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Back in 2007, I began to be puzzled by the high incidence of tongue-tie in babies, and how much it can affect breastfeeding. I blogged about it here at the time: Tongue-Tie, unsure whether tongue-tie was being overdiagnosed, whether it had always been with us at this level, and whether something was inhibiting our ability to cope with tongue-tied babies. In so many ways it seems to me the obstacles to breastfeeding happen when we deviate from natural birth and separate mothers and babies after birth whether in the early hours with routine newborn procedures, or weeks or months later as moms are forced back to work by pathetic maternity leave policies. And yet on the issue of tongue-tie, it’s the breastfeeding supporters advocating to diagnose this more often and treat tongue-ties with clipping procedures – more medical intervention to make breastfeeding work better.
Because this is an anatomical issue, it’s not likely that medical interventions or cultural practices contribute much to the breastfeeding difficulties. Minor tongue-ties can resolve themselves if the mother can stand some uncomfortable latching at first as the baby’s tongue stretches out over the early months, and if the mother is willing to let the baby hang out for long hours at the breast trying to get enough milk with a poor latch. But some descriptions I’d read of the pain and supply drops that can come with nursing a tongue-tied baby convinced me that cultural attitudes about breastfeeding management weren’t the only factor in the high modern incidence of tongue-ties requiring clipping.
Another explanation could be that lactation consultants are clip-happy and perceive a higher tongue-tie rate than is warranted. And again, that maybe be a factor, but I’m not convinced that explains the observed tongue-tie rate either.
This April, I finally found a plausible theory, and it’s been chilling to think about. The prevalence of endocrine disruptors in our personal care products, our food packaging, our drinking water may be leading to increased birth defects – particularly the “midline” defects that involve glitches in formation along the long axis of our body during the first trimester of pregnancy. Tongue-tie is a midline defect, as is cleft palate, some heart defects, hypospadias (a penile deformation) and spina bifida. A doctor in Indianapolis – Paul Winchester – even claims to have found a seasonal variation in such birth defects – hypothesizing that this is due to exposure to agricultural pesticides. An interview with Dr. Winchester on the radio show Living on Earth aired in April, 2009 and the transcript is also available at that link.
What inspired me to write this now was the column this week by NY Times op-ed columnist Nicholas Kristof: It’s Time to Learn from Frogs. He goes over the mounting deformities in fish and amphibians and connects it to genital deformations in male babies – 7% now with undescended testicles, and 1% with hypospadias. He also appeared on the Colbert Report to spread the news more widely.
Seems to me we can chalk up another consequence of the toxic environment we have made for ourselves – increased struggles with breastfeeding due to anatomical defects in our babies. More mothers experiencing pain and difficulty breastfeeding – more babies unable to nurse adequately – more babies needing doctors to believe that clipping at a bit of skin can save their chances at breastfeeding. The vast intervention of our toxic load precipitates more interventions to try to restore healthful normal feeding and development.
Of course the effects of endocrine disruptors go beyond breastfeeding success, but breastfeeding never seems to get mentioned as a casualty of toxic exposure, perhaps because breastfeeding is so often framed as a matter of personal choice and personal struggles. I’d like to draw a line from this private pain to a constellation of other disruptions of the natural order, and admit that I’m more convinced now that we really are seeing more tongue-tie now than in decades past.
Thanks for writing about this and connecting the dots. WOW– I had no idea about the increase in tongue-tie and the possible link to endocrine disrupters. I wonder if Silent Spring Institute knows about this? Every time I blink it seems there’s another finding about the devastating cumulative effects of endocrine disrupters.
Interesting that you’ve mentioned this. I’ve noticed a lot of babies in our circle being born tongue-tied as well. I thought it was a coincidence. I guess I should have known better.
Wow. This is a very eye opening post. I’ve always wondered about tongue tie. It seemed to me that there are alot of babies with tongue tie who need clipping. I’m a pretty firm believer in if Nature put it there it’s there for a reason, but I’m not a doctor or an LC, so I dismissed it as my own naivity and ignorance on the matter, especially since neither of mine had tongue tie isses. But It sure made me wonder, did this many babies have tongue tie 100 years ago? What happened then? Didn’t they, couldn’t they figure out a way to breastfeed? Did they know to clip back then?
And then your mentioning of endocrine disruptures. Jeepers. It totally makes sense. Scary stuff.
Again, thanks for such an informative read!
i’ve heard of in the good old days midwives keeping their pinky fingernails long to slice tongue ties. hopefully they kept the other ones nicely trimmed
Thank you for sharing this. My daughter had a terrible time getting started nursing due to a posterior tie that went undiagnosed for 6 weeks. (We’re going strong now, though.) I, too have wondered about its origin – frightening to think about.
Great post!! Thank you!! Chilling also. My son, who was born 9/07, was tongur tied. Within 2 weeks of birth he had lost over a pound. After many unsuccessful pediatrician visits (at one she actually questioned the content of my milk because I’m vegetarian!!) a LC consultant diagnosed him and told us we both had thrush. I’m not sure if it was the thrush alone or the 2 combined, but the pain was staggering and I had a natural childbirth so I now guage pain differently. We would both be in tears at each feeding. He did get snipped and we finally got the thrush cleared up and are still bf at 23 mos. It does make me wonder what all our environment has done/is doing to his system since we live in central Illinois surrounded by farm land. So sad.
Shelly – so glad you managed to find someone who would clip – it can be the end of the line for some nursing couples, and others have to travel great distances to find someone willing to clip. I’m a vegetarian, too, and the suggestion that your milk would be insufficient because of that is pretty ridiculous – ack! I wonder if the thrush was able to thrive better because of the damage caused by his tongue-tie? I wouldn’t be surprised if those co-exist a lot. Happy soon-to-be-2nd birthday to your little guy!
Ditto @Melodie, I’ve always wondered about those incidences too. I had no idea they were more prevalent, but I did wonder if clipping was really the answer, or what did people use to do before that, when breastfeeding was a must? Did those baby die?? Or did they have ways to cope with it, ways they we maybe lost in the in-between generations when formula was first introduced??
Thank you for this eye opener, I try to make conscious choices to limit our exposure to chemicals, and this is one more reason to do so.
I do think some clipping was done of the more obvious ones. There are some more obscure varieties that might be harder to clip without modern tools? And they’re harder to diagnose, too.
While it may have been a pain, if it was the only way to feed a child, a mom could hand-express and then cup or spoonfeed the baby. Or I’ve heard of pacifying babies with a cloth soaked in sugar water or whiskey… maybe you could get them their milk this way, too?? And if mom’s milk supply dried up, maybe another nursing mom could help express some extra milk, and probably a few weeks in transition baby to cow milk anyway. Not the best nutrition for a baby, but better than not feeding them.
To address some things in your follow-up comment – it’s possible your baby did have a tongue-tie that went undetected – they are not all the same classic style. Hopefully your LC was paying attention to all the symptoms and basically knew whether to look for tongue-tie or whether that was unlikely to be a problem.
I used to have some aversion to the idea of so many babies having TT’s clipped, but if the problem is due to an intervention (toxins) then it may well be that another intervention (frenotomy) is necessary to compensate. I have also heard that some babies’ apparent tongue-tie problems are resolved or improved after structural work – especially after difficult births that involving pulling on them (forceps, vacuum, c-section) or unusual positioning in utero (breech, twins, posterior). if modern birth practices make it harder for some babies to nurse effectively with a tongue-tie, then that could be another reason for an increased incidence.
have you watched any videos of frenotomy? it does look pretty quick and painless, sometimes even bloodless. not saying it should become routine, but it’s not a huge intervention either. and yet it can make such a big difference in breastfeeding.
Thanks for your input!
RE: other moms nursing other’s childs – I do suppose this would have happened. Haven’t thought about hand expressing – of course, not ideal, but do-able.
I haven’t watched any videos of it – I tend to be put of by the visuals of medical interventions…
It’s too bad in a way how medical interventions begets more medical interventions – one of the reason I wanted to avoid an epidural during labour (and any other interventions unless absolutely needed – thankfully, none were).
Forgot to write in my previous comment: I agree that perhaps if we can revert our exposure to chemicals (ha! if that’s even possible – but we can definitely try to limit it, in any cases), then we might see the rates of birth defects such as tongue-tied (and other more serious ones) go back down.
However, the fact is that, right now, we have these high incidences. So I’m wondering: is clipping still the answer, in these cases? You point out an interesting solution for mothers to consider with the initial pain and struggles, but that eventually settled themselves.
But what if that doesn’t work out? I had a lot of issues bfing my daughter, and I don’t think she was tongue-tied (you know – I don’t think we ever looked into that possibility, although my LC probably did a check, so maybe it was fine). She was active, colicky, knew exactly what she wanted, and how to say “no” if it didn’t go her way. Nothing bad here, not complaining, but I know that she wouldn’t have been the baby to nurse longer to get enough milk – she would have probably done what she did, i.e. latch up screaming because it’s not fast enough, or whatever it was that was bothering her
(we ended up pumping exclusively for a while!)
Just curious that see what others’ take is on that matter – clipping or not, is it acceptable in such situations, when the problem IS present? It’s a good idea to work on prevention, but what about the now? I’m not sure where I stand myself… =/
my son born 9/15/08 couldn’t breastfeed effectively for 9+ weeks, it was so traumatic after our peaceful homebirth, it must have been a posterior TT (because he did not have the classic tongue tie), we also struggled with thrush.
Now at 13 months he is still breastfeeding (more than ever), our story has a happy ending, but I wouldn’t judge anyone for giving up long before we succeeded, you would have to be crazy to go through everything we went through – with no clear direction about why breastfeeding wasn’t working, or if it ever would. If TT is on the rise, for whatever the reason, word needs to get out so that vulnerable new parents can find resolution sooner.
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I am a lactation consultant in Perth, Western Australia, and have used the advice of the Canadian Pediatric Society as a basis for my assessment of tongue tie. The Hazelbaker score requires the clinician to view the tongue and estimate the degree of the problem – mild , moderate, severe. I found this to be difficult, so on the advice of the Canadians – if its a problem, its a problem.
I devised a check list of 7 items to help me in discussing the problem with the mother and deciding when the opinion of a medical practitioner was required.
Does mother have sore/traumatised nipples?
Can baby maintain good attachment (no leaking, clicking , slurping) for 8-10 minutes?
Do feeds take more than 50-60 minutes (perceived as a long time by mum)?
Is baby gaining weight at a slow rate < 60 gms / week?
Is there weight loss?
Has mother had blocked ducts or mastitis?
Is there a family history of tongue tie?
and of course look at and then feel the frenulum – is it tight?
Back in the 40s – doctors snipped tongue ties at the same time as they did the circumcision – more common in boys. They even had a small multipurpose tool – one end for holding back the tongue and the other for serpating the foreskin. They used to love doing surgery – take out your tonsils, adenoids, appendix, teeth – then it all changed and they said 'we don't do unecessary surgery'.
In my lactation clinic – I assess the function – if baby has a dysfunctional suck, he/she is referred to a pediatric surgeon. If it is not a problem right now – no maternal or infant symptoms – we 'wait and wonder'.
At 9 months baby should be able to swallow lumpy foods – if the restriction prevents this, go and see the ped surgeon – if not – 'wait and wonder'.
At 4 years a child should be able to pronounce 'L, R and S'. If not see the ped surgeon before you start speech therapy.
Dentists such as Brian Palmer, tell us that there are ramifications from uncorrected tongue tie because to the tension on soft facial bones and later on incompletely masticated food. It's not just about breastfeeding – we should heed the messages that our nipples send us.
I am starting to wonder if this should be talked about as a midline defect – is it a syndrome?
In my clinic the incidence is about 20% in the feeding problem mums but I think it is about 10% in the general population. Nobody seems to know – doctors retreat behind the mantra – 'its a controversial area'. Oh really, ask the mum with the mangled nipples.
Cheers
Ailsa
I read this with interest, and of course there is always a possibility that polutions cause all sorts. I would say that I don’t know if tongue tie is on the rise – it is definately being noticed more. One link is that it is heraditary, I heard that it doesn’t have to be the tongue, there are lots of frenulums in the body including the penis!
Another reason could be the fact that our young are born earlier than they were origionally suposed to – this was due to us standing on 2 feet, therefore our pelvis’ had to become smaller, hence our young having to be born smaller and less developed.
As for problems caused by tongue tie
I had an over supply caused by constant feeding but barely a latch – my poor son, just could not get any of the lovely fatty milk, and got covered in spray everytime he fed.
So whilst I am all for nature, I am so glad my son got his clipped.
Don’t know why I hadn’t seen this post before – as the parent of a (formerly) tongue-tied baby (he was clipped at a week old), I find this incredibly fascinating. I think you hit upon a very interesting and controversial concept – that perhaps the influx of breastfeeding “issues” in America (compared to other industrialized nations) might be due to factors other than societal. I honestly think that the supply issues, tongue ties, and milk intolerances that are becoming more prevalent are real, and that by ignoring them or brushing them off as mothers “looking for excuses” or “giving up too easily”, we’re doing women (and babies) a real disservice. I wish that whoever if funding the breastfeeding research would take some interest in these issues, rather than proving and re-proving how superior breastmilk is to formula. Of course it’s superior. Now let’s help all the women who want to breastfeed, and are struggling, do so successfully by taking these problems seriously!
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