Tongue tie surgeries are on the rise, but experts say try other solutions first for baby's breastfeeding issues

• Procedures to fix tongue ties have skyrocketed as more parents breastfeed.
• Pediatricians say that there can be benefits, but tongue ties won't fix all nursing problems.
• Data on the efficiency of the procedure is mixed, said parenting researcher Emily Oster.

Breastfeeding rates in the US have held steady for the last couple of years, according to the CDC, but more moms want to do it comfortably. Google searches for "tongue tie release" have been climbing since 2004, reaching an all-time high in 2023. It's gotten many doctors talking about tongue ties or frenotomy — a procedure to cut the tissue under the tongue, often with a laser — but is that really right for mom and baby?

With an increased focus on improving breastfeeding rates, the number of tongue tie revisions done on American babies has skyrocketed, more than doubling between 2012 and 2016, according to a study from 2020.

"There likely are some cases in which a tongue tie revision would improve eating," economist Emily Oster, who wrote about the issue in a recent edition of her "Parent Data" newsletter, told Business Insider by email. "But the rapid growth in the procedure does suggest it may be over-used."

Experts say that parents should consult with professionals, including their doctor, lactation consultant, dentist, or speech and language pathologist, to carefully consider whether having their child's tongue cut is the right decision.

"Revision may not be necessary or even helpful in all cases," said Dr. Daniel Ganjian, a board-certified pediatrician at Providence Saint John's Health Center in Santa Monica.

Research shows the impact on breastfeeding can be limited

Tongue ties, medically known as ankyloglossia, occur when a short or tight band of tissue connects the tip of the tongue to the bottom of the mouth. This can make it difficult to stick the tongue out and lead to trouble latching at the breast.

"To nurse efficiently and comfortably, an infant needs good tongue-to-palate mobility," said Dr. Harry Pellman, a pediatrician with Children's Hospital of Orange County's Primary Care Network.

Oftentimes, infants are evaluated for a tongue tie after a nursing parent reports pain or other feeding difficulties. But a frenotomy may not even help with those issues.

"In the best data we have — randomized trials where an outside observer evaluates the efficacy of breastfeeding — there is limited evidence that breastfeeding success is improved with a tongue tie revision," Oster said. "There is even less — really, no — evidence on the impacts on long-term breastfeeding success."

There's limited self-reported data that a tongue tie revision can improve pain during breastfeeding, Oster said, but "it is difficult to know how much of this is a placebo effect."

Tongue tie revisions shouldn't be the first step

If you believe your child might have a tongue tie and need a revision, Oster recommends getting multiple opinions.

"Having multiple providers evaluate before having this surgery is one way to evaluate whether it is likely to work in your case," she said. Lactation consultants and speech-language pathologists can weigh in on whether a child has a tongue tie and how severe it is, Ganjian said.

A severe tongue tie can cause challenges beyond breastfeeding, Pellman notes, including speech problems, orthodontic issues, and trouble with the tongue sweeping through the mouth to keep teeth clean. There are other seemingly mild impacts, like not being able to lick an ice-cream cone with the tip of the tongue, he said.

If breastfeeding concerns are the main reason for considering a frenotomy, try other interventions first. Position and latch techniques can contribute to pain during breastfeeding, Ganjian said. An experienced lactation consultant or pediatrician may be able to address pain by adjusting position and technique.

There are certainly some infants who will benefit from frenotomy, Ganjian said. Yet media coverage, social media, and increased pressure to breastfeed have all led to more awareness of and interest in the procedure.

"Ultimately, the decision of whether to proceed with a tongue tie revision should be made on a case-by-case basis, in consultation with a healthcare professional who understands your child's individual needs," he said.