Tongue Tie Release: A Collaborative Approach to Infant Wellness
- sweetlynourish
- Dec 11, 2024
- 7 min read
As an International Board Certified Lactation Consultant (IBCLC), I spend my days guiding families through the complex world of infant feeding. One challenge that frequently arises is tongue tie—a condition that can profoundly affect feeding, development, and family well-being. Recently, the New York Times published an article that cast a shadow over this important intervention, portraying it as overprescribed and profit-driven. While such concerns warrant discussion, the article missed critical nuances, leaving families uncertain and misinformed.
This post aims to set the record straight, offering an evidence-based perspective on tongue-tie treatment, emphasizing the need for a collaborative approach, and addressing the emotional toll this condition can have on families.
What Is Tongue Tie? Why Does It Matter?
Tongue tie, or ankyloglossia, is a condition where the tissue under the tongue (the frenulum) is too short or tight, restricting tongue movement. This restriction can lead to:
• Poor latch during breastfeeding.
• Nipple pain and maternal discomfort.
• Inefficient milk transfer, contributing to weight gain issues.
• Digestive problems, such as aerophagia-induced reflux.
• Long-term complications like speech delays, airway issues, nervous system dysregulation, digestion issues, oral & facial development challenges, and dental problems.
When left untreated, tongue tie can significantly impact not only feeding but also a child’s overall development and quality of life.
The Frenotomy Procedure: Evidence and Misconceptions
A frenotomy is a straightforward, low-risk procedure to release the restrictive tissue under the tongue. When performed by a skilled practitioner as part of a comprehensive care plan, it has demonstrated benefits, including:
• Improved breastfeeding efficiency.
• Reduced maternal pain.
• Prevention of early weaning.
• Potential mitigation of long-term complications like sleep apnea, speech issues, digestive issues and more. See above.
Diagnosis should involve a thorough assessment of feeding dynamics and oral function, conducted by experienced professionals such as skilled IBCLCs, dentists, and ENTs. Please note that not all listed providers have training and experience in oral function. It is imperative to have a skilled provider evaluate for tongue tie.
While some argue that frenotomies are overprescribed, the vast majority of practitioners prioritize evidence-based care. It is not a “business boom” but a well-considered intervention aimed at improving infant health and family well-being.
The Importance of a Collaborative Approach
Successful tongue-tie treatment goes beyond the procedure itself. It requires a multidisciplinary team working together to ensure the best outcomes:
1. IBCLCs (Lactation Consultants): Often the first to identify feeding difficulties, IBCLCs provide critical support through oral function assessments, latch assessments, oral motor exercises, and guidance on pre- and post-procedure care.
2. Pediatric Dentists or ENTs: These specialists assess the need for frenotomy and perform the procedure with precision, considering both anatomy and function. In the state of Connecticut, currently most ENT's are not skilled or trained in identifying a tongue tie.
3. Bodyworkers: Chiropractors, craniosacral therapists, or myofascial release therapists help address tension patterns in the infant’s body that may be exacerbating feeding difficulties or contributing to poor recovery post-procedure.
4. Parents and Caregivers: The most vital members of the team, parents play an active role in exercises, comfort measures, and nurturing their baby’s recovery.
Pre- and Post-Procedure Care: The Key to Success
Releasing a tongue tie is not a standalone solution. Comprehensive care includes:
• Oral Motor Therapy: Before and after the procedure, many infants benefit from oral motor therapy. This can help them strengthen their suck, improve tongue movement, and support more effective breastfeeding. For infants with significant feeding issues, this therapy is essential to help them fully recover from the restrictive effects of tongue tie and learn to use their newly released tongue in a functional way.
• Bodywork: Particularly techniques like chiropractic, myofascial release or craniosacral therapy, can also be an important part of the healing process. These therapies help release tension in the body that may be contributing to feeding difficulties, improve muscle coordination, and promote overall comfort and relaxation. For many babies, tongue tie can be part of a broader pattern of tension in the body that interferes with feeding and comfort. Working with a skilled bodyworker can help release these patterns, contributing to a smoother recovery after the procedure.
• Follow-Up Support: Regular check-ins with the care team to monitor feeding progress and overall development.
This holistic approach ensures that frenotomy is just one part of a broader plan tailored to the baby’s and family’s unique needs.
The Emotional Impact on Families
Parenting is challenging enough without the added stress of feeding difficulties. Tongue tie can leave families feeling overwhelmed, guilty, or helpless—especially when their concerns are dismissed or misunderstood. A successful resolution often brings profound emotional relief:
• Parents regain confidence in their ability to nourish their child.
• The bond between parent and baby is strengthened.
• Families feel empowered by a supportive care team that listens to their concerns.
A compassionate, collaborative approach is critical in addressing not just the physical but also the emotional toll of tongue tie.
The Risks of Untreated Tongue Tie
While not every case requires intervention, untreated tongue tie can lead to:
• Persistent feeding difficulties.
• Long-term oral health issues like tooth decay or misalignment.
• Airway problems, including sleep apnea.
• Speech delays or articulation challenges.
These potential complications underscore the importance of proper assessment and timely intervention when needed.
A Note on Media Representation
The New York Times article presented a skewed view of tongue-tie treatment, focusing on isolated cases and financial motives while neglecting the larger body of evidence and expert consensus. Such narratives risk discouraging families from seeking necessary care and undermine the credibility of dedicated professionals.
Addressing the Bias and Fear-Mongering
The NYT article focuses primarily on the business side of tongue-tie treatment, implying that practitioners—particularly those in private practice—are capitalizing on a trend without fully considering the risks. The tone of the article suggests that tongue-tie procedures are overprescribed, potentially causing harm, and that the financial incentives behind these treatments may be clouding clinical judgment. The article presented a very one-sided, misleading view of the subject. As IBCLCs, we’re trained to focus on evidence-based practices, and unfortunately, the article omitted key information that would have offered a more balanced perspective.
For one, there was no mention of the critical role of oral functional evaluation prior to any tongue tie release. A thorough assessment of a baby’s oral motor skills is crucial in determining whether a release is necessary, and this process is typically guided by experienced practitioners who specialize in infant feeding and development.
The article also overlooked the substantial body of research supporting tongue tie release and its benefits for breastfeeding, including improved latch, feeding efficiency, and maternal comfort. While the article did touch on a few isolated cases of negative outcomes, it did not consider the broader range of research and clinical success stories we see daily in our practice.
**As IBCLCs, it’s important to note that we are bound by a strict ethical code. We do not receive any financial incentives or kickbacks for referrals to dentists or bodyworkers—such practices would violate our professional standards. Any suggestion otherwise is not only misleading but also detrimental to our credibility and trust with families. Our primary goal is to support families and ensure their well-being through evidence-based practices.
The article’s focus on the few cases of babies facing complications after release, including dehydration and feeding difficulties, raised alarms, but those cases seem to lack crucial context (I truly believe these cases had more complexities underlying than just tongue ties). From my experience working closely with many IBCLCs, I have never encountered a case remotely similar to the ones described in the article, neither have I heard of any similar cases amongst my IBCLC and dentist peers. The vast majority of infants benefit significantly from a tongue tie release, not only with feeding but also in areas such as sleep, airway, speech, digestion, nervous system regulation, and tension reduction (and so much more).
It’s unfortunate that the article failed to highlight these successes or to engage with leading experts in the field who could have provided a more balanced perspective. The article was clearly biased, one sided, and not “true journalism,” only sparking fear and doubt amongst parents and healthcare professionals alike.
When we do recommend a release as experienced providers who follow a comprehensive treatment plan- this includes pre- and post-release bodywork and oral motor rehabilitation, which are crucial components of ensuring the best outcome- we have seen incredible results with this holistic approach.
As an IBCLC who works closely with both families and medical professionals, I can confidently say that the narrative presented in this article is not only misleading but also harmful.
The reality is that tongue tie is a well-documented condition that can have significant consequences.
Frenotomy—a relatively simple and low-risk procedure that involves releasing the restrictive tissue under the tongue—has helped countless infants overcome these challenges and thrive.
However, like any medical intervention, it should never be undertaken without proper assessment and consideration of the whole child, their feeding history, and the family’s specific needs. That’s why tongue-tie treatment should always be part of a comprehensive care plan that includes not only the procedure itself but also pre- and post-procedure oral motor therapy, bodywork, and ongoing support from a skilled and collaborative care team.
Resources for Families
If you’re considering tongue-tie treatment, explore these reputable resources:
• International Affiliation of Tongue-Tie Professionals (IATP)
• Dr. Bobby Ghaheri’s Blog
• Lisa Paladino’s The Tongue Tie Experts Podcast
• Dr. Richard Baxter’s Blog
I can provide additional resources upon request. Please contact me directly.
Conclusion
Tongue-tie treatment, when approached collaboratively and thoughtfully, can transform the lives of infants and their families. It’s not about profit but about addressing a legitimate medical issue with care and compassion.
If you’re facing feeding challenges or considering a frenotomy, seek out a knowledgeable, supportive team—including an IBCLC, dentist, and bodyworker—to guide you. Remember, every family’s journey is unique, and the right care plan will always center on your baby’s needs and your family’s goals.
Warmly,
Julie
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Please consult with a qualified healthcare provider for individualized care.
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