Breastfeeding, tongue-tie and frenotomy is still a controversial issue. Online, there are many different Facebook parenting groups providing family to family information about tongue and lip-tie. As well, there are professional groups providing support and information to both families and to the multidisciplinary professionals who together support these families. The goal is to provide evidence-based information and encourage further research in this area.
Families need current unbiased information and support from their healthcare providers so they can make informed decisions about the care or treatment of their infants. This should be no different for families with tongue or lip-tied infants.
In 2004, the AAP published an article by Dr. Elizabeth Coryllos and colleagues entitled, Congential Tongue-Tie and it's Impact on Breastfeeding which provided important information about presentation, assessment, diagnosis and treatment of tongue-tie. The authors also addressed the issues associated with breastfeeding an infant with a tongue-tie.
The AAP has this year published an article on breastfeeding with tongue and lip-tie by Dr. Jennifer Thomas and Dr. John E. McClay. This article entitled, Breastfeeding: what to do about ankyloglossia, lip-tie addresses the difficulties that can occur with breastfeeding an infant with tongue and lip-ties. This article also includes the results of the Agency for Healthcare Research and Quality report entitled, Treatments for Ankyloglossia and Ankyloglossia with Concomitant Lip-Tie. The authors of this report endeavoured to answer the following questions:
- What are the benefits of treatments, including frenotomy by clipping or laser, complementary and alternative medicine therapies (e.g., craniosacral therapy), lactation intervention, physical/occupational therapy, oral motor therapy, and stretching exercises/therapy in breastfeeding newborns and infants with ankyloglossia?
- What are the effects of these treatments on medium and long-term feeding issues?
- What is the benefit of frenotomy and upper lip-tie clipping at the same time?
Not all of these questions could be answered because of gaps in the research yet the report did conclude as follows:
"A small body of evidence suggests that frenotomy may be associated with improvements in breastfeeding as reported by mothers and potentially in nipple pain. However, with small, inconsistently conducted studies, strength of evidence is low to insufficient, preventing us from drawing conclusions at this time."
Evidence does support claims that maternal pain while breastfeeding is improved, but surgical intervention for other postulated problems caused by a tongue-tie is not evidence-based or, like lip-tie, has not been studied adequately. Those who do see imporvement with frenotomy are careful to caution that the limitation on function, not just the anatomical appearance, should be the reason any intervention is done.
This article will hopefully encourage our professional colleagues who are helping families with breastfeeding difficulties and infants with tongue and or lip-tie to continue to conduct and publish research on this subject. This also reminds us that families need to know that a team approach with experienced health care providers who can assess breastfeeding is important. Releasing only the tongue and or lip-tie without lactation support may not be best practice.
Until next month,
Carole and Lenore