Letter to the Editor
I am writing in regard to your recent article “Why So Many Babies Are Getting Their Tongues Clipped” by Rachel Morgan Cautero on March 12, 2019. I have some concerns regarding this article and the influence it may have on mothers and their children.
As the co-author of Functional Assessment and Remediation of Tethered Oral Tissues (TOTs) and international lecturer on the topics of tongue-tie, TOTS, feeding disorders, oral motor disorders and orofacial myology, I feel this article is a one-sided opinion of a mother who perhaps did not have proper medical or therapeutic care during her infant’s tongue-tie journey. While I sympathize with Ms. Cautero, her specific case study and opinions are not reflective of the latest research on this topic, or many patients who have greatly benefited from a tongue-tie release. In fact the current research mainly focuses on breastfeeding infants with positive correlation that breastfeeding does improve post-frenectomy (see reference list).
First and foremost the article contains interviews with physicians from well-respected facilities, but not necessarily physicians who specialize in this condition. I am a speech-language pathologist and it is within my license and scope to treat stuttering at my facility, but I do not because I have not been trained in stuttering for almost twenty years. Ms. Cautero had access to many preferred providers in the tri-state area who are published on TOTs, yet she only interviewed those who shared her opinion. An article which can affect the medical care of infants and children needs to be well-rounded and provide all pertinent information. I have no issue with presenting an opposing view, as TOTs is a controversial topic, but when a widespread publication chooses to report on a medical condition it is their obligation to provide all sides of the story.
While I agree functional impact is the key to determining frenectomy, the article was also not clear on what functional impact means and focused only on breastfeeding. TOTs can impact a person across the life span and cause issues with: body alignment and posture (such as torticollis), reflux, dental malocclusion, palatal development, oral resting posture, TMJ, sleep, speech clarity and feeding.
What the author failed to mention is that these skills need to be assessed by a licensed and TOTs trained speech-language pathologist (SLP), registered dental hygienist (RDH), chiropractor, occupational therapist (OT), physical therapist (PT) and /or lactation consultant (IBCLC) prior to a revision dependent on symptoms and age of the patient. In addition, the patient requires pre- and post-operative therapy/neuromuscular re-education in order for functional changes to occur. Most of the cases we see that do not improve are those who do not follow this advice, or were under the care of a provider who does not share this information. In other words, the surgery is one piece of the TOTs puzzle. We need all the pieces to fit to complete the picture.
The article makes it seem that these situations are black and white and does not explain the ideal scenario that will result in the best outcomes. Of course TOTs should not be surgically released by appearance alone, but the author is overgeneralizing her experience and this could cause harm to infants, children and adults that need medical attention for this condition. Ideally TOTs care follows the following flow chart:
Clearly the author also did not do a thorough evidence based literature review. There are two recent texts on this topic easily accessed via Amazon: 1) Tongue-Tied by Dr. Richard Baxter (and associates) and 2) Functional Assessment and Remediation of TOTs by Robyn Merkel-Walsh and Lori Overland, both rich with citations and leads to more literature. The risks she describes are very low and out of a two year research project of international publications on the topic, my co-author and I only found three case studies on acute surgical complication all of which were caused by underlying conditions that the surgeon was unaware of at the time of the procedure (see references). This misinformation could also cause a patient to be frightened by addressing a tongue-tie, and suffer unjustly with functional problems.
I know I am not the only TOTs subject matter expert deeply concerned by this article. It has basically gone viral and the exposure is dangerous because it is not well-rounded article. I suggest in good faith, and for public safety, you review the attached evidence based practice references and explore the links I am providing. Please consider an opposing editorial to explore more factual information on this important topic.
Robyn Merkel-Walsh MA, CCC-SLP/COM®
Licensed Speech Pathologist NJL#41S00305300
Certified Orofacial Myologist®
Certified Talk Tools Therapist & Instructor
PROMPT Trained / Beckman Trained
Orofacial Myofunctional, Feeding and Oral Motor Therapy
Board Chair, Oral Motor Institute
Attached: Evidence Based References and Links
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