Snip eases breastfeeding for some babies

U. FLORIDA (US)—Many doctors don’t perform a simple procedure that would make breastfeeding easier for some babies because they believe it’s not medically necessary.

Studies show about 2 percent to 5 percent of babies have tongue tie—a condition when the connective tissue under the tongue is too tight—and about half of those babies have problems with breastfeeding, in some cases so severe that new mothers give up breastfeeding altogether.

“It is called a frenotomy, and it is far simpler than a circumcision, which we do fairly routinely,” says Sandra Sullivan, assistant professor of pediatrics at the University of Florida.

“It literally takes longer to fill out the consent form for the procedure than to do the actual procedure itself.”

The study appears online in the journal Pediatrics.

For babies to breastfeed effectively, the tongue has to be able to perform a more complex type of sucking than what it takes to drink from a bottle, Sullivan says. Tongue tie can hinder a baby’s efforts to move his tongue up, down, and out, which is necessary to nurse.

“If you take a bottle with an artificial nipple, there is not a lot a baby has to do to get milk,” Sullivan explains.

“To get milk out of the breast, they have to make a vacuum and if they cannot get their tongue to the roof of their mouth, they cannot do this. They also need to use their jaw and tongue to move the milk along through the milk ducts in the breast.

“If they just bite on the nipple (like a bottle), first, it hurts (the baby’s mother) a lot and second, it blocks off all those little tubes, which keeps the milk stuck in the breast.”

About 4 million babies are born in the United States annually, meaning that between 40,000 and 100,000 babies are born each year with a tongue tie problem, says Isabella Knox, associate professor of pediatrics at the University of Washington.

“That’s a lot of babies,” Knox says. “I don’t think general pediatrics training gives us a lot of skills in supporting breastfeeding.

“A lot of pediatricians have lactation consultants, but we don’t really know how to help somebody and for some people it is not always a priority.”

According to the American Academy of Pediatrics, breast milk is considered the optimal food for babies. Studies have shown that exclusive breastfeeding offers infants some protection against diseases and common childhood illnesses, such as ear infections.

“Breastfeeding is best for babies, and we want to encourage mothers to breastfeed and do it successfully for as long as they would like,” says Jerry Isaac, a pediatrician and past president of the Florida chapter of the American Academy of Pediatrics.

“This (paper) is an important piece of information adding to the body of knowledge that this may be a significant problem in some babies.”

Sullivan is part of an international organization focused on issues related to tongue ties. She and other members of the group’s screening committee are working to develop a screening tool that would help nurses quickly screen for a tongue tie while assessing the baby after birth.

“There is not a lot of literature about frenotomy, and there are still a lot of doctors who say, ‘Is this really necessary?’” Sullivan says.

“Whether or not there is an epidemic or whether we ignored tongue ties and are looking for them now, this is something that is coming up more often in nurseries.”

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