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October 2011

cut the frenulum

Tongue-tie occurs in up to 10% of newborns and can affect breastfeeding and even speech.

Article by Dr Luisa Dillner in The Guardian

So should you cut the frenulum?

What is it?

For a relatively minor congenital problem, there is some controversy about tongue-ties.

Tongue-ties affect 3%-10% of newborns and are diagnosed when the baby is checked over by the midwife or doctor. The tongue is usually only loosely connected to the floor of our mouths, but in tongue-tie the tissue connecting the two (called the frenulum) is shorter and tighter. It can vary from a thin membrane that can break naturally, to a thick and fibrous tissue that restricts normal movement. Most tongue-tie is mild and stretches as the baby grows.

Professor Mitch Blair, a consultant and officer for health promotion at the Royal College of Paediatrics and Child Health, says tongue-ties used to be routinely snipped, but some doctors now think the risk of infection and tongue damage means babies should be watched, not automatically cut.

But watched for what? They may have problems breastfeeding, be unable to suck properly, fail to put on weight and give their mothers sore nipples. They may struggle with bottles because their mouths can’t form a seal round the teat. Tongue-tie might also interfere with speech development (lisps or mispronouncement of Ls as Ws). There are studies showing that adults with tongue-tie have problems licking ice-creams or kissing. So is it better to snip the frenulum just in case?

The solution

In 2006, health watchdog Nice concluded there was controversy about the significance of tongue-tie and that only children whose tongue-tie is causing problems should have frenulotomy. So, first of all find out if the tongue-tie is affecting feeding. A doctor or expert in breastfeeding should watch feeding to see if the tongue-tie is causing problems. There isn’t always a correlation between what the tongue-tie looks like and what it does. A survey of lactation consultants and paediatricians found the former much more likely to blame tongue-tie for poor feeding, so advice may differ. Some doctors wait to see if the baby is losing weight, while others think this is going too far. The frenulotomy, however, should be done using local anaesthetic by an experienced operator. One study, comparing frenulotomy with 48 hours of support from a lactation consultant, found 19 out of 20 babies had better breastfeeding 48 hours after frenulotomy, compared with one in 20 whose mother had the support. Even allowing for some bias – a mother who allowed frenulotomy may be more motivated to say it worked – the number is still high. Complications are rare but include ulcers under the tongue, bleeding, infection or damage to the tongue and salivary ducts.

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