Pediatricians Warn Against Overuse of Tongue-Tie Surgeries

In recent years, more and more women struggling to breastfeed have taken their babies to a dentist to sever the tissue under the tongue.

But little evidence supports the use of these “tongue-tie releases” for most babies, according to a report published on Monday by the American Academy of Pediatrics, which represents 67,000 doctors. The tongue procedures, which often cost several hundred dollars, should be done only to the small fraction of infants with severely tethered tongues, the report said.

“Our patients are paying out-of-pocket, outrageous amounts for something they don’t need,” said Dr. Jennifer Thomas, a pediatrician in Wisconsin who oversees the academy’s breastfeeding group and was the lead author of the report.

Dr. Thomas said she and her colleagues began working on the report nearly nine years ago when they noticed a significant uptick in parents asking them to check their infants for tongue-ties. One study estimated an 800 percent rise in the number of tongue-tie procedures between 1997 and 2012.

A New York Times investigation last year found that some dentists and lactation consultants aggressively promoted the surgery, despite a risk of side effects. Serious complications are rare. But doctors told The Times that they had seen the cuts cause such pain that babies had refused to eat, becoming dehydrated and malnourished. A few said that newly floppy tongues blocked infants’ airways.

Proponents of tongue-tie releases claim that a tethered tongue not only impedes breastfeeding but can also cause future problems for the child, such as sleep apnea and speech delays.

The A.A.P. report notes that tissue connecting the tongue to the bottom of the mouth is a normal feature of human anatomy. For the relatively small number of babies with tightly tethered tongues, the surgery could be helpful. But even then, the report says there is no advantage to cutting the tissue with a medical laser, which many dentists tout as leading-edge technology. Instead, pediatricians can use scissors with minimal side effects.

A tongue-tie release is often recommended in the earliest days of breastfeeding, which can be challenging for any parent. A recent survey of more than 1,400 women found that nearly 40 percent had at least one nursing complication, such as latching pain, cracked nipples or sore breasts. But those issues often resolve on their own without surgical intervention.

To weather those early problems, the academy recommends that mothers work with lactation specialists, pediatricians and feeding therapists, who can provide less invasive treatment options.

Finding that support system can be difficult for some parents because of the significant cost of seeing a medical specialist or a lactation consultant.

“It’s clear we need to do a better job of supporting breastfeeding families,” Dr. Thomas said. “We’re getting better, but obviously it’s not perfect.”

The new report also cautions against unnecessary procedures that are sometimes recommended in tandem with tongue-tie releases, such as snipping “cheek ties,” or tissue that tethers a baby’s gums to the cheeks, as well as extensive mouth-stretching routines. These procedures should not be offered, the report says, echoing guidelines released in 2020 by the American Academy of Otolaryngology-Head and Neck Surgery.

Dr. Thomas, who is a practicing pediatrician and certified lactation consultant in Franklin, Wis., has become so accustomed to fielding parent questions about tongue-ties that she has made a point of checking for them on each baby, even before she has been asked.

“We usually don’t announce a negative. Like, I wouldn’t announce that a liver isn’t enlarged,” she said. “But we just see so many people asking about it.”