NY Times Letter to the Editor Re: Article about Tongue Tie Treatment

breastfeeding fenotomy ibclc tongue tie tongue tie team Dec 20, 2023

Here is Lisa Paladino's response to the article "Inside the Booming Business of Cutting Babies’ Tongues" published 12/18/23 in the NY Times.

As the face behind the popular “Tongue Tie Experts” social media platform, and the Tongue Tie Experts Podcast, I feel compelled to respond to the latest article about tongue tie treatment, from the NY Times.  I am a Certified Nurse Midwife, Lactation Consultant (IBCLC), Registered Nurse, and published author, who has over 35 years of experience in the health care system.

I am upset by the tone of this article, but also encouraged by the conversations it is creating. We need to have these important discussions.

First, you may wonder why I have a social media presence as a health care provider? Why are so many families turning to social media for their medical needs? In my experience, they are looking for help because they aren’t getting it from the doctors and nurses who they are seeing in real life. Sad, but true. My social media popularity grew accidentally. Trust me, I never intended any of it, it just evolved.

Let’s talk about social media “advice”. It comes in all shapes and sizes. Some of us are experienced, some are pretenders. Some of us give real support and education, others, well, not so much.

The point is that many women want to breastfeed and they aren’t finding the right support when things don’t go smoothly, from their doctors, and my resources fill a void. My inbox is filled with messages of gratitude from parents who learned from my content.

Women want to breastfeed for a myriad of reasons, most are not choosing breastfeeding because of pressuring by lactation consultants as implied in the article.  It is a biological norm to feed our infants at the breast, and it should be a social norm, but we are far from that.

The influence of the marketing of breast milk substitutes (World Health Organization term, not my own), is too great, and is reliant on the so-called “mommy wars” perpetuated in said article, and in the comments that followed, but I digress.

Breastfeeding is not just about nutrition and nurturing. Feeding comfortably and efficiently at the breast is imperative for optimal development of the muscles and bony structures of the head, face, and neck.

But let’s get back to my profession, in this case, lactation consultant. An International Board Certified Lactation Consultant is the title that is highest in the lactation field. The education, training and experience needed to obtain and maintain this designation is complex, long, and difficult. We learn more than any health care provider about how lactation works, how to manage it, troubleshoot problems, counsel parents, etc. Yes, I claim to know more about infant feeding than your doctor, because I understand that as a health care provider, I learned very little in my formal education on these topics. As a nurse, I was taught about breastfeeding by formula company representatives who brought us cookies or donuts to keep our attention.

I challenge any MD to take a practice test for the IBCLC certification exam. I doubt they’d pass. Trust me, we learn more than “suggesting ways to position the baby that will decrease a mother’s pain”.

Of course, as in all professions, some of us are better at our jobs than others. Some of us bring other education, licenses, experiences, and certifications to the table. There are people who are expert at being doctors, and some who are less so. Same with lactation consultants.

Of course lactation consultants make money, some more than others. Some through medical insurance, some outside of it. We provide an important service to those who need us and who seek us out. Our value is rewarded, as it should be.

There is a problem when a reputable and popular journal makes comments that may be considered slanderous, such as insinuating that we are recommending unnecessary procedures to make money. I am insulted by this, as it is against all the standards that I hold for my practice, and I don’t know anyone who gets kickbacks for this procedure.

But let me explain what has me most upset about the slant of the article. There are almost no references to the thousands of mother/infant dyads who have had successful outcomes with proper tongue tie assessment and treatment, without complications. Of course there are sometimes poor outcomes. That’s the case for all medical and dental procedures. But I have had parents in my office who cry with happiness at finally having someone talk to them honestly, understand their concerns, and make sense of the symptoms they are experiencing. They express elation when they are on their way to meeting their breastfeeding goals, when their infant latches to the breast comfortably and transfers enough milk to not have to supplement or pump.

In my programs for professionals and parents, I educate the risks, benefits, and options for tongue tie treatment. Treatment is not always surgical procedure. We make an assessment, give information, answer questions, and NEVER promise an outcome.

The assessment for tongue tie is based on function. This is not a diagnosis that should ever be made by a picture or through a social media post.

As a lactation consultant, the function is feeding comfortably and efficiently, meaning able to transfer milk in a reasonable amount of time. We should never recommend a procedure on a baby whose function is currently perfect to prevent future issues. Their isn’t a way to know how that baby will do. Anticipatory guidance is given for warning signs to look out for when a frenum appears tied, but there are no current problems with feeding.

For bottle feeding or older children, the function to be evaluated is speech, and feeding. A Speech Language Pathologist who is a feeding therapist, preferably with oral motor training is the best professional to evaluate the function at this stage.

Meeting breastfeeding goals is a journey. Many times there are interventions by lactation consultants or other medical professionals that improve feeding or get the family set up for optimal results. A quick snip or laser treatment is not usually the answer, and preparation and follow up will improve outcomes.

I am truly sorry for the infants in the article who had poor results. I’d love to hear their full stories, so that we could all learn from the process. Did they have proper functional assessment, were they fully prepared, evaluated for other reasons that feeding wasn’t working, given analgesia post op, etc?

A message for parents who are pregnant and are planning to breastfeed. Do your research before the baby comes. Meet with a lactation consultant, establish a relationship, learn how milk is made, how to optimize the first days, and when to reach out for assistance. Mostly, follow your instincts - only you can know what’s best for you and your baby. 

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