Doctors question benefits and risks of infant tongue-tie surgery

Infant tongue-tie surgery is increasingly being used to treat breastfeeding problems, but some doctors question its benefits and warn of possible complications, Yle reports. A Finnish paediatric association has also warned about overdiagnosis, saying breastfeeding difficulties can have many causes other than a tight tongue-tie.

The procedures have become a subject of dispute among healthcare professionals in Finland. A private child health clinic that sells aftercare for infant tongue and lip-tie surgery is seeking compensation from paediatrician Lotta Immeli, whom it accuses of damaging its business. Immeli has criticised unnecessary tongue and lip-tie operations on babies, including in an earlier Yle article.

How a tight tongue-tie can affect breastfeeding

During breastfeeding, a baby should form a suction that creates pressure against the breast. This happens when the baby raises its tongue towards the roof of the mouth and presses it against the nipple.

A tight tongue-tie can prevent the baby from forming a good seal and make it difficult to obtain milk. The baby may then try to grip the breast with its gums, which can cause pain for the breastfeeding parent. The nipple skin may also break, increasing the pain.

Study examines whether surgery helps

Outi Aikio, a specialist in paediatrics and neonatology at Oulu University Hospital, is leading an ongoing study at the University of Oulu into whether tongue-tie surgery benefits babies and breastfeeding mothers.

Some earlier international studies have suggested that cutting a tight tongue-tie can help with breastfeeding problems. Aikio says further research is needed because the earlier studies included too few babies and mothers and could not be blinded. Blinding is intended to prevent the placebo effect.

The Oulu study aims to identify babies who have both a tight tongue-tie and feeding problems. Some babies appear to have a tight tongue-tie even though their mothers have no breastfeeding difficulties, Aikio says.

The study is now at the analysis stage, and its results are not yet available. Aikio says the results are expected during the coming winter. A total of 1,559 mother and child pairs took part in the study.

Surgery can also cause harm

The Finnish Paediatric Association has said in a position statement that doctors regularly encounter overdiagnosis of tight tongue-ties and problems linked to unnecessary treatment. Conflicting information about the issue is circulating on social media and among healthcare professionals.

Surgery can involve complications, Aikio says. According to her, the most common problem is that the scar may tighten the tongue more than the tongue-tie did before the operation.

In some cases, a blood vessel has been hit during surgery, causing heavy bleeding in the baby’s mouth. Such cases are very rare, Aikio says.

There may also be other harms that cannot be confirmed with certainty. Sensory nerves run along the surface of the tongue-tie and continue into the tongue. It is not known how cutting them affects the baby’s sensations because babies cannot describe what they feel.

It is possible that the procedure could reduce sensation in the tongue. Learning to eat is important for a baby, and a change or reduction in sensitivity could affect feeding. Aikio stresses, however, that this is speculation because current research methods cannot provide reliable information about sensation in a baby’s tongue.

Breastfeeding problems have many possible causes

Aikio says Finland should invest more in breastfeeding guidance, including help with finding the correct breastfeeding position. She says Finland lacks a breastfeeding clinic where the most difficult cases could be concentrated.

According to Aikio, breastfeeding support in the United States is more advanced than in Finland, with clinics and specialists focused exclusively on breastfeeding.

Not every breastfeeding problem requires tongue-tie surgery, but it is difficult to determine whether operations have been performed unnecessarily because proper criteria for carrying them out have been lacking. Aikio says the field has been left open, and existing classifications have not been validated or shown to be reliable.