NEW YORK — Tongue-tie, a condition in infants that can affect breastfeeding, may be overdiagnosed in the U.S. and too often treated with unnecessary surgery, a prominent doctors' group said.
This combination of photos shows a baby with ankyloglossia where the tongue does not extend beyond the gums, left, and a baby with an indentation at the tip of a the tongue that may be a sign of ankyloglossia. The American Academy of Pediatrics is the latest, and largest, medical society to sound an alarm about the increasing use of scissors or lasers to cut away some infants' tongue tissue when breastfeeding is difficult. “It's almost an epidemic,” said Dr.
Maya Bunik, a Colorado-based co-author of the report. Experts say there isn't a good count of how many infants each year are being treated for tongue-tie with surgery, though Bunik believes the annual tally may exceed 100,000. Research suggests many of those treatments are not necessary, she added.
The academy's new report encourages pediatricians and other medical professionals to consider nonsurgical options to address breastfeeding problems. The report cites a study that suggests less than half of the kids with the characteristics of tongue-tie actually have difficulty breastfeeding. Ankyloglossia, or “tongue-tie,” occurs when an infant is born with a tight or short band of tissue that tethers the bottom of the tongue’s tip to the floor of the mouth.
The condition can make it hard for the infant to extend and lift their tongue to grasp a nipple and draw milk — which in turn can be painful for the mother. Past research shows that cannabis use has increased significantly among women before pregnancy and after pregnancy, but experts are now warnin..
. Doctors say it's critical to get breastfeeding on track in the first three to four weeks, and surveys indicate most parents want to breastfeed, so it's natural that they want a quick solution to a problem, Bunik said. Ankyloglossia diagnoses have been increasing worldwide, though there is no uniform diagnostic criteria for this condition and no consensus on how to treat it.
One common approach is to cut the tissue with scissors, but dentists increasingly are using lasers to vaporize the tissue — some charging $800 or more. But the procedures can cause pain and sore mouths, potentially deterring babies from trying to breastfeed, Bunik said. “The practice (of treating tongue-tie) got to be very common without a lot of good data," said Wisconsin pediatrician Dr.
Jennifer Thomas, who also co-authored the report. The report also recommends lactation experts, pediatricians and surgeons and other medical professionals work with parents to evaluate possible reasons for breastfeeding challenges and make the best treatment decision. The American Academy of Pediatrics, which has 67,000 members who specialize in treating children, started working on the report in 2015 after some pediatricians began to notice that an increasing number of patients were going to dentists to get treatment for tongue-tie, Thomas said.
Pediatricians were finding out after the surgeries. At least two other medical groups have issued statements about tongue-tie. In 2020, the American Academy of Otolaryngology-Head and Neck Surgery issued a consensus statement in which member physicians said they believe tongue-tie is being overdiagnosed in some places and that there isn't sufficient evidence to support claims that using lasers is superior to other techniques.
A year later, the Academy of Breastfeeding Medicine, an international group, issued a position calling for more research into tongue-tie treatment and stressed that decisions “require a high level of clinical skill, judgment and discernment.” The American Dental Association didn't directly respond to The Associated Press' questions about the new report. It sent a statement saying the organization agrees with a 2022 policy statement by the American Academy of Pediatric Dentistry, which noted not all children with ankyloglossia need surgical intervention and that a team-based approach with other specialists can aid in treatment planning.
Haley Brown saw a lactation consultant two years ago after her son Shiloh, who was born prematurely, had trouble nursing. But as months passed and the situation didn’t improve, Brown turned to a Denver dentist she heard about on social media The dentist diagnosed Shiloh with tongue-tie and also lip-tie, in which the tissue inside the upper lip is too tight. Shiloh underwent a short laser procedure that cost $750.
Breastfeeding improved immediately. “Things just seemed a little easier for him,” said Brown, 33, of Englewood, Colorado. Brown later had another baby, and another lactation consultant told her that a scissors snip could have been less involved and just as effective.
Brown said the laser treatment worked for Shiloh, but added: “I probably should have consulted with my pediatrician before I went straight to the dentist.” New parents who choose to breastfeed will find plenty of barriers to starting and even more to continuing breastfeeding. While about 83% of babies have been breastfed at least once in their first month, according to the latest Centers for Disease Control and Prevention data from 2020, parents find it difficult to maintain.
By the third month, 45% are exclusively breastfed, down to 25% by their sixth month. Exclusive breastfeeding, meaning an infant receives only breastmilk, requires support. For parents who can and choose to do so, policy can make a significant difference.
Health policy at all levels can make or break the amount of support and resources breastfeeding parents receive. For instance, on the federal level, before the PUMP Act went into effect in April 2023, only some hourly workers at certain employers were required to provide short, unpaid breaks for parents to pump. Because returning to work is one of the main barriers to continued breastfeeding, policy that limits the right to pump at work for nursing parents makes exclusive breastfeeding difficult.
The PUMP Act, which expands the number of hourly working parents eligible for lactation breaks and includes salaried workers, provides more protections—including legal recourse for noncompliance, clear guidance regarding pay during breaks, and lactation space requirements. Policy at the state level further contributes to breastfeeding's accessibility issues. Only eight states have relatively generous paid family leave policies , according to a Northwestern Medicine study published in November 2023, which evaluated the generosity of states' paid family and medical leave policies.
There is no national paid parental leave policy and the maximum time a parent can get off is 12 weeks—unpaid. Considering the American Academy of Pediatrics recommends exclusively breastfeeding infants for 6 months, the lack of paid time off leaves many families unable to do so. How states decide to implement federal programs can also make exclusive breastfeeding recommendations seemingly impossible.
Temporary Assistance for Needy Families provides cash assistance to low-income families, with return-to-work requirements varying across states. In states with strict return-to-work requirements, where all household adults have to go back to work sooner and work a certain number of hours to keep benefits, parents are less likely to continue breastfeeding, according to the Department of Health and Human Services. Even before leaving the hospital after birth, many families are not set up for success in pursuing long-term breastfeeding plans.
Many hospitals don't prioritize educating new mothers about breastfeeding and don't provide feeding routines that would support it. In 2007, 24% of birth facilities surveyed by the CDC gave healthy, full-term babies supplemental feeding, which can derail plans to breastfeed. Northwell Health partnered with Stacker to explore breastfeeding rates with CDC data , highlighting the barriers families face to exclusively breastfeed their children.
Read on to learn about major disparities to access, and what states are doing to alleviate them. Some health-related barriers are more difficult to resolve, but in other cases, parents don't breastfeed due to employment limitations, ambivalence from doctors, embarrassment, limited public spaces to feed, and/or poor social support. For instance, many workplaces don't have scheduling or private spaces built in to allow parents to pump.
For others, breastfeeding can cause physical pain that exacerbates postpartum stress. For still many more, their babies simply can't latch, or their milk supply is too low. In some cases, parents want to exclusively breastfeed—but economic and social challenges can make it difficult.
This is particularly true for Black people, who breastfeed at lower rates than white and Hispanic mothers. Black women have the highest workforce participation rates of all women and are more likely to be the sole breadwinner of their household. They're also more likely to be offered formula instead of lactation support at the hospital.
Thankfully, some solutions are being presented. Doctors, doulas, midwives, and lactation consultants are taking part in state-funded public campaigns aimed at increasing access to education and resources for first-time families. The American Academy of Pediatrics is pushing pediatricians to become health advocates for families who wish to breastfeed, both inside their offices and at the voting booths.
The Affordable Care Act updated its requirements so that insurance plans must cover breastfeeding supplies. And for Black parents, many organizations are undertaking targeted education and awareness campaigns, like Mississippi-based Sharing Health Education Awareness and national Black Breastfeeding Week (Aug. 25-31).
These efforts are producing results, too: Expanded family leave policies, federal assistance programs (including TANF), and workplace policies have helped increase breastfeeding rates . For example, California's paid leave law, enacted in 2004, has been linked to a 20% increase in rates for breastfeeding in the state. Story editing by Ashleigh Graf and Kelly Glass.
Copy editing by Kristen Wegrzyn. This story originally appeared on Northwell Health and was produced and distributed in partnership with Stacker Studio. Receive the latest in local entertainment news in your inbox weekly!.
