Over the past several years, I have noticed a MASSIVE increase in the number of babies with a breastfeeding and/or bottle-feeding aversion who have had, or are booked to have, a tongue-tie snipped or lasered.
Tongue-tie (ankyloglossia) was once an underdiagnosed cause of breastfeeding difficulties. Now, just like reflux and milk allergy and intolerance, it has become an overdiagnosed excuse for any troubled feeding behavior displayed by breast- and bottle-fed babies. In the feeding aversion cases I have been involved with, a thorough assessment of baby’s feeding history and current feeding behavior, which would have ruled out tongue-tie as the cause of his/her feeding issues, was not done prior to the procedure.
Tongue-tie is relatively common. Many babies, children, and adults have a tongue-tie to varying degrees. For the vast majority, it causes no ill effects on feeding or speech.
Just as tongue-tie is common, so too are infant feeding problems. It’s estimated that 25 to 45 percent of normal developing babies – with or without a tongue-tie – experience feeding problems. The fact that a baby has a tongue-tie and also feeding difficulties does not prove causation.
Your health professional or pediatric dentist can see if your baby has one of 4 grades of tongue-tie. However, without knowledge of reasons and solutions for behavioral infant feeding problems – such as feeding aversion due to being repeatedly pressured to feed, faulty or inappropriate feeding equipment, poor positioning or latch, misinterpretation of infant feeding cues, forceful or delayed letdown while breastfeeding, and severe sleep deprivation affecting feeding – health professionals in general don’t ask relevant questions to check for these problems, and instead make assumptions that the cause is physical. At some point, generally after acid-suppressing medications and hypoallergenic formula have failed to improve the situation (which will be the case for a behavioral feeding problem), a tongue-tie snip or laser procedure may be recommended as part of a process of systematically eliminating physical causes.
Any diagnosis that excludes an assessment of the various behavioral reasons for a baby’s troubled feeding behavior has the potential to be way off the mark. Exposing a baby to minor trauma associated with having her tongue-tie snipped or lasered (plus weeks of stretching to prevent the wound from reattaching), based solely on a vague hope that it might help, is likely to cause more harm than good.
A small percentage of babies with severe tongue-tie that tethers the bottom of the tongue’s tip to the floor of the mouth, and thus restricting movement of the tongue, may benefit from having a tongue-tie division procedure. For most, it will make no difference to their feeding behavior. For others, it can further complicate the situation by triggering or worsening a feeding aversion. Hence, if you’re concerned about tongue-tie affecting your baby’s feeding, it may be prudent to do your own assessment rather than rely solely on assumptions made by your health professional.
There are ways you can tell if your baby’s tongue-tie is affecting feeding or not. Below is a brief guide on how you might be able to rule out or rule in tongue-tie, and how this compares to a feeding aversion.
1) Tongue-tie is FAR more likely to affect breastfeeding than bottle-feeding due to the different way a baby’s tongue moves for each feeding method. While breastfeeding, Baby’s tongue needs to be free to roll in a wave-like action to ‘milk’ the mother’s milk ducts. While there is some degree of suction involved, effective breastfeeding is mostly achieved by Baby’s tongue compressing the mothers’ milk ducts, which then pushes milk into baby’s mouth. Whereas, while bottle-feeding, a baby’s tongue cups the nipple as she sucks. Movement of her tongue while bottle-feeding is minimal.
A behavioral feeding aversion can affect both breast- and bottle-fed babies.
2) Tongue-tie often runs in families and is thought to be more common in boys than girls.
3) Tongue-tie is a condition that is present at birth. And therefore, in the case of a bottle-fed baby, feeding difficulties would be evident from the time she first started to bottle-feed. In the case of a breastfed baby, a tongue-restriction problem may only become evident after a mother’s oversupply of breastmilk settles, at which time baby needs to actively feed rather than be a passive recipient of milk spraying into her mouth.
A behavioral feeding aversion typically develops around the age of 6 to 8 weeks and worsens as Baby matures. See Chapter 3 in my book, ‘Your Baby’s Bottle-feeding aversion’ for further description of how a behavioral feeding aversion first presents and develops.
4) Tongue-tie and other structural and functional impairments that negatively impact on feeding will affect ALL feeds, both awake and drowsy/sleepy feeds.
It’s very common for babies with a behavioral feeding aversion to appear like she is having feeding difficulties while awake and during the day, but feed well at night while relaxed or in a drowsy/sleepy state.
5) There is a difference between a baby ‘having difficulty feeding’ and ‘not wanting to feed’.
Conflicted feeding behavior, which is commonly displayed by babies who are averse to feeding, is often mistakenly interpreted as the baby experiencing pain while feeding, or having trouble remaining latched to the breast, or having an uncoordinated suck.
There are many causes of infant feeding problems. Don’t rush to blame tongue-tie. And be wary of clinicians who have not assessed behavioral causes and who charge hundreds of dollars for procedures.
Written by Rowena Bennett RN, RM, MHN, CHN, IBCLC.
© Copyright Rowena Bennett 2022. All rights reserved. Permission from the author must be obtained to reproduce all or any part of this article.