Sufficient evidence
Infants should only receive treatment for tongue-tie when an indication for treatment is present (13). There is currently a lack of high-quality studies of treatment efficacy (7). However, clinical reference works such as UpToDate (13), and the overall body of research comprising small randomised studies, follow-up studies and case reports, shows that the frenetomy of a tongue-tie on the basis of an appropriate indication is associated with improved breastfeeding (7, 13, 16). This is also the experience of practitioners and patients (mothers), and this must be taken into account when preparing guidelines for evidence-based practice.
The frenotomy of a tongue-tie on the basis of an appropriate indication is associated with improved breastfeeding
In common with all other medical treatments for infants, it is the parents' consent that applies. In our experience mothers have often struggled for some time with breastfeeding prior to being referred, and are at risk of giving up on breastfeeding prematurely. They may have been treated for wound infections, had recurrent mastitis, or the child may have suffered from failure to thrive. These are complicated issues that do not resolve spontaneously. Follow-up with breastfeeding counselling and support should be offered irrespective of whether a frenotomy is performed or the tongue tie is treated conservatively, with the aim of enabling all mothers who wish to breastfeed to do so successfully.
The new Norwegian guidelines for the diagnosis and treatment of tongue-tie in infants have been prepared by a nationwide working group, consisting of neonatologists, paediatricians, otorhinolaryngologists, a dentist, a speech therapist, midwives, school nurse practitioners, general practitioners and doctors specialising in community medicine, as part of an initiative from the Norwegian National Advisory Unit on Breastfeeding. The guidelines can be read and downloaded from the Advisory Unit website (3).