Talking about tongue-tie…

When to do frenulotomy in babies who appear to have tongue-tie remains controversial. ADC Fetal and Neonatal has recently carried a paper by Emond et al and an editorial by Lawson on this subject, adding to the evidence that frenulotomy can be effective in maintaining breast-feeding (Arch Dis Child Fetal Neonatal Ed 2014;99:189–95 and Arch Dis Child Fetal Neonatal Ed 2014;99:178-9). The UK media recently reported dissatisfaction among parent groups that service provision is so variable throughout the country (www.bbc.co.uk/news/health-26199591). Published simultaneously with the ADC F&N articles (and hence not referenced), a systematic review from Canada identified 20 intervention studies from the world literature, of which only 5 were randomised controlled trials (RCTs) (Webb A et al. International Journal of Pediatric Otorhinolaryngology 2013;77:635–46). Quality was variable, and there were a number of important differences between the studies: methods of assessing degree of tongue-tie, criteria for division, and outcome measures. Some of the RCTs claimed to be double-blind, but it is difficult to see how a mother could have been truly unaware of the procedure. They conclude that tongue-tie division ‘improves most aspects of breast-feeding’ for both babies and mothers. …