Leave their tongues alone!
NCT calls for more newborn cutting!
The normally sensible National Childbirth Trust has just launched a campaign (click here*) for more NHS doctors and midwives to cut the frenulum, the fold of skin joining the tongue to the floor of the mouth, for babies having trouble breast feeding. They reckon 3 to 10% of babies need it doing. If they are right, that would amount to between 18 and 60 thousand babies a year in theUK. Their website (click here) reads like a circumcision site for tongue-tie cutters!
“It’s quick and simple, and young babies usually don’t need any pain relief. […] Although some babies may cry briefly, the procedure doesn’t seem to cause discomfort or distress. […] Research has shown that […] division results in improved feeding for the majority of babies. […] there are some risks, such as significant bleeding rather than a few drops of blood when the cut is made, but the chances of this happening are small.”
NCT spokespeople make much of the fact that the National Institute for Clinical Excellence (NICE) has issued guidance (click here) that there are “no major safety concerns about division of ankyloglossia (tongue‐tie) and limited evidence suggests that this procedure can improve breastfeeding.”
But this is a long way from a recommendation. Cutting tongue-tie is an old-fashioned procedure, of doubtful scientific rationale, which has crept into use without proper evidence. NICE conducted their review to check if there was sufficient evidence of harm to advise stopping it. There was not.
But the evidence for benefit remains very thin. There is no Cochrane review. One non-Cochrane review (click here) included the following four randomised trials. They are not pretty! All were tiny, two were never registered at all and two were registered late, none used independent third party randomisation, and none reported any hard endpoints. Importantly the researchers and parents were so convinced of the benefits that they all cut the control babies within a few days!
Hogan et al. 2005 (click here) randomised 58 babies with breast feeding problems to immediate cutting (n=28) or cutting after 48 hours, using sealed envelopes. Apparently 27/28 early, and 28/29 delayed “improved” within 24 hours of the procedure! Full text pdf available here tongue tie trial hogan.
Dollberg et al. 2006 (click here) randomised 25 babies to real (n = 14) or sham (n = 11) cutting using sealed envelopes. The mother’s nipple pain score was reduced after the real cutting. Again the control group also got cut – this time delayed by one feed! Full text here tongue tie dollberg.
Berry et al 2012 (click here) registered their trial (click here) seven years late! Conducted between 2003 and 2004 and registered in 2011! Sixty breastfed babies were randomised using sealed envelopes to cutting or not. 21/27 in the cutting group reported improvement in feeding compared with 14/30 controls. Again the controls got cut one feed later. Full text here tongue tie berry.
Boryuk et al 2012 (click here) registered here in August 2009 after recruitment (Dec 2007 – Dec 2008) was complete. 58 patients were randomised using “a random number generator […] implemented by a research assistant” to frenotomy (n=30) or sham (n=28) operation. Short term breast feeding scores were better in the frenotomy group but by 2 weeks all but one patient in the control group had also undergone frenotomy. Full text here frenotomy boryuk rct.
In summary no randomised trial, comparing cutting with no treatment, has measured any outcomes beyond 48 hours! There’s no data at all on rate or duration of breast feeding, weight gain, stress to the baby, speech, or any other baby health outcome. Nor can there be, because all the controls got cut as well. This evidence cannot possibly justify cutting thousands of babies. The NCT should call for decent research, not more widespread use.
*5th May 2014 update. The link above is now dead (thank you SouthwarkBelle) and the NCT campaign seems to have been quietly dropped. Sadly their tongue-tie advice (click here) remains uncritically supportive of frenotomy. Further update, see comment below, the campaign apparently continues.