A miracle solution for some, ‘barbaric’ for others. The truth behind the boom in cutting babies’ tongues

It’s been five years, but Jemma Collins can still hear her three-week-old daughter’s screams echoing through the dental clinic.

The new mother watched as her daughter Ayla was wrapped tightly in a swaddle and held down on a table by a dental assistant while another prised her little mouth open.

Then the dentist got to work, pointing a laser into Ayla’s mouth to cut the delicate tissue that ran from the underside of her tongue to the floor of her mouth.

“I’m traumatised just thinking about it,” Jemma says of the 2018 tongue tie procedure.

“She was screaming the whole time so they had to stop and start,” she recalls. “It was barbaric.”

Ayla is among a skyrocketing number of Australian children who have had a tongue tie release. The controversial procedure involves using scissors or a laser, often without anaesthetic, to cut soft tissue called a frenulum that connects the tongue with the floor of the mouth.

It’s estimated that between 2 and 10 per cent of babies are born with a tongue tie, a congenital anomaly that can make it difficult for some babies to breastfeed because their tongue movement is restricted.

While many parents swear by the procedure – which is often promoted as a solution to breastfeeding issues such as nipple pain, fussiness at the breast and a poor latch – others, including Jemma, say it made no difference and instead inflicted unnecessary pain on their babies.

In rare cases, the procedure can be life-threatening.

In 2019, the seven-week-old son of Australian comedian and children’s entertainer Jimmy Rees was rushed to Gosford Hospital, on the NSW Central Coast, by ambulance after a main blood vessel was accidentally cut during a tongue tie procedure.

“Mack is on a ventilator,” his wife Tori posted about the harrowing experience on Instagram. “Please give him so much strength for us. We are speechless.”

In the post, she detailed how Mack needed CPR, a blood transfusion and was put on a ventilator, before being transferred to the intensive care unit at Sydney Children’s Hospital.

“Mack is on a ventilator. Please give him so much strength for us. We are speechless.”

Tori Rees

The procedure has boomed in popularity, with the number of Medicare-funded tongue tie releases for Australian children aged four and under increasing by almost 700 per cent between 2003 and 2023, according to an analysis of government data by this masthead.

Last year, 8719 children aged four and under received Medicare-funded tongue and lip tie releases (a condition where the skin of the upper lip is attached to the gums in a way that restricts movement). There were just 1097 procedures performed on this age group in 2003.

These figures are just the tip of the iceberg as they do not capture a large proportion of the procedures which are being performed by private dentists and don’t attract rebates. One Melbourne dentist, who charges $900 for the procedure and after-care, told this masthead he performs around 1000 tongue tie releases every year.

The data also does not capture those performed in public hospitals.

Social media, intense pressure to breastfeed and poor breastfeeding support are fuelling the rise in tongue tie surgeries, according to the medical practitioners interviewed for this piece.

But while scores of lactation consultants and dentists promote the practice, there is limited evidence that tongue tie releases improve feeding.

A 2017 Cochrane review concluded that while tongue tie releases reduced women’s nipple pain in the short term, investigators “did not find a consistent positive effect on infant breastfeeding”.

“None of this has an evidence base but it does have a movement,” says Dr Pamela Douglas, a breastfeeding expert, GP and adjunct associate professor at Griffith University in Queensland.

While all the health practitioners interviewed for this piece agreed that tongue tie releases were necessary for some babies, there was a large divide in opinion about how often the procedure should be performed and what constitutes a tongue tie.

Douglas believes classic tongue ties should be snipped with scissors to give babies better movement of their tongues. But she’s concerned about the unnecessary cutting of what’s known as “posterior tongue ties”.

The term was coined in 2004 to refer to a tight, hidden band of tissue at the base of the tongue. It dramatically expanded the definition of what was considered a tongue tie.

“It misunderstands the anatomy,” says Douglas. “We are looking at normal anatomic variations. These breastfeeding problems require different solutions to surgery.”

Desperate parents are flocking online for answers, with Google search interest in the term “tongue tie” almost quadrupling over the past decade in Australia.

At the same time, Australian mothers and lactation consultants are spruiking the surgery as a miracle cure for everything from breastfeeding issues to sleep apnoea and reflux on one pro-tongue tie Facebook group that boasts more than 36,000 members.

Nikki, a Melbourne mother who does not want to disclose her surname for privacy reasons, says she was blocked from this group after posting about her negative experience following her son’s tongue tie release.

“It was really clear that the tongue tie release at three weeks old did nothing,” she says. “His weight continued to drop.”

The rise in tongue tie releases has coincided with a steady stream of complaints to the national health watchdog.

The Australian Health Practitioner and Regulation Agency has received 42 notifications relating to either tongue or lip tie procedures in the decade to February 2024. The bulk of these (23) related to dental practitioners followed by medical practitioners (7) and then midwives (6).

Most of these complaints have resulted in no further action, with two leading to regulatory action and one practitioner is due to appear before a tribunal in coming months.

It’s an issue that has also caused rifts across the medical community.

“It was really clear that the tongue tie revision at three weeks old did nothing.”

Melbourne mother Nikki

A 2020 consensus statement released by the Australian Dental Association (ADA), the Australian College of Midwives and 12 other medical associations urged families to seek professional advice to “ensure a restricted frenum is actually causing a baby’s problems” before resorting to surgery.

It said there was a lack of evidence supporting the term “posterior tongue tie” and it should not be used as a medical diagnosis.

“Use of this term can result in a normal lingual frenum being classified as abnormal,” it said.

It also warned practitioners against advising parents to stretch their babies’ wounds following surgery. This prolonged healing time, increased the risk of scarring and infection and created a medico-legal risk for clinicians, according to the practitioners.

Brisbane dentist Dr Marjan Jones and Melbourne dentist Dr Jeff Kestenberg, who run clinics specialising in tongue tie releases, published a rebuttal accusing the ADA of being biased, omitting key research and failing to consult dentists with experience in the field.

”These attempts have the potential of denying mothers and infants the care and assistance they need to overcome the very real challenges they face to sustain that most significant and lifegiving practice of providing sustenance to their infants,” they wrote.

Kestenberg, who works at Coburg Dental Group in Melbourne’s north, says he performs laser tongue tie releases on around 1000 babies every year.

“I think one to two weeks after birth if you haven’t been able to establish appropriate breastfeeding, then you should be doing the treatment,” he says.

He says the quick procedure enables 90 to 95 per cent of patients to successfully re-establish breastfeeding.

Parents aren’t allowed in the room where the procedure takes place because some have fainted in the past, according to Kestenberg.

He’s concerned that waiting longer leads to babies moving onto bottle feeding, and then refusing to breastfeed.

He rejects criticism that dentists aren’t well-placed to perform the procedures because they don’t understand breastfeeding. “I don’t assess breastfeeding,” he says. “I work together with other practitioners who refer to me. Who better to do the actual tongue tie release than the person who knows the best about the anatomy of the mouth?”

He also advises parents to perform the stretches on their babies’ wounds. “When I have patients where the stretches weren’t done, or where they weren’t done as prescribed, we see reattachment or regrowth of the frenulum and we need to re-treat it.”

Dr Mihiri Silva, who is chair of the Australian Dental Association’s oral health committee and helped write the consensus statement, says non-surgical interventions, such as working with a lactation consultant to improve the positioning of a baby, reduced unnecessary tongue tie releases.

“While most procedures are simple and safe, there are also serious risks that you want to avoid,” she says.

These risks, according to Silva, might include bleeding, infection and what is sometimes referred to as a feeding aversion.

It’s something that Anita Moorhead, a clinical midwife consultant from Royal Women’s Hospital Melbourne, has witnessed.

Every year, she sees a handful of babies who have been left with sore, uncomfortable mouths following tongue tie surgeries. In some cases, the discomfort means that the babies have become reluctant to breastfeed.

“We can’t undo what has been done,” she says.

Moorhead has been assessing babies for tongue ties for 17 years at the Royal Women’s and teaches other nurse midwives to do the same.

While rates of tongue tie releases have skyrocketed in the broader community, the number of releases performed at the major maternity hospital has remained stable at around two to three a week.

She believes the procedure should be performed by people who are qualified to assess breastfeeding.

“We take it carefully and cautiously,” she explains. “We don’t want to trivialise a procedure on a baby. But for some babies, we have exhausted all other avenues that we can to improve breastfeeding, and this is part of the puzzle.”

A recent tongue tie release resolved breastfeeding issues for Amanda Jenkins and her five-week-old daughter Charlotte.

“We were having issues with latching,” she explains. “She lost a lot of her birth weight.”

A Gold Coast GP performed the procedure last week with a pair of scissors and Jenkins noticed an immediate difference.

“The latching is much better,” she says. “It has made our lives a lot simpler, not having to do as much bottle feeding and expressing. We hardly noticed her little tongue sticking out before and now we can.”

In Jemma and Ayla’s case, a tongue tie was recommended when there were no obvious issues with breastfeeding. There was no pain and Ayla was a settled baby who was putting on weight.

But a midwife from the Queensland maternity hospital where Jemma gave birth was concerned about a clicking noise that Ayla made when she fed.

She said it could be a tongue tie and recommended that Jemma see a chiropractor.

The chiropractor determined that Ayla had a tongue and lip tie and said this could lead to a reduction in milk supply, a gap between Ayla’s front teeth, speech issues and feeding issues when she started solids.

The pair were then referred to the dentist who performed the procedure.

Jemma’s daughter continued to make a clicking noise following the surgery, which she later discovered was due to her fast flow of milk.

The dentist instructed Jemma to perform stretches on Ayla’s tongue, which involved running her finger over the baby’s wound four times a day for three weeks following the surgery. She was told this would ensure the tie did not grow back.

“Imagine having an open wound on your knee,” she says. “It wants to heal, and stick back together but four times a day you are pulling that wound apart. That’s what they want you to do with the tongue.”

She stopped the exercises after seeking the advice of another lactation consultant who said they could lead to feeding aversions.

Lactation consultant, Lois Wattis, says an excessive number of tongue tie releases are being performed on babies who don’t need them.

“There’s been an enormous amount of over-treatment that has happened, primarily by dentists,” she says.

Confirmation bias, where people seek only evidence that supports their existing views, is a powerful force at play, according to Wattis.

“In all aspects of this treatment you will have people wanting it to work,” she says. “Parents want it to work because they are struggling.”

Breastfeeding issues often resolve over time as babies grow and their mothers discover the best positioning for feeding, Wattis says.

Jemma has since gone on to have two more children, including a three-year-old who was also diagnosed with a tongue tie by a lactation consultant.

“”Imagine having an open wound on your knee. It wants to heal, and stick back together but four times a day you are pulling that wound apart.”

Jemma

“I just did the watch and wait and she was fine: talking by 18 months, eating solids like a champion, no issues whatsoever,” she says.

Her three-month-old son Eric also makes a clicking noise when he feeds and she suspects he also falls under the definition of a child with a tongue tie.

She’d like to see tighter controls over who can assess and perform tongue tie releases.

“In our case, it might not have been necessary in the first place.”

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