Tongue-tie: To clip or not to clip?

Do you think clipping the tongue is necessary in a tongue-tied child? Does it affect speech development? My child was diagnosed late, so if he were to have it clipped now at 20 months of age, he would need general anesthesia. I want to know whether this procedure is warranted.

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Tongue-tie or ankyloglossia is caused when the membrane under the tongue (the frenulum) extends excessively toward the tip of tongue. Sometimes this membrane is an intact piece of tissue attached to the floor of the mouth and extending down the length of the underside of the tongue. Sometimes this membrane is interrupted, leaving a small strand of membrane, which attaches close to the tip of the tongue. In either case, this frenulum limits the mobility of the tongue, often giving it a characteristic heart shape when extended.

When it comes to whether or not clipping the frenulum is necessary, two things are clear. First, rampant unwarranted clipping has occurred in the past. Clipping the tongue is a procedure that dates back at least a couple hundred years, and many babies endured this procedure unnecessarily. Second, there are clearly some babies who have significant difficulty breastfeeding because of tongue-tie. These infants may actually have trouble gaining weight and cause the mother a good deal of breast tenderness from a disorganized suck due to tongue-tie. The question then remains which babies truly need clipping of the frenulum. And the answer to that is a source of much controversy.

Ankyloglossia severe enough to significantly impede breastfeeding is thankfully an uncommon problem. And tongue-tie significant enough to truly cause speech problems is even more uncommon. Most of the time, as the child gets older, the frenulum stretches such that speech problems do not occur. It doesn't surprise me that you have found conflicting answers from different doctors and books because there simply is no consensus on this issue. And unfortunately, there are no good scientific studies to guide in this decision. That being the case, many physicians deal with this issue on a case-by-case basis and recommend clipping only when problems are clearly being caused by the tongue-tie rather than doing it on the assumption that the tongue-tie might cause problems in the future.

I hope this helps.

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