Re: Are We Overdiagnosing Tongue-Tie In Breastfeeding Newborns? | My response
Read Time | 6 min
I recently stumbled upon a Huffpost article that poses the question of whether or not tongue-ties are over diagnosed.
It's a valid question and a relevant concern to many parents who experience pain with breastfeeding or whose babies may struggle with feeding regardless of the method.
As a lactation professional who not only deals with all types of infant feeding but has extensive experience supporting families whose babies are tied, I figured I would give my input on the subject.
If you've read any of my previous blog posts on this topic, you may already know that I find the conversation regarding oral restrictions very complex.
Read More:
There's quite a bit of disagreement among professionals in various fields which makes it hard to find a good starting point to build a strong foundation to develop a deep a knowledge base.
And the media coverage of the recent JAMA study did nobody any favors in helping clear up some of the confusion. The reported take away from that study? Babies don't need tongue-tie surgery to breastfeed.
Without getting too deep into the issues with that study (and there were many) the question remains, assuming their conclusions were correct, are oral restrictions being over-diagnosed?
No.
And yes.
Before I explain my answer further, I want to make it clear: I do NOT think tongue-tie is a fad, I do NOT believe that babies with a limitation in oral function are being overdiagnosed, and I do NOT think we need to assess fewer babies for oral restriction.
So why do I think that some babies may be diagnosed with tongue-tie when there isn't one present?
The answer lies in a disconnect in the thought process surrounding body mechanics and its impact on oral function.
Babies may be "overdiagnosed" with tongue-tie based on the findings of a functional and visual oral examination if providers are not well versed in the appearance of normal frenulae, providers aren't skilled at assessing musculofascial tightness or if issues such as Torticollis or Cranial Nerve Dysfunction are under-diagnosed.
For some, the idea of overdiagnosis is supported because a revision may seem ineffective, and one may conclude a tie was not present when symptoms do not improve. This scenario is most likely to occur if no pre and post revision bodywork was completed.
Oral restrictions cause a decrease in oral function capacity, which revision surgery is designed to remedy. But oral restrictions may not be the cause of decreased oral function in all babies who present with the key symptoms of tongue tie. If 100 percent of babies with decreased oral function get body work and expert infant feeding guidance, those whose issues are not of a result of a tight, short or inelastic frenulum will not get a procedure unnecessarily.
And despite the potential for "over-diagnosis" in a small population of babies, so many more babies will be underdiagnosed. Those babies will continue to struggle to compensate for their reduced oral function into adulthood.
Instead of asking the question of whether or not ties are over-diagnosed, we should be demanding a base level of knowledge regarding oral restriction of all Medical doctors that deal with infants and infant feeding, family Docotors, Pediatricians, midwives, etc so that not another tongue tie is missed.
Far too many babies are being forced into a lifelong pattern of compensation because so many providers are not adept enough at evaluation to even make it an argument worth exploring.
So what can parents do to ensure their baby isn’t ‘overdiagnosed’ with tongue tie?
A skilled provider will be able to physically feel the difference between a tight frenulum and tight supporting anatomy. A skilled provider will understand the impact of body mechanics on oral function such as tongue lift, lateralization, cupping, etc. so ask questions regarding the quality of their training and their level of experience. Ask their opinion on how effective bodywork and lactation/infant feeding support is on outcomes.
Interested in assessing oral function at home? Click here to read more about the FREE DIY Oral Assessment worksheet.
Get evaluations done by providers who have a good track record of successfully supporting families with infant feeding problems, those who continue their education yearly, those who teach and those who observe under the best in their field.
This may seem counterproductive as the number of providers able to diagnose ties is already limited, and that may mean parents must drive further to get their babies evaluated , but the current state of things is doing nobody any favors.
I want to end on this:
In the Tongue Tie Baby Support group there are over 75 thousand parents searching for answers in a FB group, a large majority because their baby’s tongue tie was missed.
In the Tongue Tie Adult Support group, there are over 11 thousand parents who are just now finding out that the issues they’ve dealt with for years (apnea, TMJ, dental issues, speech issues, etc) are due to a missed tongue tie.
When there are over 11 thousand confirmed cases of revisions for tongue tie where there was none present, then I think that we can officially say that we are over-diagnosing tongue tie.
Until then, it will do far more harm to adopt this belief and our time is better spent demanding an improvement in care from all providers dealing with infant feeding.
Thoughts?