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My three-month-old was diagnosed with tongue- and lip-ties. In the absence of feeding problems (he’s nursed like a champ from day one), what’s the data on the importance of frenectomy to prevent future eating/breathing/sleep problems as he ages?
—Gretchen and Little E
The main reason for surgery to fix lip- and tongue-tie is to address breastfeeding problems. A frenectomy is often recommended when infants are struggling to latch, though randomized support for the success of the procedure is fairly limited.
Increasingly, this condition has been diagnosed even in the absence of any feeding issues, due to concerns about speech and sleep issues later. However, the evidence for these is thin.
For example, this 2022 systematic review of the literature found no consistent link between frenectomy and speech articulation. In the case of sleep, the evidence is largely starting from a sample of kids with sleep problems and identifying which of them have a short frenulum. This could be evidence for a link, but it isn’t strong evidence. Moreover, it is hard to identify magnitudes from that type of analysis, since children with sleep problems are a small set of the world — you do not know how many kids with a short frenulum do not have these issues.
In addition, if issues do crop up later, this procedure can be done on older children.
In short: if there are no current feeding issues, there is nothing in the data to suggest you should engage in this procedure proactively.
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