• tongue-tie
• breastfeeding
• ankyloglossia
• frenulotomy
• frenotomy

As a medical student I was taught by an eminent paediatric surgeon that tongue-tie never required treatment “unless they wanted to play the trumpet” and as a registrar I was appalled to find that a consultant paediatrician was snipping tongue-ties in the clinic—a practice I had been taught was “unnecessary, dangerous and cruel”. However, when approached 10 years ago by an experienced midwifery colleague whose own tongue-tied infant was having great difficulty in breast feeding and failing to thrive, I was surprised to find that, although not of high quality, there was reported evidence for the treatment of tongue-tie to help breast feeding and no published scientific information against it. Since then further evidence has been collected and the paper by Emond et al1 adds to our knowledge.

Although considerable effort is expended on breastfeeding promotion in the UK, there is still frequent failure to support mothers who have already decided to breastfeed, but meet difficulties. Initiation rates have risen to >80%, but exclusive and partial breastfeeding rates still fall rapidly in the first week and 6 weeks, with exclusive breast feeding until 6 months, as recommended by the WHO, being a rarity. This suggests that promotion is not now the most important step, but rather support and intervention to correct early problems stopping a mother and baby from achieving successful breast feeding. Tongue-tie is an abnormality associated …