"My baby is not gaining weight." "She will not take a bottle." "Breastfeeding is painful, am I doing something wrong?"
Here are some of the questions and comments from mothers in breastfeeding support groups, online forums and in the waiting rooms of pediatric surgeries. The first tip that mothers get is often to check if they are "knotted," or ankyloglossia – attach the infant's tongue to the floor of the mouth with a small piece of tissue called the frenulum that makes it difficult to maintain the breast. suck.
This condition can be corrected by simple surgery of cutting or cutting tissue. But is it necessary for most babies?
That's the question that researchers at the Massachusetts Eye and Ear's Boston Eye and Ear Pediatric Airway, Voice and Swallow Center have been trying to answer after seeing an influx of parents asking for second and third opinions about to to know if their baby needed the procedure, which takes about a minute. and is usually done without anesthesia.
"We have seen the number of surgeries release the tongue and lip increased dramatically nationally, with no real evidence that these interventions are effective for breastfeeding," said Dr. Christopher Hartnick, lead author, director of pediatric otolaryngology division at mass. Eye and Ear, said in a statement.
They initiated a study of 115 babies, who were referred to a pediatric surgeon for nose and throat surgeries, for surgery on the tongue and / or upper lip ties. The upper lip tie occurs when a small piece of tissue attaches the upper lip to the gums.
The procedure was not necessary for 63% of infants, according to their findings published Thursday in the journal JAMA Otolaryngology – Head & Neck Surgery. Babies have learned to breastfeed successfully after thorough evaluation of feeding by teams of clinicians, including a speech therapist.
The study did not specify whether the children had been misdiagnosed or had undergone other non-surgical treatments to relieve their language problems.
"We do not have a crystal ball that can tell us which babies could benefit the most from loosening the tongue or upper lip," Hartnick said. "But this preliminary study provides concrete evidence that this multidisciplinary nutritional assessment stream is helping to prevent babies from undergoing this procedure."
The results raise the question: if many babies do not need tongue surgery, why are so many of these surgeries done?
Does the language attachment procedure help?
A language link occurs in 4 to 11% of all newborns, according to a 2017 Cochrane report. Tongue surgeries, or frenectomies, are performed on babies who have a tight frenulum.
However, previous studies had suggested that a tongue link did not always complicate breastfeeding and that releasing it did not always improve breastfeeding. Indeed, it is possible that the improvement observed by the parents is sometimes due to wishful thinking, in other words to the placebo effect.
Most experts say that the rise of surgeries to language is linked to the success of global efforts to increase breastfeeding. In fact, more than 80% of American mothers start breastfeeding after delivery, but less than half are exclusively breastfed after three months, according to the Breastfeeding Report of the Centers for Disease Control and Prevention. diseases.
"As a new mother, you can not access any parenting or breastfeeding support websites without hearing that the tie is the main reason your child has difficulty keeping breast or why breastfeeding is painful, "said Dr. Jonathan Walsh, a pediatric otolaryngologist: head and neck surgeon and assistant professor at the Johns Hopkins School of Medicine.
Some mothers may check to see if their baby has a malformed tongue or has trouble getting their tongue out. However, it can be difficult for mothers to detect their attachment themselves, which results in the disease going unnoticed after a few weeks of painful breastfeeding, Walsh said.
Despite the lack of evidence linking surgery to improved breastfeeding, the number of such procedures has increased rapidly in recent years, said Walsh, author of a study in 2017 on rates of breastfeeding. surgeries with tongue ligation from 1997 to 2012. Walsh was not involved in the new research.
"In general, the rates of language-related diagnoses … are increasing dramatically in the US and around the world, resulting in more children being treated," Walsh told NBC News. His study of 2017 revealed an estimated 10-fold increase in the number of tongue ligation surgeries from 1997 to 2012.
Walsh said that the increase in the number of language control procedures is not just the result of public health efforts to increase breastfeeding practices, but also the result. a greater number of lactation services, a greater awareness and a broader definition of this type of link.
What should mothers do?
Some mothers who have trouble breastfeeding can adjust their breastfeeding position or review breastfeeding techniques with a breastfeeding professional.
As with any surgical procedure, complications can occur, including bleeding, infections, or tongue or salivary gland damage. Although complications are rare, Walsh advised mothers to consider asking for a second opinion about the diagnosis or the choice of procedure, in order to save babies unnecessary discomfort.
"If you step back and critically examine these children, you will often find another diagnosis or alternative treatment," said Walsh. "It's not because you have the diagnosis that you have to undergo surgery," Walsh said.