Inside the Booming Business of Cutting Babies' Tongues

[Lou Brickated]

Tess Merrell had breastfed three babies and never expected trouble with
her fourth. But after a month of struggling with her newborn, she hired
Melanie Henstrom for help.

Ms. Henstrom, a lactation consultant, identified a culprit: The infant’s
tongue was tethered to the bottom of her mouth. It was a common problem,
she said, and could be fixed with a quick procedure at a dentist’s office.

“It was touted as this miracle cure,” said Ms. Merrell, a high school
soccer coach in Boise, Idaho.

Ms. Henstrom recommended a dentist, who in December 2017 cut under the
baby’s tongue with a laser. Within days, the infant, Eleanor, was refusing
to eat and had become dangerously dehydrated, medical records show. She
spent her first Christmas on a feeding tube.

For centuries, midwives and doctors have been cutting such “tongue-ties”
to ease breastfeeding. But the procedure’s popularity has exploded over
the past decade as women face intensifying pressure to nurse.

Lactation consultants and dentists have aggressively promoted the
procedures, even for babies with no signs of genuine tongue-ties and
despite a slight risk of serious complications, a New York Times
investigation found.

A small fraction of babies are born with a bundle of tissue that attaches
the tip of their tongue to the bottom of their mouth. In some pronounced
cases, doctors snip that tissue. But many tongue-ties are harmless, and
the evidence that cutting them improves feeding is scant.

Yet some lactation consultants and dentists pitch laser surgery to anxious
and exhausted mothers like Ms. Merrell as a cure-all that will improve
breastfeeding and prevent a litany of health problems, including sleep
apnea, speech impediments and constipation, according to dozens of
parents, dentists, doctors and consultants.

Tongue-tie evangelists recommend lasering not only the tissue under the
tongue but also the webbing that connects the lips and cheeks to the gums.
Diagnosing and cutting these “oral ties” — often for hundreds of dollars —
has become a niche industry.

One well-known dentist in Manhattan takes in millions of dollars a year
from his tongue-tie practice. Lactation consultants who refer patients and
assist dentists get paid, too. And companies that make lasers are also
jumping on the trend.

It is difficult to tally the volume of surgeries, which are often not
covered by insurance. But by all accounts the numbers are soaring.

Tongue releases done in hospitals — a small proportion of the total — grew
more than 800 percent nationally between 1997 and 2012, to more than
12,000, one study found. Ear, nose and throat specialists in 25 states
said they had seen sharp increases in requests for tongue-tie
consultations, sometimes overwhelming their schedules. And searches for
“tongue tie” on Google reached a record in June, more than doubling over
the last five years.

Many families swear by the procedures. But the tongue-tie boom has
unnerved pediatricians across the country.

In 2020, a large practice in New Jersey sent an email to families warning
that babies were “being clipped, snipped and lasered at an alarming rate.”
Last year, an office in Kentucky issued a similar alert, citing babies who
refused to eat and were in “severe pain” after laser procedures. Dr.
Charles Cavallo told The Times he wrote that alert in response to what he
saw as a “money grab” by local dentists and lactation consultants.

Serious complications are rare. But doctors said they had seen the cuts
cause such pain that babies refused to eat, becoming dehydrated and
malnourished. A few said newly floppy tongues blocked infants’ airways.

Some parents said their guilt from seeing their babies suffer tipped them
into depression. Others spent thousands of dollars on chiropractors and
speech therapists who claimed their services were necessary for successful
recoveries.

Unlike most medical specialties in America, the tongue-tie world operates
with little oversight. State dental boards accept complaints from the
public, but they rarely suspend dentists’ licenses. And only three states
regulate lactation consultants.

Ms. Henstrom, for example, has continued to practice as a lactation
consultant in Boise, despite health care workers and clients repeatedly
filing complaints about her.

In a brief phone call, Ms. Henstrom said she gave careful attention to
each client. “I have literally thousands of people who are thrilled with
what I’m doing,” she said. She did not respond to a list of detailed
questions.

‘Profit, Greed and Ignorance’
The idea that tongue-ties can interfere with breastfeeding has been around
for centuries. Midwives once used a long, sharp fingernail to rip the
tissue beneath a baby’s tongue. In 1601, a royal surgeon cut the tongue-
tie of Louis XIII, the future king of France.

But doctors have also long raised alarms about the procedure. “Frequently
the parents are deceived, for profit, greed and ignorance,” a German
obstetrician wrote in 1791. “This aid is abused, and one unties where
nothing is tied.”

With the arrival of mass-produced formula in the 20th century,
breastfeeding fell out of favor, and tongue-ties were rarely discussed.
That began to change in the 1970s, as breastfeeding made a comeback.

Sucking from a bottle is easy. But to breastfeed, infants must learn to
use their tongues to extract milk.

Specialized lactation consultants like Alison Hazelbaker emerged to teach
nursing techniques. Some babies she saw in the 1980s had obvious tongue-
ties that prevented them from nursing, she said, but pediatricians knew
little about the condition. In 1993, she developed an assessment tool for
tongue-ties that is still in use.

At the time, pediatricians carried out the releases with scissors,
typically on babies with ties under the front of their tongues.

But in 2004, an article in the newsletter of the American Academy of
Pediatrics suggested that a wider range of babies might benefit. A
pediatric surgeon and a lactation consultant wrote that some patients had
subtle tethers at the back of their tongues. Others had tissue tightly
connecting their lips to their gums. Any of these ties, the authors
warned, could impede breastfeeding.

Despite relying on anecdotes, the article became influential. Ms.
Hazelbaker said she watched with alarm as the diagnosis of tied tongues,
cheeks and lips accelerated. Before long, Facebook groups about tongue-
ties gained thousands of members. “Everything started to go to hell in a
handbasket,” she said in an interview with The Times.

In 2020, a panel of 16 leading ear, nose and throat specialists published
guidelines warning that tongue-ties were being over-diagnosed and that
cheek-tie releases simply “should not be performed.”

With or without surgery, breastfeeding often improves over time, making it
hard to sort out cause and effect. Many women credit the procedures for
making nursing easier.

Before the release, “I was sob-crying, it was so painful,” said Adrianne
Parkey of Little Rock, Ark., whose baby was born this month. After, she
said, she felt immediate relief. Some research has shown that the
procedure reduces nipple pain.

Searches for “Tongue Tie” Have Steadily Risen
Relative monthly Google search volume for the term “tongue tie” in the
U.S.


Source: GoogleBy The New York Times
The procedures appear to be more popular than ever. Even some of their
original proponents now worry the releases are performed too often.

“I have huge concerns,” said Catherine Watson Genna, a lactation
consultant in New York who co-wrote the 2004 newsletter article. Newer
research, she said, has shown that some babies might be mistaken for
having tongue-ties when in fact they have other conditions that restrict
the tongue. “Everything looks like a nail because everybody’s got a hammer
now.”

While lasting problems from oral releases are rare, they can be wrenching
for families.

In Montana, a dentist released lip and tongue-ties on Clara Reck’s infant
daughter in November 2022. Ms. Reck said her baby lost the ability to
suck. Medical records show that she dropped from the 97th to the 15th
percentile for weight in three months. Until last month, her daughter was
still getting feeding therapy.

In Delaware, Dr. Nicole Aaronson, a pediatric ear, nose and throat
surgeon, said that last week, she saw an 11-day-old boy who was
hospitalized for weight loss because of tongue damage from a laser
procedure. “He will heal and eventually do fine, but my point is that
these procedures are not without risk,” she said.

And in Texas, Satina Bolton said she was pitched on “how we’re going to
save your breastfeeding journey.” After two tongue-tie procedures, her
daughter was hospitalized and needed a feeding tube.

Lasers and Tequila

Dr. Scott Siegel of Manhattan has been cutting babies’ tongues for two
decades, ever since he took over the practice of one of the authors of the
2004 article.

He said he sees up to 100 patients a week, charging $900 for a five-minute
procedure to release oral ties.

In November, Times reporters watched Dr. Siegel perform releases on three
babies.

Before each procedure, he met with the parents, listing what he described
as tongue-tie symptoms, including spitting up, gas and falling asleep
while trying to breastfeed.

One mother came in because of trouble breastfeeding. Another had a fussy
baby, and the third was hoping to avoid future health issues. Dr. Siegel
told one family that the release could prevent problems like sleep apnea.
“We’re looking at being proactive,” he said.

Working with two assistants, he swaddled the babies and covered their eyes
with protective glasses. The laser released a plume of white vapor as it
cut tissue.

Dr. Siegel acknowledged that few medical studies supported releasing oral
ties. But his experience had convinced him that the procedures improved
feeding and had other benefits. He has hundreds of five-star reviews
online.

Not every family has been satisfied. Lainie Goldwert’s lactation
consultant referred her to Dr. Siegel because her newborn was constantly
nursing, never seeming satiated. After the tongue release, she said, her
daughter’s mouth became weak. Ms. Goldwert had to squeeze her cheeks to
help her suck, even when using a bottle.

“We went from a child who was breastfeeding voraciously to one who was not
able to breastfeed,” she said. “It felt like, what the hell did I just do
to my child?”

Dr. Siegel said he had very low complication rates. As for Ms. Goldwert’s
baby, “this is a case that I would most likely treat differently now,” he
said, including by warning parents that the recovery process might be long
and complicated.

Companies that manufacture the lasers used by Dr. Siegel and other
dentists are catering to this new market.

One company, Biolase, sells an $80,000 laser machine. In April, it hosted
a conference at a resort in Scottsdale, Ariz., for more than 100 pediatric
dentists and their colleagues. It was called “Tequila and Tongue Ties.”

Before rounds of tequila shots and margaritas, attendees were trained on
how to perform tongue-tie releases and use social media to build their
businesses. Dentists posed for photos with bottles of tequila against a
backdrop that read, “Nacho average dental meeting.”

Biolase’s chief executive, John Beaver, said he thought tongue-tie
releases were beneficial to patients. He said the company’s financing plan
meant dentists needed to perform only three procedures a month to break
even and could generate a “huge” return on investment by doing more.

Dr. Soham Roy, chair of the pediatric ear, nose and throat practice at
Children’s Hospital Colorado, has operated on babies injured by lasers.
“There are some folks out there who either buy or rent these lasers and
they use them as cash-making machines,” he said.

‘Trust Me’

Ms. Henstrom, the lactation consultant in Idaho, was converted to the
benefits of tongue-tie releases after undergoing the procedure herself in
her 40s. She claimed that it improved her scoliosis and that she stopped
getting migraines and acid reflux. “I immediately felt a release of
tension not just in my mouth, but throughout my entire body,” she wrote on
her website.

After arriving in Boise in 2017, Ms. Henstrom got to work establishing her
lactation consulting business, Baby Bonds, taking midwives out to lunch
and offering free breastfeeding classes. Undiagnosed tongue-ties were
always her focus.

“If your baby is super fussy, chances are your babe has a missed tongue
tie,” her website states.

While the group that grants credentials for lactation consultants says
they should not diagnose tongue-ties if they don’t have medical degrees,
Ms. Henstrom often unequivocally tells parents that their infants are
tongue-tied, sometimes without examining them in person, according to
parents and her social media posts.

“According to pics and video, babe is for sure tied,” Ms. Henstrom wrote
in 2020 in response to a parent’s post on a tongue-tie Facebook group.

In 2017, Ms. Merrell, fed up with trying to get Eleanor to nurse
comfortably, contacted the local chapter of La Leche League, a well-known
organization that promotes breastfeeding. Ms. Henstrom, a volunteer with
the group, responded in a Facebook message that Eleanor’s problem was
“likely” a tongue-tie.

Ms. Merrell replied that her pediatrician, a physical therapist and a
previous lactation consultant had all said that wasn’t the issue.

“Trust me,” Ms. Henstrom said later in the exchange. “I have seen this
hundreds of times and a revision always fixes it.”

“I hope so,” Ms. Merrell responded. “It would be nice to have an easy
fix.”

After the surgery, Eleanor initially seemed to be improving. But then she
stopped eating and became dehydrated. Her pediatrician sent her to the
hospital. “We felt really stupid afterward because we paid to hurt our
baby,” Ms. Merrell said.

“I feel terrible for what the Merrell family had to endure,” said Dr. Joel
Whitt, the dentist who performed the procedure. He said this was the only
bad outcome of nearly 800 such surgeries he had performed. He referred The
Times to two past clients, who confirmed that their babies had benefited
from surgery.

Dr. Whitt said he later dramatically reduced the volume of surgeries he
was performing, in part because he worried that the benefits of releasing
lip ties were being overstated.

By early 2020, Ms. Henstrom was exclusively referring patients to another
dentist, Dr. Samuel Zink. She also assisted during the procedures, holding
babies down while Dr. Zink cut their numbed mouths with a laser, according
to a recent podcast interview and interviews with her clients.

Ms. Henstrom’s clients said she charged $150 for attending the tongue-tie
release session, with optional follow-up visits. Parents said Dr. Zink’s
fee was usually about $600. Insurance rarely covered the costs.

Dr. Zink did not respond to requests for comment.

Several of Ms. Henstrom’s clients said that when they expressed
trepidation about the releases, she warned that untreated tongue-ties
could lead to learning disabilities, scoliosis and sleep apnea.

Lauren Lavelle hired Ms. Henstrom to help with breastfeeding before giving
birth to her daughter, June. Without even meeting the 3-day-old baby, Ms.
Henstrom warned that, absent laser surgery, “she will never breastfeed,”
according to Ms. Lavelle. “She will never eat solids.”

Two days after Dr. Zink performed the procedure, Ms. Henstrom visited Ms.
Lavelle’s home and swept her fingers around June’s sore mouth. After that,
the baby’s crying intensified and she began clawing at her face. Ms.
Lavelle took her to the emergency room, where she said a doctor asked how
such a tiny baby had such a large wound in her mouth and gave her pain
medication.

Ms. Lavelle said the experience made her question her ability as a mother.

Several other parents said Ms. Henstrom also placed her fingers inside
their babies’ mouths to prevent the tissue from reattaching, and she
instructed the parents to do the same every six hours.

There is no research supporting the use of such techniques, which some
specialists said can cause babies to fear eating because they associate
their mouth with pain.

Courtney Wambeke tried to keep up with Ms. Henstrom’s instructions, prying
her fingers into her daughter’s clenched mouth. But at a follow-up
appointment, Ms. Henstrom said the tongue-tie had reattached. Ms. Wambeke
was shocked when the consultant reached into the crying baby’s mouth and
broke open the wound with her finger.

A Barrage of Complaints

Last summer, an employee at St. Luke’s contacted the Boise police
department, asking officers to check on the well-being of a 2-month-old
who was being treated “for injuries from a tongue-tie,” according to a
police report. The baby had lost weight “due to pain during eating.”

Ms. Henstrom had recommended the procedure and later “put her fingers in
the infant’s mouth to manipulate the area recently operated on,” the
police report said.

The investigation did not proceed, according to the report, because the
baby had recovered and the parents said they were satisfied with Ms.
Henstrom’s care.

It wasn’t the first time that health care workers had raised concerns
about her.

In 2018, Ms. Henstrom worked part-time at a Boise midwifery practice.
Soraya Mazloomi, a doula who also worked there, said several mothers
complained about Ms. Henstrom’s pressuring them to get surgery for their
babies. She was encouraged to leave. (The practice, Treasure Valley
Midwives, is under new management, and a representative declined to
comment.)

Most states, including Idaho, do not regulate lactation consultants. But
more than 19,000 of the consultants have credentials from the
International Board of Lactation Consultant Examiners. That group has
received at least three complaints about Ms. Henstrom since 2020.

Kathy Strickland, a pediatric physical therapist, filed one that February.
“I was getting referred to parents who were uncomfortable, who went in for
follow-up and said it was traumatic, that she pushed so hard on their
baby’s mouth,” she said in an interview.

Later in 2020, Ms. Lavelle also complained to the board, describing how
she had been traumatized by her daughter’s tongue-tie release.

The lactation board, which reports its disciplinary decisions, has not
taken action against Ms. Henstrom. A spokeswoman for the board, Susan
Brayshaw, declined to comment on the complaints, citing a policy of
confidentiality. “Some complaints take significantly longer than others
due to the nature of the allegations and related investigations,” she
said.

Since 2002, the board has revoked the certifications of only three
lactation consultants.

Ms. Lavelle also filed a complaint against Dr. Zink with the Idaho board
of dentistry. The board collected medical records and statements from Ms.
Lavelle and Dr. Zink. Dr. Zink told the board that June’s procedure was
“uneventful” but that an extremely small percentage of patients do not
respond well to the procedure. He said none of his hundreds of other
tongue-tie patients had previously complained.

The board’s executive director informed Ms. Lavelle via email that the
group “didn’t feel that further investigation was warranted.” It found
that Dr. Zink was not at fault.

Late last year, Ms. Henstrom recommended tongue, lip and cheek tie
releases for an infant named Vivi. Sitting in Dr. Zink’s waiting room a
few days later, Vivi’s mother, Aubrey Nobili, could hear her baby’s
screams over the muffling hum of a noise machine.

When Ms. Henstrom brought Vivi back into the room, the wailing infant
couldn’t catch her breath. Ms. Nobili pulled her daughter close and
smelled charred flesh.

Vivi never breastfed again.

Six months later, a specialist at St. Luke’s assessed Vivi because she was
having difficulty swallowing and would sometimes choke while drinking from
a bottle. The specialist wrote in her medical records afterward that the
problems were “likely due to” the laser surgery.

Ms. Nobili is a stay-at-home mother, and her husband, Ryan, works at
Costco. They have four other young children. They said they ran up more
than $5,000 in credit card debt paying for Vivi’s feeding therapies.

She turned 1 in November. Her family decorated their home with red and
pink balloons and dressed her up as a strawberry.

Only one thing was missing: a birthday cake. Vivi still can’t eat solid
food.

https://www.nytimes.com/2023/12/18/health/tongue-tie-release-
breastfeeding.html