Tongue Tie and Breastfeeding: of the Gap or Another Hype?

Tongue tie (ankyloglossia) is where the strip of skin connecting the baby’s tongue to the floor of their mouth is shorter than usual. Some babies who have tongue tie don’t seem to be bothered by it. In others it can restrict the tongue’s movement,making it harder to breastfeed. Tongue tie is sometimes diagnosed during a baby’s routine newborn check but it is not always easy to spot. Tongue tie affects around 4-11% of newborn babies.It is more common in boys than girls and sometimes runs in families.Babies with tongue tie are not able to open their mouth wide enough to latch on the breast properly.They may have difficulty attaching to the breast or staying attached for a full feed,feed for a long time and be unsettled and seem hungry all the time.They may not gain weight as quickly as they should and can make a “clicking “sound as they feed [13]. Tongue tie can cause problems for a breastfeeding mother as sore or cracked nipples,low milk supply or mastitis. Recently,the subject tongue tie and breastfeeding received much attention in the press and media [4-7]. Tongue tie surgery is sky-rocketing in Australia. During 2006-2016 52.473 Medicare frenotomy items for 0-4 year old children were recorded;the rate increased from 1,22 per 1000 population in 2006 to 6,35 per 1000 in 2016.These data do not capture frenotomies performed by dentists by CO2 laser frenotomy [8]. Between 1997 and 2012 the U.S. showed an increase in frenotomies of 886% [9] and Canada (2004-2013) an increase of 89% [10]. Ths raises the question of whether this surgical management is supported by sufficient evidence [11,12]. In this mini-review pathogenesis,pathophysiology,course and treatment of tongue tie will be discussed.