@ Inside the big “tongue-tie” business

[Velar Fricative]

Gift link: www.nytimes.com/2023/12/18/health/tongue-tie-release-breastfeeding.html?unlocked_article_code=1.HE0.QRd0.jMXDnSeaI1Gd&smid=nytcore-ios-share&referringSource=articleShare

I really had no idea about this being a huge business enterprise until reading this. My kids are 10 and 6 and I only breastfed the older one, and I was never told whether she had a tongue tie or not so I never really thought about the procedure. I did know it’s a common procedure, but never thought about the necessity or knew about the risks.

[pixy0stix]

This is going to be a 6 page post with everyone telling their breastfeeding stories, isn't it?

Sigh ...

It's amazing how we can over diagnose anything in this country if there's a potential for profit.

[winemaker06]

This is lengthy! It will take a bit to get through all of this, but I'm very interested in it.

@ Both of my kids had ties corrected and neither were an immediate magical cure but it DID help. I remember being extremely conflicted about whether or not to do it with the first kid, because our doctor did go over risks. At the time, it felt like a huge decision to make for a brand-new parent of a newborn. 

Doctors really do need to go over all of the risks along with the benefits and answer questions instead of treating the procedures like an assembly line. For this and any medical care, honestly.

[pixy0stix]

Friends, the intent of the story is not if a tongue tie release worked for your kids. The intent is to highlight that the people recommending the procedures are most often unlicensed, and those performing the procedures are doing it mostly for profit whether the procedure needs done or not.

The story also states there is very limited medical evidence that they do work, and that issues reported would most often have worked themselves out in time.

[winemaker06]

Dec 18, 2023 20:09:56 GMT -5 pixy0stix said:

The story also states there is very limited medical evidence that they do work, and that issues reported would most often have worked themselves out in time.

And how does any layperson assess that, especially if a presumed medical professional says they have the solution to your problem?  (mostly rhetorical since I doubt there is a good answer, and sleep-deprived new parents are a very easy mark in this case)

Even with the internet at our fingertips, it's difficult to find the 'right' medical evidence for every potential medical decision. And that's if you even have the time and resources to try to go digging. So yea, frustrating problem with no good solution, and not just for this procedure in particular. 

[penguingrrl]

I read this article this morning and was really alarmed. I’m surprised to learn there aren’t real credentials for being a LC. I would have assumed they at least needed to be an RN with further training, like a midwife. The idea that they prey on scared new parents is terrible.

It’s also typical of America to make a profit off elective procedures starting at birth…

[sent]

I'll spare my breastfeeding stories, just for you pixy0stix

This topic makes me so mad as a dental professional. There is so much misinformation out there with the "tongue tie release" people pushing their agenda. This article talks about the mess that happens at the newborn level when lactation consultants act like they know everything about the tongue. This procedure is also heavily pushed by "airway centric" dentists on older kids.  Or they will say that the newborn who had a tongue tie release now needs a "revision" at age 3/6/whenever the kid walks into their office. They sell parents on how a tongue release will help prevent a list of medical conditions which the article discussed. These "airway" dentists imply that the rest of us don't know to look for tongue ties. No, we are looking for them, we're just referring out for the worst ones and not referring every single tongue that walks into the office.

I'm really glad this is being put out there by regular news outlets. The ideal candidate for this procedure is a new mom who is awake at 3:30 am with a crying 7 day old baby googling "how to get my newborn to latch." She comes across "maybe your baby has a tongue tie!" and decides to drop $600 because at that point you're ready to do whatever to win at breastfeeding to make your LC proud. And get some sleep. Hopefully they will come across this article and think twice.

I recoiled when I read the part about the LC putting her finger in the baby's mouth to prevent reattachment. I usually read these articles without emotion but that part really hit me in the feels.

[pixy0stix]

Dec 18, 2023 20:23:46 GMT -5 winemaker06 said:

Dec 18, 2023 20:09:56 GMT -5 pixy0stix said:

The story also states there is very limited medical evidence that they do work, and that issues reported would most often have worked themselves out in time.

And how does any layperson assess that, especially if a presumed medical professional says they have the solution to your problem?  (mostly rhetorical since I doubt there is a good answer, and sleep-deprived new parents are a very easy mark in this case)

Even with the internet at our fingertips, it's difficult to find the 'right' medical evidence for every potential medical decision. And that's if you even have the time and resources to try to go digging. So yea, frustrating problem with no good solution, and not just for this procedure in particular. 

My test is if I Google a medical procedure and little to no scholarly articles pop up then I know to look farther.

Like one day I got curious about elderberry syrup everyone was pushing during cold season. First page there were two scholarly articles saying there was little evidence it worked, plus several news articles discussing the same thing. Googling isn't hard, and a little knowledge of knowing what sources to trust goes a long way.

[Susie]

when the only tool you have a hammer, everything starts to look like a nail.  

I'm sure that's multiply true when you're really well compensated for using a hammer.

[fortnightlily]

When I was in elementary school my dentist wanted to snip the thingie under my tongue, saying by 4th grade I wouldn't be able to pronounce the letter 'S' properly. I said hell no, and lo and behold, no issues. I remember another friend getting a lip tie snip around that age, too. I wonder if they still push this on older kids or just on infants and vulnerable moms.

[wanderingback]

Dec 18, 2023 20:27:56 GMT -5 penguingrrl said:

I read this article this morning and was really alarmed. I’m surprised to learn there aren’t real credentials for being a LC. I would have assumed they at least needed to be an RN with further training, like a midwife. The idea that they prey on scared new parents is terrible.

It’s also typical of America to make a profit off elective procedures starting at birth…

Fwiw to be an IBCLC there are specific qualifications to become one. To be a CLC there are certain requirements as well. From what I’ve seen health insurance reimburses for IBCLCs.
I’ve been meaning to do the work to become a CLC for about 2 years now.

Anyway, off to read the article.

[pixy0stix]

Dec 18, 2023 21:34:07 GMT -5 fortnightlily said:

When I was in elementary school my dentist wanted to snip the thingie under my tongue, saying by 4th grade I wouldn't be able to pronounce the letter 'S' properly. I said hell no, and lo and behold, no issues. I remember another friend getting a lip tie snip around that age, too. I wonder if they still push this on older kids or just on infants and vulnerable moms.

The article said that rates are rising for older kids, too.

[bee20]

The quote "He has hundreds of five-star reviews online" really sums up American healthcare for me. As a patient I've had doctors I consider good and bad, but it's very difficult to find objective reviews and I've seen medical professionals struggle with if they should offer me a popular treatment or something else.

Women are constantly being told what to do in pregnancy and childbirth which is also an overall exhausting time, so I'm comfortable blaming the practitioners and medical system over individuals not doing enough or the right research.

[sent]

Dec 18, 2023 21:34:07 GMT -5 fortnightlily said:

When I was in elementary school my dentist wanted to snip the thingie under my tongue, saying by 4th grade I wouldn't be able to pronounce the letter 'S' properly. I said hell no, and lo and behold, no issues. I remember another friend getting a lip tie snip around that age, too. I wonder if they still push this on older kids or just on infants and vulnerable moms.

There are legit reasons to do a tongue tie release. It’s usually when the tip of the tongue is still tethered in the mouth so the person physically can not stick their tongue out. Despite not being able to stick their tongue out, many of these people figure out how to speak normal and figure out to eat so they grow at a normal pace. So sometimes when the dentist does point out the anomaly at an older age, parents don’t always want to do the procedure.

The tongue tie releases that these fringe practitioners are pushing are cutting the attachment under the tongue that is much deeper into your mouth.

I will say that after I came home from a conference last winter where one speaker talked about why she thinks tongue releases are important, I started observing tongue attachments more formally on every new patient in the office as part of their overall exam. Before this I really only looked at the attachment to see if it was a worst case scenario like what I described in the first paragraph. Or I looked under the tongue to make sure there wasn’t pathology hiding under there. It’s been interesting what I’ve noticed about tongue attachments to be able to make my own assessment that most of what these people are pushing is all about the $$$.

[pixy0stix]

I can see how my comment comes across as blaming people for not doing research. I was specifically responding to the question asked.

My original comment was more to point out that the supposed professionals were prescribing something with little to no research to support the outcome they promised.

[zaneyzoo]

My 11 year old daughter started speech therapy almost two years ago because of some speech issues. About 3 months in, we were told she had a tongue tie. Not once had that ever been brought up as a concern. They referred us to a dentist, who happened to be the one we went to, and long story short, DD had her tie lasered, twice.

I can’t say for sure if it helped or if her work in therapy has helped. I had no idea this was even a thing and now I’m wondering if we caused her harm for no reason. 😞 it sucks because we trust these professionals to help. Not pad their pockets.

[katespade]

This is interesting timing, because I just saw a tongue-tie reel on IG yesterday targeted toward adults. The woman was talking about how if you have headaches or neck strain or (insert list of vague symptoms) you probably have an undiagnosed tongue-tie and getting it clipped would cure you of all your ailments. The comments were full of people who were all in on the idea.

[sent]

zaneyzoo , I wouldn't feel bad. When I get asked as a second opinion or asked "did we do the right thing?" for kids like your DD's age - I usually tell the parents that releasing a tongue tie can only help with speech and there isn't much to lose if it doesn't work. I looked at my own DD's tongue last year when she was 8 and still struggling with speech wondering if it really was all about her tongue. Everything we learned in school/residency said it's rarely about the tongue when it comes to speech therapy deficits, but I am aware that recommendations can change over time. 

[Poppy]

The pediatric dentist who did ours didn't charge us. He was so kind to us clearly-nervous-first-time-parents, too.

[wanderingback]

Dec 18, 2023 21:50:17 GMT -5 sent said:

Dec 18, 2023 21:34:07 GMT -5 fortnightlily said:

When I was in elementary school my dentist wanted to snip the thingie under my tongue, saying by 4th grade I wouldn't be able to pronounce the letter 'S' properly. I said hell no, and lo and behold, no issues. I remember another friend getting a lip tie snip around that age, too. I wonder if they still push this on older kids or just on infants and vulnerable moms.

There are legit reasons to do a tongue tie release. It’s usually when the tip of the tongue is still tethered in the mouth so the person physically can not stick their tongue out. Despite not being able to stick their tongue out, many of these people figure out how to speak normal and figure out to eat so they grow at a normal pace. So sometimes when the dentist does point out the anomaly at an older age, parents don’t always want to do the procedure.

The tongue tie releases that these fringe practitioners are pushing are cutting the attachment under the tongue that is much deeper into your mouth.

I will say that after I came home from a conference last winter where one speaker talked about why she thinks tongue releases are important, I started observing tongue attachments more formally on every new patient in the office as part of their overall exam. Before this I really only looked at the attachment to see if it was a worst case scenario like what I described in the first paragraph. Or I looked under the tongue to make sure there wasn’t pathology hiding under there. It’s been interesting what I’ve noticed about tongue attachments to be able to make my own assessment that most of what these people are pushing is all about the $$$.

Yeah my cousin has a legit tongue tie. We used to joke about it all the time as kids. He can’t stick his tongue out, his tongue doesn’t leave his mouth. My aunt said he breastfed just fine and he’s an actor with no speech problems.

In regards to breastfeeding it’s sad because people often want answers for problems without realizing that breastfeeding doesn’t always have a smooth upward trajectory to success. The IBCLC I worked with was great and realistic. We supplemented with formula for a week or 2 till we got the hang of things and she never pushed anything unrealistic like don’t use a pacifier. It’s a shame that people are preyed upon during vulnerable moments.

I am not at all surprised that this has turned in to a profit over people situation.

[waverly]

I wonder if they just take any BFing problem and label it tongue tie. The surgery is only going to help those that actually have a severe tongue tie and definitely not those that have other issues. BFing is going to be harder immediately after surgery due to the wound.

[al dente]

Charging $900 and performing 100 surgeries a week is absolutely wild money.

I had a baby in 2018 and 2021 and every single possible issue is related back to tongue/lip ties on parenting groups. I feel like esp in 2018, but maybe I just paid more attention to those things since I was a new mom. In the parenting influencer space there's not a single big influencer I can think of that's had a baby recently that HASN'T had a tie of some sort needing correction.

My pediatric dentist mentioned it as a possibility for my 2yr old if they start getting cavities because it is very tight trying to brush teeth, and when I asked the pediatrician I could feel him internally rolling his eyes lol.

[lessel]

When we did this for DS1 in 2015 at the rec of the hospital-based lactation consultant, she then had an infant feeding specialist/SLP or something come to my next LC appt and she demonstrated and gave me a list of these follow-up exercises I was supposed to do for DS1 to help him strengthen his tongue and improve control after the surgery. It felt like really comprehensive care that made me take the procedure seriously... but zero of this info I got from the ENT practice that did the procedure... it was a very in-and-out routine thing for them. No post-op care instructions.

When we had to do the same thing for DS2 in 2018--both lip and tongue tie for him though--I got zero information all around and I had to like dig through old papers to find the exercise instructions from DS1. And the ENT who did it kind of effed up the lip tie and we had to have a dentist revise it.

I guess my anecdote is just to share that it feels like there is a better way to do this where parents are told risks and given post-op care instructions vs. just this super blasé attitude toward it.

[ssmjlm]

The bottom line is that women are still told that Breast is Best and despite all the propaganda otherwise, they feel like they've failed if they can't. Enter the super hero who is going to save the breast feeding relationship with a relatively simple laser.

If we could just say to the moms "it's ok to use formula to supplement, fully, etc" then these doctors wouldn't be as profitable.

Course this also goes back to mental health check-ins with the mom. They're tired, hormones are whack, and then they get to feel like shit because they can't feed their kid.

[chickadee77]

I admit I always kind of wondered if it was being used to prey on women who had difficulty breastfeeding - like, "Oh, *this* will help, so let's do this medical procedure because we can."

I don't doubt there are legit cases, but it seemed like when my kids were infants, *everyone* was correcting tongue ties. It didn't play into anything I was doing, but the mom boards were covered up in the issue at the time.

[fortnightlily]

Dec 18, 2023 21:50:17 GMT -5 sent said:

Dec 18, 2023 21:34:07 GMT -5 fortnightlily said:

When I was in elementary school my dentist wanted to snip the thingie under my tongue, saying by 4th grade I wouldn't be able to pronounce the letter 'S' properly. I said hell no, and lo and behold, no issues. I remember another friend getting a lip tie snip around that age, too. I wonder if they still push this on older kids or just on infants and vulnerable moms.

There are legit reasons to do a tongue tie release. It’s usually when the tip of the tongue is still tethered in the mouth so the person physically can not stick their tongue out. Despite not being able to stick their tongue out, many of these people figure out how to speak normal and figure out to eat so they grow at a normal pace. So sometimes when the dentist does point out the anomaly at an older age, parents don’t always want to do the procedure.

I could/can stick my tongue out and had never had any evident speech or eating problems, so the recommendation seemed baseless at the time. 

[deadwing]

Dec 18, 2023 21:50:17 GMT -5 sent said:

Dec 18, 2023 21:34:07 GMT -5 fortnightlily said:

When I was in elementary school my dentist wanted to snip the thingie under my tongue, saying by 4th grade I wouldn't be able to pronounce the letter 'S' properly. I said hell no, and lo and behold, no issues. I remember another friend getting a lip tie snip around that age, too. I wonder if they still push this on older kids or just on infants and vulnerable moms.

There are legit reasons to do a tongue tie release. It’s usually when the tip of the tongue is still tethered in the mouth so the person physically can not stick their tongue out. Despite not being able to stick their tongue out, many of these people figure out how to speak normal and figure out to eat so they grow at a normal pace. So sometimes when the dentist does point out the anomaly at an older age, parents don’t always want to do the procedure.

The tongue tie releases that these fringe practitioners are pushing are cutting the attachment under the tongue that is much deeper into your mouth.

I will say that after I came home from a conference last winter where one speaker talked about why she thinks tongue releases are important, I started observing tongue attachments more formally on every new patient in the office as part of their overall exam. Before this I really only looked at the attachment to see if it was a worst case scenario like what I described in the first paragraph. Or I looked under the tongue to make sure there wasn’t pathology hiding under there. It’s been interesting what I’ve noticed about tongue attachments to be able to make my own assessment that most of what these people are pushing is all about the $$$.

I am the person your first paragraph describes.  I can lick my lips, but that's as far as my tongue goes.  I've never had a speech impediment.  I think I even breast fed successfully as a baby. 

However, it has occasionally made me wonder if it makes me a terrible kisser.  That's the only issue I can think of.

[noodleoo]

Dec 19, 2023 7:57:33 GMT -5 ssmjlm said:

The bottom line is that women are still told that Breast is Best and despite all the propaganda otherwise, they feel like they've failed if they can't. Enter the super hero who is going to save the breast feeding relationship with a relatively simple laser.

If we could just say to the moms "it's ok to use formula to supplement, fully, etc" then these doctors wouldn't be as profitable.

Course this also goes back to mental health check-ins with the mom. They're tired, hormones are whack, and then they get to feel like shit because they can't feed their kid.

THIS 100%.  I had extremely challenging issues BFing with DD1 and there was nowhere to go for help.  Both my OB and pediatrician basically shrugged.  The lactation consultants at the hospital I delivered at were awful and basically keep trying, it will get better.  Spoiler, it did not get better (well it did, 6 miserable months later).  It was extremely painful and I was miserable, but DD1 was gaining weight ok so no one cared. I ended up trying every single BFing and hospital LC group within a 45 min drive (I live in Boston so there were a lot!).  I found one that was really supportive and had a LC who was an IBCLC and was known for being awesome, specifically at diagnosing tongue ties. She was the only one who helped me but I remember being disappointed when she told me DD1 didn't have a tie.  I know so many moms from those BFing groups who had them cut.  I was really hoping it was the miracle cure that would somehow make this miserable time in my life the epitome of motherhood that was promised.

Basically, it sucks that there is NO SUPPORT for women after we pop the baby out.  And NOTHING prepared me for how hard and painful BFing would be.  

Looking back, I really should have given up with DD1 and switched to formula for my own mental health. I would have done it for her if she needed it, but since she was eating well, I felt like I couldn't stop just because I hated it.

[bears]

Dec 18, 2023 20:32:09 GMT -5 pixy0stix said:

Dec 18, 2023 20:23:46 GMT -5 winemaker06 said:

And how does any layperson assess that, especially if a presumed medical professional says they have the solution to your problem?  (mostly rhetorical since I doubt there is a good answer, and sleep-deprived new parents are a very easy mark in this case)

Even with the internet at our fingertips, it's difficult to find the 'right' medical evidence for every potential medical decision. And that's if you even have the time and resources to try to go digging. So yea, frustrating problem with no good solution, and not just for this procedure in particular. 

My test is if I Google a medical procedure and little to no scholarly articles pop up then I know to look farther.

Like one day I got curious about elderberry syrup everyone was pushing during cold season. First page there were two scholarly articles saying there was little evidence it worked, plus several news articles discussing the same thing. Googling isn't hard, and a little knowledge of knowing what sources to trust goes a long way.

I agree with you, but I think that a lot of early motherhood is pushed as "trusting your instincts." I think a lot of these quacks, like Henstrom, prey on this. One mother in the article said she was pressured into saving her "breastfeeding journey"--which is for sure a phrase that is meant to elicit an emotional response! 

A lot of these parents thought they were doing their research, but ignored the advice of their own pediatricians, LCs, PTs on this because they were desperate to get their babies to eat. It's completely predatory.

[bears]

Dec 19, 2023 9:43:47 GMT -5 noodleoo said:

Basically, it sucks that there is NO SUPPORT for women after we pop the baby out.  

I didn't have issues breastfeeding, but OMG this sentence. This is why this predatory shit exists--these dentists and LCs say that they are providing a solution but they are only able to do this because there really is so little support to address things.