© 2013 Roy Benaroch, MD
Anita wrote in: “My little newborn has this bit of tissue under his tongue, so he can’t stick his tongue out. Should it be removed?”
I’m thinking Anita means, should the little bit of tissue be removed. Not the whole tongue. Probably.
That little bit of tissue is called a “lingual frenulum”, or a “sublingual frenulum.” What to do about these things is something that’s changed as years have gone by. When I was a baby, doctors would routinely just clip the things, right there in the nursery, as a matter of course. Probably without consent or any handwringing discussions.
Then, the pendulum swung away from clipping. By the 1990’s, the standard teaching was to leave the darn things alone. We figured that they didn’t do much harm, and seemed to go away on their own, so why mess with them?
Now, the pendulum may be swinging back towards at least considering clipping those frenula. Several small but good studies have shown that at least some mom-baby pairs have trouble nursing with a tight frenulum (sometimes called ankyloglossia, or a “tongue-tie.”) Clipping a tongue-tie in a baby who is nursing poorly can dramatically improve latching and milk transfer, and can really reduce the pain some women experience when trying to nurse a baby with a tight frenulum.
It’s less clear whether clipping has longer term benefits. Some feel that a tight frenulum can cause speech problems, or perhaps issues with eating or kissing. Studies looking at the long-term effects of clipping on these issues haven’t been done.
Clipping one of these is a simple, safe, and quick procedure. However, few pediatricians who’ve been trained in the last 20 years have any experience with doing these. I did a CME training course that included videos and practicing on a dummy with a little pretend tongue, and it’s easy enough to learn. It is important that a good exam confirms that it’s a simple tongue-tie that can be easily clipped in the office. Some of these, if large or dense or located more towards the back of the tongue, would be better addressed by a surgeon in the operating room.
So, to answer Anita’s question: whether to clip a tongue-tie depends on what problems it’s causing. If there are nursing difficulties or pain, there’s very good evidence that clipping is a good idea. There’s not much evidence one way or the other to tell us if clipping should be done to prevent speech or language or other issues later in life. I try to judge that by how tight the frenulum appears, whether the tongue can be extended, and how much I think I can improve the tongue movement with a little snip, but that’s a call that has to be made individually for each baby.
If your pediatrician doesn’t have experience judging whether a tongue-tie needs to be clipped, ask for a referral to an ENT who can help decide if the procedure is needed, and how to do it safely.