It is popular among American mothers to cut their babies’ tongues, and they say it can “cure all diseases”?

The much-debated tongue tie.

Feeding a baby is very painful for many women. Studies show that about 40% of mothers who choose to breastfeed encounter various problems in the early stages of breastfeeding , such as the baby not being able to latch on properly, or nipple injuries and pain. Sometimes, some problems can be solved by changing breastfeeding positions, but some mothers find that their babies cannot eat milk and their weight cannot keep up with the normal growth and development rhythm.

As more and more people advocate breastfeeding in recent years, feeding children with formula seems to be an "irresponsible" practice. Therefore, some anxious mothers will turn to doctors and others for advice. At this time, someone may remind her that this is because your baby's "lingual tendons" (scientific name: lingual frenulum) are too short, and you only need to do a small operation to cut it off.

Tongue tie (Image source: NHS)

According to the New York Times, due to the increasing nursing pressure faced by mothers, this tongue-tie surgery has become more and more popular in the past decade and has been vigorously promoted by many lactation consultants and dentists. They told parents that this surgery can not only solve the problem of breastfeeding difficulties, but also prevent children from having a series of health problems including sleep apnea, speech disorders and constipation.

What's more, many people will suggest that parents take their children for "comprehensive" surgery , not only cutting the tongue frenulum, but also removing the lip frenulum and cheek frenulum that connect the lips and cheeks to the gums, claiming that this will be more conducive to breastfeeding.

But is there any scientific basis for this surgery?

What is tongue tie

The frenulum is a thin tissue under our tongue that stabilizes the tongue root and assists in tongue movement. Some embryos have abnormalities during development, which may cause the frenulum to be shortened, lack elasticity, or be attached too far under the tongue or too close to the alveolar ridge, limiting the range of movement of the baby's tongue, making it difficult to hold the mother's breast, and affecting swallowing. Not only will the child not be able to eat enough, it may also cause nipple pain in the mother, which in turn creates a psychological burden.

If the condition is mild, it may get better as the child grows. However, for older children, ankyloglossia may make it difficult for them to make certain sounds with their tongue, which can affect their speech . Some studies have also shown that ankyloglossia may also affect the way their teeth fit together .

Therefore, hundreds of years ago or even earlier, people began to try to cut the tongue tie with scissors to "liberate" the baby's tongue. It is said that midwives in Italy and Germany used to leave long and pointed little finger nails specifically for cutting the tongue tie of newborns. With the development of technology, more and more hospitals and clinics now choose to use lasers instead of knives to cut the tongue tie.

Tongue-tie surgery in 1620. Image source: original paper

But this practice, which has been used for hundreds, if not thousands of years, is not widely scientifically proven. While some studies have shown that frenotomy can "reduce nipple pain in the short term in women who choose to breastfeed," not all studies have reached the same conclusion . For example, some data have shown that tongue-tie cutting does not improve a baby's ability to feed.

The controversial frenotomy

The lack of scientific evidence has not cooled parents and medical institutions, who are still enthusiastic about this type of surgery. Studies in the United States, Canada, Australia and other countries have shown that the number and proportion of babies who have undergone frenotomy for tongue-tie have increased significantly in the past decade . Taking Australia as an example, the number of babies who have undergone frenotomy has increased from 1.22 cases per thousand in 2006 to 6.35 cases per thousand in 2016, an increase of 420%. In the Australian Capital Territory, this increase is as high as 3710%.

This type of surgery is not cheap. In the United States, a 5-minute frenulum laser surgery costs $900 (about RMB 6,400), and in the United Kingdom it costs about £300 (about RMB 2,700). According to the Global Times, the price of such surgery in China generally ranges from RMB 1,000 to RMB 3,000 . According to the Fujian Health News, a 5-year-old boy in Fuzhou has had his tongue tie cut almost every other year since birth, and has had it cut four times in total, but still has not been able to solve the problem of delayed language development.

The proportion of children undergoing frenotomy in different regions of Australia from 2006 to 2016. Image source: original paper

Even if we put aside the effectiveness of frenotomy, many parents have wasted their money. This is because a large number of babies who have undergone frenotomy are not really tongue-tied . It is estimated that the incidence of short frenulum is about 0.02% to 10.7%. You can certainly realize that this range is ridiculously large. This is precisely because there is no unified definition of "short frenulum" in academia, and babies in many regions are overdiagnosed with short frenulum.

In 1999, American scholar Kotlow proposed a scoring system that divides short frenulum into four categories based on the distance between the frenulum attachment point and the tip of the tongue (i.e., the length of the "free tongue"). However, in later clinical practice, people found that there is no one-to-one correspondence between abnormal frenulum position and tongue motor function , and it is also difficult to measure in actual operation. Later, researchers proposed a variety of tools to evaluate tongue function, but different countries and regions often use different scoring methods.

Overdiagnosis not only brings additional costs, but may also cover up the original problem. For example, in the case of the boy in Fuzhou mentioned earlier, the fundamental problem of his delayed language development was intellectual disability rather than a short tongue tie. However, because parents and doctors have been obsessed with solving the problem from the perspective of tongue tie, they have not discovered the root cause behind the child's symptoms in time, and ultimately missed the golden period for treatment. Similarly, some parents and doctors have only seen the impact of tongue tie on breastfeeding, ignoring other organic lesions of children that may cause breastfeeding difficulties.

Classification of tongue-tie based on anatomy. Image source: original paper

Although frenotomy is very safe in most cases, it can sometimes cause additional pain to the child . A study in New Zealand showed that the annual incidence of complications from frenotomy is not high, about 13.9 cases per 100,000 infants under 1 year old per year, but most (75%) infants with complications require hospitalization . Common complications include difficulty in breastfeeding (44%), difficulty breathing (25%), pain (19%), bleeding (19%), and weight loss.

The current academic consensus is that surgery is only recommended when the tongue-tie is so short that it affects breastfeeding. Abnormal speech or asymptomatic short tongue-tie cannot be used as an indication for frenulum surgery. In addition to surgery, researchers have also developed physical therapy, speech therapy, oral and facial muscle function therapy and other methods that are also expected to improve tongue function. Therefore, if you or someone around you finds that your child has symptoms such as difficulty breastfeeding or slurred speech, be sure to go to a professional hospital for treatment under the professional guidance of a doctor.

References

[1]https://www.nytimes.com/2023/12/18/health/tongue-tie-research-breastfeeding.html

[2]https://www.nytimes.com/2023/12/18/health/tongue-tie-release-breastfeeding.html

[3] Ji Yuezhi, & Ruan Wenhua. "Diagnosis and treatment of tongue tie in infants and young children." West China Journal of Stomatology 38.4(2020):6.

[4] Wang Chengshuang, & Zeng Tieying. "Current status of newborn tongue-tie care and research progress on support programs." Chinese Journal of Modern Nursing 27.1(2021):4.

[5] Yang Min, He Hongxiao, Zhu Xiu, Ma Xueqian, & Lu Qi. "Research progress in breastfeeding management of children with tongue-tie." Chinese Journal of Nursing Management, 2023, 23(11): 1752-1756.

[6]https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2790350

[7]https://www.mdpi.com/2077-0383/12/23/7415

[8]https://journals.sagepub.com/doi/full/10.1177/0194599820915457

[9]https://world.huanqiu.com/article/4FqBfj0epPR

[10]https://mp.weixin.qq.com/s/vSF11TA3QWkAsnxRKfVgOA

[11]https://onlinelibrary.wiley.com/doi/full/10.5694/mja17.00438

[12]https://karger.com/neo/article-abstract/97/2/83/228866/Much-Ado-about-Nothing-Two-Millenia-of-Controversy

[13]https://onlinelibrary.wiley.com/doi/10.1111/jpc.14682

[14]https://www.bmj.com/content/371/bmj.m3928

[15]https://www.bmj.com/content/372/bmj.n8

Planning and production

Source: Global Science (ID: huanqiukexue)

Author: Huang Yujia

Editor: Yang Yaping