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Re: Tongue-tie and Infant Feeding

Dear Editor,

Although for centuries physicians recognised that tongue-tie was a congenital anomaly that might interfere with infant sucking, paediatric opinion since 1950 has emphatically denied that the condition exists or causes a problem(1). Judging from Mr. Mervin Griffiths’ recent letter(2), it appears that this scepticism persists.

I became convinced in 1960 that tongue-tie sufficiently severe to impair sucking was a real, though uncommon, entity. During the next 28 years my experience suggested that its prevalence was at the very least 1/1000 newborn infants. Diagnosis was based on the presence of a tight frenum that prevented the tongue projecting beyond the lower gum margin, combined with a weak and intermittent suck; when diagnosis had been delayed for any reason, there was a history of slow and difficult feeding and a poor weight gain. Careful division of the tongue-tie in the early neonatal period proved to be straightforward and without complication. Justification for this small operation came from the mothers who testified at once to the improved sucking capacity of their infant and to the shorter feeding times. In cases where weight gain had been poor, there was usually a dramatic and rapid increase. In one case, I measured the strength and pattern of the suck with a pressure transducer before and after snipping the frenum. There was a dramatic improvement(1).

The time has come, I think, for those who deny the existence of symptomatic tongue-tie to undertake an objective clinical trial. Among the parameters that might be measured before and after division of tongue- tie are: (a) the strength and pattern of the suck; (b) the time taken to complete a feed or to ingest a given volume of milk; (c) the rate of weight gain.

It is splendid news that NICE(3) has recently recognised that tongue- tie may interfere with infant feeding and has supported the need for frenotomy when required.

P.M. Dunn Southmead Hospital, Bristol, UK P.M.Dunn@bristol.ac.uk

References:

1. Dunn, P.M. Bridled babies: a history of tongue tie. Proc. Bristol Medico-Historical Soc. 1995-99, 3, 15-23.

2. Griffiths, M. Tongue ties and breast feeding. Arch. Dis. Child. 2006, 91, 542.