Opinion: More discussion on tongue-tie


Discussion on ankyloglossia, otherwise known as tongue-tie.

More discussion on tongue-tie

Puppies and children

Thank you for the information and discussion about tongue-tie (January and March 2008). Some more tips to share:

How to pick it up?

In the Type 4, submucosal tongue-tie, the attachment is far back on the base of the tongue, giving the tongue a shortened appearance. It occurs in boys more than girls and one study found a family history of tongue-tie in 21%.2

If I think the baby has a tongue-tie, I ask family members to stick out their tongues. Recently, a new dad broke down into tears when he saw his son's tongue-tie. He then showed me his still tightly tied tongue and shared with me words he still couldn't say.

To clip or not to clip?

Not every tongue-tie needs to be clipped. Some ties (usually Types 1 and 2) are thin, quite elastic and cause no problems with latch, while others are tight and restrictive (Types 3 and 4). Recently published randomized studies support clipping to improve breastfeeding success.6,7 Ricke and colleagues found that tongue-tied infants were three times more likely to be exclusively bottle-fed at one week than matched control subjects with normal tongues.3 Information about the latch and nipple trauma may be helpful in determining which tie to clip.

We recommend clipping to the family if there is "anatomy plus dysfunction." Dysfunction may include: excessive early weight loss (>7% for breastfeeding baby born by vaginal birth and >8% for baby born by C-section) or poor weight gain; poor latch (classically, baby goes on the breast, sucks once or twice and then pops off); or painful latch (sore, cracked, bleeding nipples or compression stripes).

When to clip?

The procedure is so simple that if you have "anatomy plus dysfunction," clip it-and the sooner the better. Almost all of our tongue-ties that fit the criteria are clipped prior to discharge from the hospital, to give mom and baby the best chance for breastfeeding success.

Bobbi Philipp, MD Boston, Mass.


1. Messner AH, Lalakea ML: Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol 2000;54:123

2. Ballard JL, Auer CE, Khoury JC: Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics 2002;110:e63

3. Ricke LA, Baker NJ, Madlon-Kay DJ, et al: Newborn tongue-tie: prevalence and effect on breastfeeding. J Am Board Family Pract 2005;18:1

4. Coryllos E, Genna CW, Salloum AC: Congenital tongue-tie and its impact on breastfeeding. AAP Section on Breastfeeding, Breastfeeding: Best for Baby and Mother. Summer 2004

5. Genna CW: Supporting Sucking Skills in Breastfeeding Infants. Jones and Bartlett, Boston, 2008

6. Hogan M, Westcott C, Griffiths DM: Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005:41:246.

7. Dollberg S, Botzer E, Grunis E, et al: Immediate nipple pain after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg 2006;41:1598

I just had to let you know how delighted I was to read Dr. McMillan's column on puppy rearing (Editorial, March 2008). I always enjoy reading what you have to say; you really hit home with me on this one! We, too, have two standard poodles. I agree wholeheartedly with your comparisons of puppy and child rearing.

Enjoy that pup! And spend some quiet time with Zeke; he deserves it after a day with Otis!

Thanks for the great journal! Keep up the good work!

Sincerely, Jo Studley, MD East Tawas, Mich.

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