Ties’ are a hot topic. ‘Ties’ is the collective name given to tongue, upper lip, and buccal (cheek) ties. There is much controversy surrounding the topic of ‘ties’, even amongst health professionals. Most agree that releasing an obvious and significant (‘classic’, ‘anterior’, or ‘type I and II’) tongue-tie is justified, and likely to help prevent or improve various breastfeeding problems, such as latching issues. However, the release of a less obvious (posterior, submucosal, or ‘type III, IV and V’) tongue-tie, upper lip-tie, or buccal ties creates differing opinions.
If you are concerned that your baby might have ‘ties’, it can be very difficult trying to wade through the mixed information from various sources, and come up with a decision about what might be the best way forward.
When making a critical appraisal of the research on a topic, it’s important to look at what the body of evidence says. This is because each individual study is only one small piece in a much bigger puzzle, and an individual study can range in quality from low to high. Only when all the research is put together, and analysed in a systematic review, can more definitive conclusions be reached. The most recent systematic review about the treatment of tongue-tie for breastfeeding outcomes concluded: ‘A small body of evidence suggests that frenotomy may be associated with mother-reported improvements in breastfeeding and potentially in nipple pain, but with small, short-term studies with inconsistent methodology, strength of the evidence is low to insufficient’. There’s been no systematic review done on upper lip-ties, as very little research has been done with regard to the treatment of upper lip-tie for breastfeeding outcomes. Only a few non-controlled studies, which have included upper lip-tie release, have been done. Such studies typically include very small numbers of babies having upper lip-tie releases, or release of upper lip-ties and tongue-ties together, making it impossible to know whether any improvements were due to the tongue-tie release, the upper lip-tie release, or both.
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