Unregulated correction of tongue tie in first days of life raises concerns amongst paediatric surgeons
The Sunday Times (October 23rd, 2016), under the somewhat extravagant banner headline: “Doctors attack ‘needless’ baby tongue surgery”, featured two London BAPS members – Mr Shailesh Patel from Kings College Hospital, and Mr Joe Curry of Great Ormond Street Hospital.
Early division of a tongue-tie to improve breast feeding has been increasingly available as an option for a relatively small cohort of infants where the tongue-tie prohibits latching onto the nipple leading to difficulties in establishing breast feeding. Over the past decade, paediatric surgeons in alliance with lactation counsellors and midwives have set up dedicated hospital clinics where this is diagnosed and if necessary divided (without specific anaesthesia), but usually after a few weeks of life.
More recently some midwife or nursing practitioners are missing out the middle man (or women actually but anyway – the surgeon) and snipping it themselves, at home, in the first few days of life.
As the article goes on to say with only the merest soupçon of hyperbole….it is “one of the most controversial areas of children’s surgery”….because it is usually performed at home, without any supervision and more often than not as a private intervention costing up to £200.
Prof. Alastair Sutcliffe, a paediatrician at University College London has said: “It is a spreading practice but nobody knows the true incidence and whether it is being used for everything to do with difficulty breastfeeding. I am concerned about how it is being carried out in the private sector. They are not governed in the conventional sense of a proper surgical setting.”
Both Joe Curry and Shailesh Patel have also raised concerns about the operations being carried out too early by inadequately qualified and supervised practitioners, particularly if money changes hands. There have been examples where the original procedure was performed too early and following the development of scarring and recurrence, had to have a revision in a more conventional established clinic.
Shailesh Patel, who runs the Tongue-Tie Clinic at King’s College Hospital and who sees more than 60 each month, believes that tongue-tie surgery should not be carried out before babies are seven days old and mothers have had adequate time to establish breastfeeding without the intervention. He goes on to say: “I have had babies who have been treated three or four times. The concern I have is that I am not aware of anyone who has had training to revise scars outside of being a surgeon. You need to have specialist knowledge about how scars behave.”