Troubling trend for babies
Dentists, lactation consultants around nation pushing ‘tongue-tie releases’ on moms struggling to breastfeed
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. 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 Merrell, a high school soccer coach in Boise, Idaho.
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 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 New York City 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.
Tongue releases done in hospitals — a small proportion of the total — grew more than 800% 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.
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.
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, 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.
‘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 such as 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 said, could impede breastfeeding.
Despite relying on anecdotes, the article became influential.
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 2020, a panel of 16 leading ear, nose and throat specialists published guidelines warning that tongue-ties were being overdiagnosed 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.
‘Trust me’
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, Henstrom got to work establishing her lactation consulting business, Baby Bonds, taking midwives out to lunch and offering free breastfeeding classes. Undiagnosed tongueties were always her focus.
“If your baby is super fussy, chances are your babe has a missed tongue tie,” her website states.
In 2017, Merrell, fed up with trying to get Eleanor to nurse comfortably, contacted the local chapter of La Leche League, a wellknown organization that promotes breastfeeding.
Henstrom, a volunteer with the group, responded in a Facebook message that Eleanor’s problem was “likely” a tongue-tie.
Merrell replied that her pediatrician, a physical therapist and a previous lactation consultant had all said that wasn’t the issue.
“Trust me,” Henstrom said later in the exchange. “I have seen this hundreds of times and a revision always fixes it.”
“I hope so,” 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,” 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.
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, Henstrom was exclusively referring patients to another dentist, Dr. Samuel Zink.
She also assisted during the procedures, holding babies down while Zink cut their numbed mouths with a laser, according to a recent podcast interview and interviews with her clients.
Henstrom’s clients said she charged $150 for attending the tongue-tie release session, with optional follow-up visits. Parents said Zink’s fee was usually about $600. Insurance rarely covered the costs.
Zink did not respond to requests for comment.
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.”
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 Henstrom’s care.
It wasn’t the first time that health care workers had raised concerns about her.
In 2018, Henstrom worked part time at a Boise midwifery practice.
Soraya Mazloomi, a doula who also worked there, said several mothers complained about Henstrom’s pressuring them to get surgery for their babies. She was encouraged to leave.
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 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.
The lactation board, which reports its disciplinary decisions, has not taken action against Henstrom.
A spokesperson 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.