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When a new mother has a hard time breastfeeding, doctors, breastfeeding counselors and well-meaning loved ones (even if they are dominant) tend to have a lot to say. "How is the latch?" "What positions did you try?" And more and more: "Have you checked if a tie was held?"
The diagnoses of tongue attachment – which basically means that the band of tissue connecting the front of the tongue to the floor of the mouth is short or tight – have skyrocketed recently, and it is now said that up to 11% of newborns have this disease. . Similarly, the number of frenotomies or revisions by tongue attachment – essentially "cutting" the tissue in question – has increased considerably. One study found that hospitalized frenotomies increased from just over 1,200 in 1997 to more than 12,400 in 2012.
Tying the tongue can make breastfeeding a difficult task for the mother because the mobility of the tongue is not great enough to allow the baby to pick up the nipple and swallow effectively. In dedicated Facebook groups, which bring together thousands of members, mothers are ecstatic about the transformative impact that a frenotomy may have – and in some cases even, they can help.
Tongue attachment can also cause speech problems and other oral activities. But overall, there is not much reliable data on who to treat, especially in less severe cases, and the impact of this treatment.
Today, a small study published on Thursday penetrated these troubled waters, revealing that 63% of babies referred to a specialist for surgery to treat a tongue attachment or upper lip attachment were finally determined at: do not needed the procedure after a full evaluation with a speech therapist, and these same babies were able to successfully breastfeed without surgery.
"It's amazing to see such a rise over the past decade, to see people sent for something for which they had not been before," HuffPost told Dr. Christopher Hartnick, author of Study. "We asked ourselves," Is the indication correct? Are all these procedures necessary? As an ear, nose and throat surgeon, Hartnick said he now gets recommendations for such procedures for up to five newborns a week.
Hartnick thinks his study raises questions about whether babies are undergoing a procedure they may not need, but he was also frank about the limitations of the research published in JAMA Otolaryngology-Head & Neck Surgery. The study included only 115 babies, aged about 1 month old. And he and his team were only interested in the patients of his establishment.
Above all, he said it was a study that required more research. Although the procedure for correcting a language link is brief and is not thought to be particularly painful, Hartnick said, any surgery involves risks. According to figures cited in the study, basic surgery costs for a frenotomy can reach around $ 850. More complex procedures performed under general anesthesia can generate costs for drugs as well as high hospitalization costs.
"For me, it is said that it is good that parents ask not only the opinion of a surgeon, but also the search for a multidisciplinary view on [what’s happening]Hartnick said.
"There are really two issues at play here," said Dr. Casey Rosen-Carole, pediatrician and medical director of lactation services and programs at the University of Rochester Medical Center, who did not participated in the study. "One is the individual question of how parents should make that decision. And the second is the issue of public health and the "hot spot" of this debate, with which I disagree. "
In recent years, the medical community and the media have expressed their skepticism about the usefulness of intervention in case of darkness, as evidenced by stories describing this phenomenon as "fad". But Rosen-Carole pointed out that In the process of realization, it is also true that many more women are breastfeeding now than in recent decades.
She also referred to a 2017 Cochrane review which concluded that there were not enough solid studies to argue for or against the frenotomy or to provide clear guidelines, but that it reduced the pain caused by short-term breastfeeding for mothers. And that, of course, for a woman who struggles with an unbearable diet after the other is not a trivial matter.
"The instinctive reaction to a study like this is" Uh oh! "While I think we're probably going in the right direction – we just need more education to know how to diagnose and treat properly [tongue-tie], "she says," and there is a huge gap in the search. "
Hartnick and Rosen-Carole agree that the best approach is a multidisciplinary approach, involving pediatricians, breastfeeding consultants, speech therapists and specialists in the ears, nose and throat to establish a diagnosis and start treatment.
But in many parts of the country, this is simply not possible.
"I would say to moms, if you can go to a breastfeeding consultant, start there," Rosen-Carole said. And ask your pediatrician too. Then you have to find the members of your local community who take care of that and get a second opinion. See who you trust and make a decision from there. "
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