Thursday, February 25, 2021

I read Ms. Tracer’s article (“All Tied Up: Unraveling the Complexities of Tongue Tie,” January 7, 2020) with more than a little consternation. My colleagues have seen an uptick, or, more aptly, a deluge of referrals for what she refers to as TOTS, a cute acronym for tethered oral tissues, or a way to refer to all little babies or maybe both.

I am a pediatrician who has been in practice for over 45 years and have taken care of thousands of babies. Not only have I seen them as infants but I have had the privilege of following most of them into adulthood.

The incidence of tongue-tie or ankyloglossia is listed in the medical literature as 2-5%, and I would venture in my experience, closer to the lower number. For some reason, recently the number of babies diagnosed with this condition has exploded. Babies are being referred for surgical procedures on their tongues, their lips, their cheeks and any other tissues that are attached. They are being snipped, clipped and lasered at an alarming rate. These procedures are generally safe, but as the saying goes, there is no such thing as minor surgery. Occasionally there are complications like bleeding, infection or interference with saliva production.

Breastfeeding is not easy. It takes determination, commitment and some discomfort to get going, but with a little advice and some patience, it almost always works. We would not have survived as a human race if all these babies needed intervention to thrive. These babies do well after the procedures because there is no control. Offer a tired, anxious and sore mother who is having trouble nursing an option that she is told will work and she can’t say no. The problem is that many of these babies do well with a little patience, advice and no surgery. If you take antibiotics every time you have a cold, the antibiotics will work because the cold will get better no matter what.

The problem is that many of these babies are being referred for procedures before they even have their first office visit with their pediatrician. In many instances we can avoid any harm to the baby without any invasive procedures. I just saw a 2-week-old this week whose Mom called to say she was referred for a release
procedure because of difficulty nursing. I saw her a few days later after advising on how to change some feeding techniques. A few days later the baby had gained a robust amount of weight, the feedings were going much better and the baby was spared a surgical procedure.

This communication is not intended to dissuade anyone from doing what is right for their child. There are definitely some babies who have ankyloglossia who need intervention to manage feeding or speech problems; they should not be missed and they should be treated. On the other hand, we should not subject babies to unnecessary procedures unless indicated. I remember when everybody had their tonsils out whether they needed them or not. We should not be repeating that mistake with TOTS.

Ms. Tracer had the unfortunate experience of having to have all four of her children treated. Maybe that experience has colored her perception of how common the pathology really is. I tend to prefer to be a non-interventionist as a pediatrician, but as stated above, we follow these children for years, and if we were missing this disease we would know it, and we are just not seeing the long-term complications. I urge all new parents to please discuss this situation with their doctors before consenting to a procedure that may or, likely, may not be necessary. As physicians we are charged with the responsibility of Primum non nocere, meaning “First do no harm.”

David H. Wisotsky, MD
Tenafly Pediatrics