-tie in babies may be overdiagnosed and needlessly treated, AAP says

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Studies have shown a growing number of infants being diagnosed with ankyloglossia – a congenitally tight lingual frenulum that limits the motion of the tongue, more commonly referred to as tongue-tie.

But a new clinical report, conducted by the American Academy of Pediatrics, said the condition may be overdiagnosed in the U.S. and too often treated with unnecessary surgery.

"There is a lack of consensus for treatment of ankyloglossia, leading to wide practice variation in the United States and internationally," the prominent doctors’ group wrote in its report released Monday. "At the same time, the diagnosis of ankyloglossia and the frequency of performing a frenotomy has increased recently worldwide."

The AAP is the latest, and largest, medical society to sound an alarm about the increasing use of scissors or lasers to cut away some infants' tongue tissue when breastfeeding is difficult.

"It's almost an epidemic," Dr. Maya Bunik, a Colorado-based co-author of the report, told the Associated Press.

In the report titled "Identification and Management of Ankyloglossia and its Effect on Breastfeeding in Infants," the academy said the increased rate of the surgery is fueled partly by economic incentives for healthcare providers, which has led to a surge in the number of clinics and specialists offering tongue-tie surgeries.

In addition, they said social media has increased awareness of ankyloglossia, and online communities often pressure parents to seek surgical procedures when breastfeeding difficulties arise.

"Many medical professionals, however, have expressed concerns regarding the overdiagnosis of tongue-tie and surgeries that may not always resolve breastfeeding issues," AAP said in a press release.

What is tongue-tie?

Ankyloglossia, or tongue-tie, occurs when an infant is born with a tight or short band of tissue that tethers the bottom of the tongue’s tip to the floor of the mouth. The condition can make it hard for the infant to extend and lift their tongue to grasp a nipple and draw milk — which in turn can be painful for the mother.

Maternal pain is one of the most common complaints and can occur if the infant’s tongue cannot extend and elevate due to a restrictive lingual frenulum, according to the academy. Pain can lead to poor milk transfer and insufficient growth as well as premature cessation of breastfeeding.

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One common treatment is to cut the tissue with scissors, but dentists increasingly are using lasers to vaporize the tissue — some charging $800 or more.

Experts say there isn't a good count of how many infants each year are being treated for tongue-tie with surgery, though Bunik believes the annual tally may exceed 100,000.

But the procedures can cause pain and sore mouths, potentially deterring babies from trying to breastfeed, Bunik said.

Wisconsin pediatrician Dr. Jennifer Thomas, who also co-authored the report, added: "The practice (of treating tongue-tie) got to be very common without a lot of good data."

AAP noted that most difficulties with breastfeeding, including pain, are not due to ankyloglossia, and the differential diagnosis of feeding problems in newborns is extensive.

AAP says to prioritize nonsurgical interventions

AAP said it recommends prioritizing nonsurgical interventions and fostering a collaborative care model to help ensure successful breastfeeding outcomes.

The AAP continues to recommend exclusive breastfeeding for about six months, with continuation for two years or longer as mutually desired by the mother and infant.

Breastfeeding problems are common, so the Academy said pediatricians should be able to provide practical advice on techniques or refer to lactation specialists when necessary.

The AAP, which has 67,000 members who specialize in treating children, started working on the report in 2015 after some pediatricians began to notice that an increasing number of patients were going to dentists to get treatment for tongue-tie, Thomas said. Pediatricians were finding out 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 statement in which member physicians said they believe tongue-tie is being overdiagnosed in some places and that there isn't sufficient evidence to support claims that using lasers is superior to other techniques.

A year later, the Academy of Breastfeeding Medicine, an international group, issued a position called for more research into tongue-tie treatment and stressed that decisions "require a high level of clinical skill, judgment, and discernment."

The new report will be published in the August issue of Pediatrics.

This story was reported from Los Angeles. The Associated Press contributed.