Question & Answer - Breastfeeding

Is the diagnosis of tongue-tie in babies a fad?

Diagnosing tongue-tie in a baby is not a fad. When a new mom and baby come to see me in the office, I always ask them if they were referred by someone or if they did their own research and came on their own. Specifically, I ask them about the attitudes of their pediatrician, midwife, or family practitioner with respect to breastfeeding.

I also ask what other professionals think about them coming to my office, so I may get a better sense of the ideological hurdles that exist in my medical community. One of the most frequent things I hear is that primary care providers say something to the effect of "Oh, diagnosing tongue-tie is just a fad" or "This tongue-tie business is just something new that some people are doing."

While these sentiments are frustrating, I think it is important to address the various reasons why we may be seeing and hearing more about tongue-tie and lip-tie as a cause of breastfeeding problems. As is the case with any new paradigm shift in medicine, the initial response is almost always one of conservatism and doubt. 

So, why the surge in babies who are felt to have tongue-tie and/or lip-tie as potential causes of breastfeeding problems? 

GENETICS

There are several studies that examine the potential inheritance patterns of ankyloglossia (tongue-tie).

Acevedo, da Fonseca, Grinham, Doudney, Gomes, de Paula and Stanier in 2010 identified a Brazilian family that had both ankyloglossia and dental abnormalities. While it only looked at 12 patients, the study demonstrated an autosomal dominant pattern of inheritance. (For clarification, an autosomal gene is located on one of the 22 chromosomes that is NOT an X or Y chromosome. A dominant gene needs only one of the two copies to be passed to cause a specific effect - a 50/50 chance of a child getting the gene.) 

Trying to answer the question why males are more affected by ankyloglossia than females, a Korean study by Han, Kim, Choi, Lim, and Han in 2012 identified potential X-linked patterns of inheritance.

Klockars and Pitkaranta in 2009 identified that the prevalence of ankyloglossia in the general population is approximately 4 to 5% and that inheritance is also passed in an autosomal dominant fashion (like Acevedo, et al.).

What these studies demonstrate is that there is likely some genetic predisposition towards ankyloglossia. My own observation in my patients is that greater than 50% of babies with tongue-tie have a relative who also has ankyloglossia. As is the case with many genetic disorders, if a gene is passed from generation to generation and that gene is potentially passed in a dominant fashion, more and more babies will be affected by that gene with each new generation and with increasing population size (assuming those affected can have kids of their own).

MORE MOMS ARE BREASTFEEDING THAN PREVIOUSLY

As rates of breastfeeding increase, the number of moms who have difficulty with breastfeeding is bound to increase. Before the formula revolution, doctors would routinely check a baby for ankyloglossia (tongue tie) in the newborn nursery and perform a frenotomy if the frenulum (tissue connecting the tongue to the floor of the mouth) looked tight. There are historical reports of midwives using a long and sharp pinky nail to lance the frenulum in newborns who had difficulty at the breast. Was it a fad then too?

A SPECIFIC SET OF ANATOMICAL PROBLEMS

A major argument I make is that I am attributing a baby's breastfeeding problems to a specific set of anatomical problems. A doctor who doesn't know about these correlations may simply pass along what was taught to them in residency. If their mentors taught them common myths about difficulty breastfeeding, babies would be described as "lazy" or having a "small mouth or small tongue" as potential excuses for problems. If those excuses didn't seem to hold, the mom would also be blamed for not making enough milk or having nipples that weren't conducive to breastfeeding. I don't think these excuses are evolutionarily plausible explanations for why babies have problems breastfeeding. You would never hear a doctor explain away a patient's low oxygen level by saying "You just have lazy lungs."

I feel that we must find the anatomical reason why some babies can't breastfeed, and I will make the argument that many of these babies have problems because of restrictions at the tongue and/or upper lip.

Other posts on my site look at the evidence in favor of releasing tongue-ties when those ties are the cause of breastfeeding problems. Ironically, there are no data that argue against treating tongue-tie for babies having breastfeeding problems. When people describe the focus on ankyloglossia and how it relates to breastfeeding as a fad, it is very concerning as it doesn't acknowledge the struggles of the mom or the baby. It minimizes the frustrations felt by the dyad and does nothing to help solve the actual problem at hand.

I am asking doctors, lactation consultants, and other professionals to approach this problem analytically rather than passing old dogma on to their patients. Thank you for taking the time to read this article, and please visit my website for more information on tongue and lip tie.

CONTACT INFORMATION

Dr. Bobby Ghaheri

Email Link

Website: www.drghaheri.com

REFERENCES

Acevedo, A. C., da Fonseca, J. A., Grinham, J., Doudney, K., Gomes R. R., de Paula, L. M., & Stanier, P. (2010). Autosomal-dominant ankyloglossia and tooth number anomalies. Journal of Dental Research, 89(2), 128-132.

Han, S. H., Kim, M. C., Choi, Y. S., Lim, J. S., & Han, K. T. (2012). A study on the genetic inheritance of ankyloglossia based on pedigree analysis. Archives of Plastic Surgery, 39(4), 329-332.

Klockars, T., & Pitkaranta, A. (2009). Inheritance of ankyloglossia (tongue-tie). Clinical Genetics, 75(1), 98-99.

PERMISSION

Permission was granted by Dr. Bobby Ghaheri for the republication of this article. Originally published on February 18, 2014 as Diagnosing Tongue-Tie in a Baby is Not a Fad.