Baby Tongue-Tie: Eliciting Controversy for Two Thousand Years

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In the early 1970s, breastfeeding in the United States reached an embarrassing all-time low, with only 24 percent of mothers attempt­ing to nurse their newborns.¹ Fast-forward to the present, and the infant feeding picture is quite different. Over 83 percent of babies get a chance at breastfeeding—albeit with one in five receiving supplemental formula within their first two days of life—and at six months, about 56 percent are still nursing, 25 percent having done so exclusively for the first half-year.²

As the number of breastfeeding mothers rises, so does the number of moms encounter­ing breastfeeding challenges. Problems such as breast pain and latching difficulties are among the major factors prompting early discontinu­ation.^3,4 Breastfeeding support and advocacy organization La Leche League International (LLLI) counsels that most such issues can be solved with adjustments to positioning and attachment—but when “good breastfeeding management” doesn’t do the trick, the next step advised by LLLI is to consider tongue-tie and, by implication, tongue-tie intervention.⁵

AN OLD BUT SUBJECTIVE DIAGNOSIS

The lingual frenum (or “frenulum”) is the tissue connecting the underside of the tongue to the floor of the mouth. Tongue-tie (medical name “ankyloglossia”), for some reason diagnosed more often in boys than girls, is defined as an “anomalous”—meaning short or tight—lingual frenum that interferes with “normal” tongue movement. But “anomalous,” it turns out, is a rather subjective term.⁶ There is no meaningful consensus on how common infant tongue-tie even is, with estimates ranging from a low of under 1 percent to a high of about one in ten babies.⁷

In cases where tongue-tie is diagnosed and deemed—often subjectively—to cause breastfeeding problems, babies may end up undergoing a procedure called a frenotomy or “surgical release” (or a related procedure called “frenectomy”). Frenotomy typically is performed by either a pediatric dentist or ear, nose and throat (ENT) doctor and involves the cutting or clipping of the lingual frenum, either with laser or sterile scissors.

This sounds straightforward, but in 2019, concerned researchers called attention to the complete lack of evidence that “would enable an understanding of what encompasses normal [lingual frenulum] anatomy.”⁶ They also empha­sized that no “clear anatomical variables have been identified that have direct correlation with limitation of specific tongue movements, or im­provement in any objective outcome measures following frenotomy.”

As it turns out, the controversy about tongue-tie and surgical intervention dates back millennia.⁸ Early writers not only argued about the wisdom of tampering with the tongue— which Greek physician-philosopher Galen described as having been “prepared most fully and perfectly by nature”—but also debated when and how to wield the knife. In the case of midwives, who competed with surgeons for the right to carry out the intervention, the tool reportedly was the midwife’s little fingernail, deliberately kept long.

In earlier times, interestingly, the rationale for frenotomy more often than not had to do with the claim that the procedure would improve the patient’s speech. Nowadays, speech-language pathologists may recommend tongue-tie release for speech delays in older children (a practice that some believe is not supported by empirical evidence),^7,9 but in infants, it is the late twenti­eth-century breastfeeding renaissance and the emergence of legions of lactation specialists eager to help moms breastfeed successfully that appears to have shifted the primary justification for frenotomy to breastfeeding support.⁸

THE FRENOTOMY BOOM

Many practitioners agree that casual visual inspection of the tongue and frenum is an un­reliable way to assess tongue-tie, so some have developed classification and scoring systems. Even so, researchers writing in 2020 in the Eu­ropean Journal of Pediatrics argued that there is no clear relationship between tongue-tie scores, feeding problems and frenotomy outcomes; they urge clinicians to “first do no harm,” suggesting that lingual frenotomy for breastfeeding prob­lems is “not as innocent as generally accepted.”¹⁰ Others sum up the situation this way: “There’s no good evidence that an untreated tongue tie will lead to bad outcomes down the line—or that a frenotomy will help with the breastfeeding relationship in the short term.”¹¹

Despite these cautions, the number of babies proceeding directly from breastfeeding difficulty to tongue-tie diagnosis to frenotomy has, without a doubt, exploded. A U.S. inpatient study published in 2017—the first-ever national study—reported an “exponential” 834 percent increase in tongue-tie diagnoses from 1997 to 2012 and, over the same period, an astounding 866 percent rise in frenotomies.¹²

Similar trends are evident in Canada, Eu­rope and Down Under.¹³ In Australia, which even has a Tongue Tie Institute, frenotomies increased by 420 percent from 2006 to 2016.¹⁴ In New Zealand, a researcher states, “Potentially 10 to 20 per cent of all infants in New Zealand are having it done where, in fact, more like 3 per cent would actually benefit from it.”¹⁵ French doctors alarmed by the trend warn that frenotomy “should only be done in the case of a genuine issue and not as a matter of course or as a preventive measure.”¹⁶

Even among lactation experts, opinions are mixed. Nancy Mohrbacher, author of the Breastfeeding Answers textbook for lactation specialists as well as books for nursing mothers, commented some years ago on the tongue-tie phenomenon, stating “What started as a problem for a small percentage of babies seems now to be an epidemic.”¹⁷ Mohrbacher added, “Because tongue tie is the root cause of the problem for [only] a minority of babies, it is a terrible place for most mothers to start.” Her advice: “Contact someone who can help adjust baby’s latch and evaluate baby’s feeding pattern.”

Commenting on the 2017 U.S. study and the “extreme popularity” of the tongue-tie diagnosis and surgical release, Atlantic writer Rachel Morgan Cautero pointed out that while the study’s hospital-based results were “fairly incredible by any standard,” they were probably an underes­timate because they did not include data from outpatient settings.¹¹ The study authors themselves noted, “Anecdotally in clinical practice experi­ence there seems to be a corresponding increase in infants diagnosed and treated for ankyloglossia in outpatient settings as well.”¹²

The study authors agreed that the increased spotlight on breastfeeding and the greater availability of lactation consultants assessing breastfeed­ing problems is a likely explanation for the greater attention to tongue-tie and the dramatic upswing in oral surgery for infants.¹² However, they also noted that the trend is not across the board; babies from households with private insurance were “disproportionately” more likely to receive a tongue-tie diagnosis and intervention than babies from families with public insurance (Medicaid).

In terms of cost, a study published in JAMA in 2019¹⁸ reported fre­notomy fees ranging from eight hundred fifty dollars to upward of eight thousand if performed under general anesthesia; practitioners experienced in office-based frenotomy do not recommend general anesthesia. Post­operatively, parents are on the hook for in-home measures designed to prevent relapse (“stretch[ing] and massag[ing] their child’s oral frenula, cheek, and tongue multiple times a day”) but also may be asked to take their baby for multiple craniosacral or oral myofunctional therapy ap­pointments.¹³

Back in 1791, a Berlin obstetrician raised the question of practitioners’ motivation for subjecting babies to frenotomy, stating, “Frequently the parents are deceived, for profit, greed and ignorance this aid is abused, and one unties where nothing is tied.”⁸ In the present day, critics simi­larly question the “flourishing industry of frenotomy” and its subsidy by insurance providers.¹³

Those who believe that more infants are undergoing frenotomy than necessary argue that the rush to clip babies’ tongues may conceal other potential causes of poor feeding or crowd out other solutions. The JAMA study found, for example, that non-surgical support for breastfeeding difficulties could, in most cases, take care of matters.¹⁸ The impetus for the study came from the researchers’ observation of “people sent in for something they weren’t sent in for before” and their question, “Are all of these procedures necessary?”¹⁹ With comprehensive feeding assessment and targeted interventions offered by a multidisciplinary team, almost two-thirds of the babies (63 percent) initially referred for tongue-tie surgery did not undergo it, an outcome that the authors celebrated as “avoiding potentially harmful procedures. . . and maximizing the quality of care delivered.”

New Zealand researchers similarly observed that developing a “new clinical pathway” involving multidisciplinary assessment of tongue-tie in babies experiencing feeding challenges “led to a marked reduction in frenotomy intervention rate,” from 11.3 percent to 3.5 percent over a two-year period.²⁰ They also noted that “overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy.”

THE EXPLANATION FOR EVERYTHING

Discussing the tongue-tie phenomenon, a physician has argued, “There is no public health reason to explain the increase, only an in­crease in awareness and diagnosis.”²¹ The Atlantic’s Cautero suggests that greater awareness from within the mommy community itself is a major factor feeding the “frenulum frenzy.” Her Atlantic article [italics in original] begins:

“It’s uttered in hushed tones during mommy-and-me yoga classes and at Montessori-school drop-offs, discussed ad nauseum in breast­feeding support groups and on parenting message boards. It’s called tongue tie, and it’s everywhere. In online mom groups, it’s blamed for all sorts of parenting woes. Baby isn’t gaining weight, or won’t take a bottle? Have you tried checking for ties? Kid won’t nap? It’s probably related to tongue tie. Baby have a rash? Check under the tongue!”¹¹

Others concur that the increased attention to tongue-tie “is being led by consumer demand,” with social media and social influencers playing a major role.²¹ Is it a fad? A pediatrician who directs a university lactation program outlines “two questions at play,” stating “One is the individual question of how parents should be making this decision,” while the second is “the public health issue and the ‘hotness’ of this debate.”²²

Setting aside the debate among professionals, parental satisfaction— to the extent it has been measured—is generally high. (Preverbal babies don’t have much of a say in the matter.) A New Zealand study exploring parental perceptions found that “Parents were willing to go to significant lengths to access the procedure” beforehand, and afterwards, four out of five sets of parents reported “moderate” or “significant” improvement in the issues that prompted them to seek frenotomy for their babies.²³ About a third of mother-infant pairs studied (thirty-three of ninety-three) went from not fully breastfeeding to fully breastfeeding. A recent Danish study likewise reported “compelling” parent satisfaction, with 78 percent of mothers who had experienced breastfeeding difficulties or pain reporting a “moderate to high degree of symptom relief” and 95 percent of parents stat­ing they would “have a frenotomy performed on their child again under similar circumstances.”²⁴

Not all mothers are thrilled with their baby’s experience, however. One Australian mom in­terviewed after the fact spoke of the pressure she encountered from a dentist who told her “in no uncertain terms” that she would be “setting [her] child up for failure” if she did not get her daugh­ter a frenotomy, even though no one had actually observed them breastfeeding.¹⁴ Describing the vulnerability of new motherhood—featuring pain and sleep deprivation—the mother suc­cumbed to the dentist’s pushiness, but after “blood curdling” screams and a burning smell emanated from her daughter during the laser surgery, the mom pronounced the procedure “absolutely barbaric.”

THE RISE OF LASER

Historically, frenotomists relied on an “arsenal” of surgical scalpels, scissors, curved knives and “fork-like instruments.”⁸ Nowadays, many dentists and physicians have shifted their treatment of choice to laser—“Light Amplifica­tion by the Stimulated Emission of Radiation”— which comes with its own armamentarium of instruments, including (depending on the method) topical or injectable local anesthesia, “mouth props, loupes with magnification and high-intensity light, grooved director. . . for tissue deflection and isolation along with fine-tipped hand-held electrocauteries.”²⁵

Practitioners use the term “laser” to refer to several different types of devices, including Bovie electrocautery and soft-tissue-cutting CO2 diodes (with the latter nicknamed “hot tip cautery” because it burns off the soft tissue “on contact with the hot charred glass tip”)²⁶ as well as laser devices with the fancy descrip­tors of “neodymium-doped yttrium aluminum garnet” (Nd:YAG) or “erbium-doped yttrium aluminum garnet” (Ed:YAG). Some frenotomy websites praise the diodes as “ideal. . . for both cutting and coagulating soft tissue,”²⁷ claim­ing less postoperative swelling and pain,²⁸ but others—such as Peter Vitruk, founder of the American Laser Study Club—argue that “laser” is in fact a misnomer for the diode method.²⁶ In his experience, the diodes can lead to “exces­sive post-op pain, excessive tissue charring, deep thermal necrosis, or. . . excessive bleed­ing.” Vitruk speculates that when infants—“for whom painkillers are not an option”—undergo diode frenotomy, the aftermath may not be very pleasant.

One of the primary distinctions between the scissor and laser procedures is the ability of the parents to be with their baby during the pro­cedure; because of “safety measures,” parents are not allowed into the treatment room during laser procedures but can hold their baby when scissors are used.²⁹ A doctor who describes the CO2 device as her surgical instrument of choice admits that the scissor procedure is also faster, and that “pain associated with the laser procedure has a delayed effect”; however, her take-home message is that the provider’s skill set “and knowledge of how the tongue tie affects each patient” ultimately are more important than the chosen tool.²⁹ Other frenotomy providers agree, stating that while “[a]nyone can buy a laser,” providers’ “skill and understanding of how tongue tie affects breastfeeding” should be the deciding factors.³⁰

Modern practitioners may be keen on laser, but a lack of relevant research means that “no conclusive suggestions regarding the method of choice can be made.”³¹ The author of a UK-based parenting support blog agrees that many of the claims used by frenotomy practitioners to argue that laser methods are superior to scissors are “unsubstantiated and non-evidence based.” While not “anti-laser,” the blogger questions the assumption that “something new and expensive is automatically better,” noting decades of suc­cessful frenotomy performance with scissors as well as the fact that “the research supporting practice is using [scissors], not a laser.”³² The author makes other points as well, including the following:

• The laser procedure (as already noted) is “significantly slower than with scissors, which only takes several seconds.”
• Pain scores with laser “may be higher and for a longer duration, resulting in many laser providers advocating the use of an­aesthetic.”
• Adults treated with laser describe “signifi­cantly higher levels of pain post procedure” and a burning sensation, which, the author states, is “of course. . . exactly what it is.”
• For older babies, “the separation from par­ents and restraint could be as upsetting as the procedure itself.”
• Research specific to babies (rather than older children) is needed.
• “[W]hat happens post procedure is much more complex than we realise.”

COMPLICATIONS UNDERREPORTED AND UNDERSTUDIED?

Early advocates and critics of frenotomy did not shy away from acknowledging the prospect of complications. In the mid-eighteenth century, obstetric textbooks regularly listed complica­tions such as bleeding to death.

Modern advocates of frenotomy, on the other hand, claim a stellar safety record, but the fact is that study of frenotomy complications is only just beginning, and some believe that com­plications are going unreported.³³ In an online survey administered in late 2019 to physician and dentist members of the Academy of Breast­feeding Medicine, 61 percent of the physician/dentist respondents had cared for a baby with either a complication or a misdiagnosis (defined as a baby “subsequently diagnosed with another problem that could have caused the infant’s breastfeeding difficulties”).³³

Another goal of the study was to assess clinician-reported frenotomy complications by method (scissors/scalpel versus “laser/bovie/electro­surgery”). The researchers found that postoperative bleeding was more strongly associated with scissors/scalpel, but babies treated with laser/ bovie/electrosurgery had four times the odds of “oral aversion.” According to Healthline, which defines oral aversion as “sensitivity to—and per­haps even fear of—food or drink taken by mouth,”³⁴ babies with an oral aversion “will refuse both the breast and the bottle,” a counterproductive outcome for moms intent on improving the breastfeeding relationship. Oral aversion and repeat frenotomy were the top complications reported.

An Australian physician who works with babies frankly states, “In my opinion, oral laser surgery hurts babies, as does wound stretching.”¹³ She describes regularly seeing babies with oral aversion, worsened breastfeeding problems and infections after such surgery. In one instance, she reports seeing “the underbelly of a tongue somewhat separated by a frenotomy that went too deep.”

In another electronic survey administered to members of the American Society of Pediatric Otolaryngology, 77 percent of respondents reported a growing number of referrals for frenotomy over the previ­ous five years, especially for breast pain and inability to latch, with 60 percent describing the number of referrals as “too many.”³⁵ Three out of five professionals reported having seen frenotomy complications, most often excessive bleeding or frenum reattachment. In another study, fully a third of children required repeat frenotomy, but 84 percent of patients or guardians nevertheless reported the procedure was beneficial.³⁶ Some providers have found that they can decrease the rate of repeat procedures with a shorter postop­erative follow-up period.³⁷

In a study published in 2020 that assessed two years of pediatric data for children under one year old, researchers identified only sixteen cases of frenotomy complications; although this translated to just 1.39 per ten thousand, twelve of the babies required hospitalization, with complications that included poor feeding, respiratory events, pain, bleeding and weight loss.³⁸ In addition, one out of four children had to have the frenotomy repeated.

Another 2020 study reviewed thirty-four case reports of complications from frenotomies performed primarily in the U.S. and Europe, identifying a total of forty-seven major compli­cations.³⁹ With breastfeeding problems being the most common indication for performing the pro­cedure, the parents were rewarded with babies experiencing poor feeding, hypovolemic shock (a life-threatening form of shock involving blood or fluid loss), breathing and airway challenges and a potentially deadly infection called Lud­wig’s angina. The researchers hypothesized that neonates might be subject to greater risks than older children or adults.

A 2021 case report from Canada, which acknowledged a “small possibility of compli­cation. . . even in expert hands,” described a six-week-old infant who experienced delayed hemorrhage and shock symptoms following laser frenotomy, requiring “fluid resuscita­tion.”⁴⁰ The authors noted that in infants, “post­operative hemorrhage is an important complica­tion to look for as even small amount of bleed may prove fatal, due to low blood volume reserve.”

Discussing frenotomy complications in a 2021 interview, a practicing ENT in Texas described complications such as salivary gland cysts (“sialoceles”), staph infections and com­plications associated with the use of topical anesthetics.⁴¹ The latter include case reports of cardiac toxicity from lidocaine, “because it’s just so hard to dose in a little bitty infant, and. . . it’s kind of unpredictable.” The physician also noted the possibility of a blood disorder called methemoglobinemia (in which too little oxygen is delivered to the cells) associ­ated with “ester-based” anesthetics.

A 2009 study summarizing two hundred forty-two episodes of methemoglobinemia related to anesthetics such as benzocaine and prilocaine noted that a “single spray of ben­zocaine may induce methemoglobinemia,” and that complications of methemoglobinemia include “hypoxic encephalopathy, myocardial infarction, and death.”⁴² The authors recom­mended discontinuing the use of benzocaine altogether and suggested banning prilocaine use in children younger than six months old (the age group often undergoing frenotomy). In a discussion of topical anesthet­ics for laser frenectomy, a pharmacy website describes lidocaine and tetracaine as the most commonly used products but notes that prilocaine or other “stronger” anesthetics may also be part of the picture.⁴³ The site urges practitioners not to use prilocaine (or similar drugs) in newborns, recommending it only for patients aged two years and older.

As an alternative to anesthetics, Spanish researchers recently reported the analgesic effect of inhaled lavender essential oil for healthy babies undergoing frenotomy, noting lavender’s “sedative and antispasmodic properties.”⁴⁴ The researchers observed a significant decrease in cry­ing time and lower Neonatal Infant Pain Scale scores in the babies who received the essential oil intervention.

“TO SNIP OR NOT TO SNIP”

Is the “seeming epidemic of moms reporting breastfeeding diffi­culty” the result of more babies with tongue-tie? Absurdly, some are now making the case for a tongue-tie gene.^45,46 There is no need to resort to genetic explanations, however, to recognize the fact that a perfect storm of sociological and economic factors is contributing to an “epidemic” of frenotomies.

Australian physican Dr. Pamela Douglas—who believes that most providers have “blindspots” about breastfeeding and a flawed understand­ing of the “biomechanics of infant suck”—accepts the need for “simple scissors frenotomy” in the minority of infants who she esteems to have “classic tongue-tie” but notes that far too often, families are “frightened into compliance” with laser surgery recommendations by warnings about phantom developmental risks.¹³ In this, pressures toward frenotomy resemble nothing so much as the bullying often endured by new parents about circumcision and vaccination of their babies.

As in these other situations, parents should do their own research, shielded from the din of social media and coercive practitioners. Knowing that “tongue-tie” as a condition lacks definitional clarity,¹³ recognizing that diagnosis “doesn’t mean you have to have a surgical procedure,”⁴⁷ being aware that babies can outgrow tongue tightness if left alone⁴⁸ and understanding that many non-surgical forms of support are available can help breastfeeding moms make a fully informed decision about how best to meet their breastfeeding goals.

SIDEBARS

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AND THEN THERE’S LIP-TIE

In addition to tongue-tie, moms experiencing breastfeeding difficulties may be told that their babies also have “lip-tie.” As discussed by UK lactation consultant and tongue-tie practitioner Sarah Oakley, lip-tie is an even murkier diagnosis than tongue-tie.⁴⁹ According to Oakley, common diagnostic classification systems “rely solely on appearance” of the labial frenum and not only fail to assess function but fail to acknowledge that the tethering that stretches “from the upper gum to behind the upper lip in the midline is normal anatomy.”

Describing exchanges with widely known tongue-tie experts, Oakley has written: “I asked them how they decide a lip requires [surgical] division. The responses were that it is based on the presence of tension and a general acknowledg­ment that they were probably all applying different criteria. . . reflected in the fact that they all reported varying numbers of babies presenting with tongue-ties who also require lip-tie division.” These “varying numbers” translate to anywhere from one in five “to almost all babies with tongue-tie” also being subjected to surgical lip-tie intervention. She notes that lip-tie surgery comes with a greater risk of pain and bleeding (because a labial frenum is “much more sensitive and more vascular than a lingual frenum”) and adds that among doctors and dentists, opinions about the procedure’s safety are mixed.

Finally, Oakley observes that lip-tie intervention is a stop-gap and generally does not address underlying causes of breastfeeding difficulties. Her conclusion: “[O]ur focus needs to be on supporting mothers and babies with our breast­feeding skills to understand and overcome the challenges they face and not to encourage them to pursue the idea that by simply cutting yet another piece of membrane in the mouth all of their issues will be solved.”

NUTRITION FOR NURSING MOMS

While health practitioners often pay some attention (even if dispensing bad advice) to the diet of pregnant women, it is rare for a nursing mom’s diet to get much attention. This is a mistake, as breastfeeding mothers and babies need an equally nutrient-dense diet to thrive.

The Weston A. Price Foundation’s recommended diet for both pregnant and nursing mothers includes the following:

• One quart whole milk daily, preferably raw and from pasture-fed cows
• Four tablespoons butter daily, preferably from pastured cows
• Two tablespoons coconut oil daily
• Two or more eggs daily, preferably from pastured chickens
• Additional egg yolks daily (added to smoothies, salad dressings, scrambled eggs, etc.)
• Fresh beef or lamb daily (consumed with the fat)
• Oily fish or lard daily
• Three to four ounces fresh liver, one to two times per week
• Fresh seafood, two to four times per week (especially wild salmon, shellfish and fish eggs)
• Bone broths (in soups, stews and sauces)
• Soaked whole grains
• Fresh vegetables and fruits
• Lacto-fermented condiments and beverages
• Two teaspoons high-vitamin cod liver oil to supply 20,000 IU vitamin A and 2000 IU vitamin D per day; do not add cod liver oil if the diet is deficient in the important animal foods—liver, egg yolks and meat fats. It is important to follow the diet in its entirety, not just selected parts of it.

The list of foods to avoid includes hydrogenated oils, junk foods, commercial fried foods, sugar, white flour, and soft drinks, as well as substances like caffeine, alcohol, cigarettes and drugs.

GALACTAGOGUES

For a variety of reasons, maternal milk supply issues are not uncommon, even when the nursing mother is eating a nutrient-dense Wise Traditions diet. Galactagogues are substances that can help boost milk production.⁵⁰

Although synthetic galactagogues are available, they come with the risk of undesirable side effects such as depression. Instead, women throughout history have turned to foods and herbal substances known for their milk-making properties. One of the most widely known herbal galactagogues is fenugreek (sometimes taken in combination with marshmallow root), although some herbalists caution that its use can be counterproductive if it is not taken consistently.

Others galactagogue herbs include fennel (also helpful for digestive discomfort), milk thistle, blessed thistle (not to be confused with milk thistle), nettle, alfalfa, red raspberry leaf, goat’s rue, the Ayurvedic herb shatavari and moringa (not to be used by women trying to conceive), among others.

 

REFERENCES

1. Wolf JH. Low breastfeeding rates and public health in the United States. Am J Public Health. 2003;93(12):2000-2010.
2. https://www.cdc.gov/breastfeeding/data/nis_data/results.html
3. Gerd AT, Bergman S, Dahlgren J, et al. Factors associated with discontinuation of breastfeeding before 1 month of age. Acta Paediatr. 2012;101(1):55-60.
4. Brand E, Kothari C, Stark MA. Factors related to breastfeeding discontinu­ation between hospital discharge and 2 weeks postpartum. J Perinat Educ. 2011;20(1):36-44.
5. https://www.llli.org/breastfeeding-info/tongue-lip-ties/
6. Mills N, Pransky SM, Geddes DT, Mirjalili SA. What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum. Clin Anat. 2019;32(6):749-761.
7. Becker S, Mendez MD. Ankyloglossia. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
8. Obladen M. Much ado about nothing: two millenia of controversy on tongue-tie. Neonatology. 2010;97(2):83-89.
9. https://www.speechpathways.ca/2019/03/25/should-i-cut-my-childs-tongue-tie/
10. Van Biervliet S, Van Winckel M, Vande Velde S, et al. Primum non nocere: lingual frenotomy for breastfeeding problems, not as innocent as generally accepted. Eur J Pediatr. 2020;179(8):1191-1195.
11. Cautero RM. Why so many babies are getting their tongues clipped. The Atlantic, Mar. 12, 2019.
12. Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997-2012. Otolaryngol Head Neck Surg. 2017;156(4):735-740.
13. https://medicalrepublic.com.au/untangling-tongue-tie-epidemic/10813
14. Bedo S. The baby surgical trend loved by some and slammed by others. News. com.au, Mar. 12, 2019.
15. Be aware of potential complications following tongue-tie surgery in babies. ScienceDaily, Nov. 20, 2019.
16. Thompson H. Doctors in France warn against “trend” of cutting “tongue-tie” babies. The Connexion, May 2, 2022.
17. http://www.nancymohrbacher.com/articles/2014/11/16/tongue-and-lip-ties-root-causes-or-red-herrings.html
18. Caloway C, Hersh CJ, Baars R, et al. Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. JAMA Otolaryngol Head Neck Surg. 2019;145(9):817-822.
19. Haller S. Most babies referred for tongue-tie surgeries to breastfeed unneces­sary, study says. USA Today, Jul. 15, 2019.
20. Dixon B, Gray J, Elliot N, et al. A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: observational study. Int J Pediatr Otorhinolaryngol. 2018;113:156-163.
21. Kean N. The dramatic rise in tongue tie and lip tie treatment. ENTtoday, Sep. 6, 2019.
22. Pearson C. Are we overdiagnosing tongue-tie in breastfeeding newborns? Huffpost, Jul. 11, 2019.
23. Illing S, Minnee M, Wheeler J, Illing L. The value of frenotomy for ankylo­glossia from a parental perspective. N Z Med J. 2019;132(1500):70-81.
24. Siggaard LD, Tingsgaard P, Lüscher M, et al. Parent-reported infant and ma­ternal symptom relief following frenotomy in infants with tongue-tie. Dan Med J. 2022;69(5):A12210934.
25. https://cdn.brandfolder.io/TVDZACS7/at/7hb9cvh8j7xj9cfhg66bwr5t/Lingual_Frenectomy_with_Electrocautery_White_Paperpdf
26. https://dentalsleeppractice.com/hot-glass-tip-diode-frenectomies-are-not-laser-frenectomies/
27. https://www.lightscalpel.com/blog/laser-frenectomy/
28. Patil P, Kabbur KJ, Madaiah H, Satyanarayana S. Diode laser frenectomy: a case report with review of literature. J Dent Lasers. 2019;13(1):19-22.
29. https://www.untetheredtonguetiecenter.com/post/the-best-tongue-tie-tool-laser-or-scissors
30. https://www.drghaheri.com/blog/2014/4/3/laser-vs-scissors-how-to-choose-your-provider
31. Suter VGA, Bornstein MM. Ankyloglossia: facts and myths in diagnosis and treatment. J Periodon­tol. 2009;80(8):1204-1219.
32. http://www.analyticalarmadillo.co.uk/2014/02/5-points-about-treating-tongue-ties.html
33. O’Connor ME, Gilliland AM, LeFort Y. Compli­cations and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey. Int Breastfeed J. 2022;17:39.
34. https://www.healthline.com/health/baby/oral-aversion#causes
35. Dhir S, Landau BP, Edemobi S, et al. Survey of pediatric otolaryngology frenotomy practice pat­terns. Laryngoscope. 2022 Mar 23.
36. Klockars T, Pitkäranta A. Pediatric tongue-tie division: indications, techniques and patient satisfaction. Int J Pediatr Otorhinolaryngol. 2009;73(10):1399-1401.
37. Nelson L, Prasad N, Lally MM, Harley EH. Fre­notomy revision rate in breastfeeding infants: the impact of early versus late follow-up. Breastfeed Med. 2021;16(8):624-628.
38. Hale M, Mills N, Edmonds L, et al. Complica­tions following frenotomy for ankyloglossia: a 24-month prospective New Zealand Paediatric Surveillance Unit study. J Paediatr Child Health. 2020;56(4):557-562.
39. Solis-Pazmino P, Kim GS, Lincango-Naranjo E, et al. Major complications after tongue-tie release: a case report and systematic review. Int J Pediatr Otorhinolaryngol. 2020;138:110356.
40. Kim DH, Dickie A, Shih ACH, et al. Delayed hemorrhage following laser frenotomy lead­ing to hypovolemic shock. Breastfeed Med. 2021;16(4):346-348.
41. https://www.backtable.com/shows/ent/articles/treating-tongue-tie-frenotomy-technique-and-complications
42. Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesth Analg. 2009;108(3):837-845.
43. https://www.parkcompounding.com/frenectomy-topical-anesthetic/
44. Maya-Enero S, Fàbregas-Mitjans M, Llufriu- Marquès R, et al. Analgesic effect of inhaled lavender essential oil for frenotomy in healthy neonates: a randomized clinical trial. World J Pediatr. 2022;18(6):398-403.
45.  https://blog.fauquierent.net/2016/11/is-tongue-tie-becoming-more-common.html
46. https://breastfeedingusa.org/content/article/tell-me-about-tongue-ties
47. Zoppi L. Ten-fold rise in tongue-tie surgery for newborns “without any real strong data.” News- Medical.net, Jul. 15, 2019.
48. Radhakrishnan R. Can babies grow out of tongue-tie? Medicine.net, Jun. 9, 2022.
49. https://sarahoakleylactation.co.uk/wp-content/ uploads/2015/05/lip-tie-article.pdf
50. https://www.westonaprice.org/book-reviews/a-mothers-garden-of-galactagogues-hilary-ja­cobson/#gsc.tab=0

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Fall 2022

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