
Classic tongue-tie has been overlooked and left untreated for decades. The work of tongue-tie and lip-tie activists in Australia, the USA, and UK today has four positive outcomes. Their work has highlighted the importance of:
- Prompt frenotomy for a classic tongue-tie;
- Careful oral and oromotor assessment as part of infant feeding support in the clinic, and the need to develop useful assessment tools;
- The connection between breastfeeding problems and unsettled babies;
- Research into the clinical support of breastfeeding and related unsettled behaviour.
- Definitions of tongue-tie are inconsistent and confused. Often, both classic and ‘posterior’ versions are lumped into the one broad category, ‘tongue-tie’, without attempts to clarify further. This lack of definition is likely to underestimate the positive effects of frenotomy for classic tongue-tie, and overestimate the positive effects of frenectomy for what is being diagnosed as ‘posterior’ tongue-tie (but which is likely to be normal anatomic variant, as is 'upper lip-tie').
- Definitions of accompanying breastfeeding difficulties are inconsistent and confused.
- The nature of the surgery is inconsistently reported. The techniques used and depth of the cut are not defined.
- Commonly used diagnostic tools, including the popular Hazelbaker Assessment of Lingual Frenulum Function (ATLFF), are flawed. For example, a well-conducted 2008 study of 148 newborn babies concluded that the ATLFF is not reliable. http://www.ncbi.nlm.nih.gov/pubmed/17276561
- Effects of the surgery are confounded by breastfeeding support, which is generally offered around the same time, although the nature of this support is not defined.
- There are no comparisons with the effects of the passage of time.
- The placebo effect is difficult to measure.
- There are no reliable long-term follow-up studies on the effects of the surgery on both breastfeeding and speech.