James Brice

October 30, 2007

October 30, 2007 (San Francisco) — For pediatric surgeon Mervyn Griffiths, MD, a simple snip under a baby's tongue is both an elegant solution to a breast-feeding problem and the basis for a double-blind clinical trial.

Dr. Griffiths, who practices at Wessex Regional Center for Pediatric Surgery in Southhampton, United Kingdom, demonstrated with previous research that mothers experience immediate improvement in their breast-feeding when a surgeon corrects tongue-tie abnormalities in their babies during the first months of life.

Some critics, however, dismissed Dr. Griffiths' positive results as placebo effects among women who were anxious to please the surgeon who treated their babies, according to Janet Hyett, MD, who was a fourth-year medical student when she assisted with the follow-up trial. Others dismissed the approach because medical textbooks say tongue ties never cause a problem. In fact, many pediatricians refuse to treat them, Dr. Griffiths told Medscape Pediatrics.

Here at the American Academy of Pediatrics 2007 National Conference and Exhibition, Dr. Griffiths and Dr. Hyett presented a poster describing results from a prospective double-blind, randomized controlled trial that appears to have proved both the critics and the textbooks wrong.

Sixty breast-feeding mothers and babies with a mean age of 32 days (range, 5 — 115 days; median, 23 days) and known tongue-tie deformities were randomly assigned to 2 groups. The tongue ties in 1 group were surgically corrected, whereas no intervention was performed on babies who served as control subjects.

A tongue tie is a band of tissue extending from the tongue to the floor of the mouth. Its severity varies, according to Dr. Griffiths, from abnormalities involving just the tongue tip to thick bands of tissue that secure the base of the tongue to the mouth floor.

Up to 10% of babies will have tongue tie, with about half of these tongue ties being severe enough to cause breast-feeding problems. The infants typically have trouble latching on to a breast during feeding. They will latch on, slip off, and then chomp down, which is painful for the mother and inefficient for breast-feeding, he said.

"The child feeds almost continually [and the] mother becomes frustrated and sore," Dr. Griffiths added.

In the procedure used to correct the problem, the baby is swaddled, and its head is immobilized by a nurse. The surgeon uses a depressor to force the tongue to the roof of the mouth, and the tongue tie is divided (snipped) — without anesthesia — using sterile surgical scissors.

Dr. Griffiths reported only 1 infection of the approximately 10,000 procedures he performed. Ten infants required pressure under their tongue to stop bleeding.

"It is a simple, safe, and successful intervention," Dr. Hyett said.

In the trial, babies were immediately returned to their mothers for breast-feeding after treatment or sequestration without treatment in a nearby room. During interviews, 21 (78%) of 27 women whose infants received corrective surgery said breast-feeding had improved compared with 14 (47%) of 30 mothers whose infants were not treated. The experiences of 3 women were excluded because of a loss of blinding. The results were statistically significant ( P < .03).

Follow-up surveys a day later found that 90% of mothers reported improved feeding, with 3.3% reporting a full resolution of problems. Repeat interviews after 3 months revealed that 90% of the mothers still experienced improved feeding compared with their presurgical experiences, but now 55% said that their breast-feeding problems were fully resolved.

Dr. Griffiths attributed the increase in full resolution of problems to the healing of breast and nipple injuries that had occurred before the tongue-tie division was performed. Half of the infants were still breast-fed at the point of the second survey (mean infant age, 4.5 months). In the United Kingdom, 29% of babies are still breast-fed at 4 months of age, he said.

The findings reflect the experience of Linda McCabe, a pediatric nurse practitioner and lactation consultant in Burlington, Iowa. Similar to the British researchers, Ms. McCabe has observed a relationship between lactation problems among mothers and the presence of tongue-tie abnormalities in their newborn children.

"If we clip [the tongue tie], we have immediate improvement with mom's comfort and lactation. The babies thrive," she said. "It makes a huge difference for our practice."

Successful surgeries are gratifying for the surgeon as well, according to Dr. Griffiths.

"It is a situation that makes you happy that you became a surgeon. These mothers are genuinely overjoyed with what we have done," he said.

American Academy of Pediatrics 2007 National Conference and Exhibition: Abstract 39. Presented October 29, 2007.

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