Why are we so divided about tongue-tie?

Ankyloglossia or tongue-tie is a congenital condition where there is an imbalance in floor-of-mouth fascial roles so that their provision of tongue stability impacts tongue mobility, resulting in a clinically significant functional disorder. Ankyloglossia contributes to a range of functional difficulties, such as the ability to breastfeed. According to three surveys of health professionals, opinion is divided about tongue-tie and the most common form of treatment for the condition. This division in opinion affects the practice of health professionals and impacts access to treatment for breastfeeding dyads experiencing difficulties due to tongue-tie. Using dialectical pluralism (DP) as the philosophical standpoint for this study, I gathered insights about what is shaping the knowledge and practice of health professionals on the tongue-tie stage. According to its proponents, DP is a process philosophy that enables dialogue with difference. The design of this study is novel in the health and social science disciplines. It is an ‘explanatory concurrent’ mixed research study where all the data is collected via a single survey instrument containing both Likert scale and open-ended questions. The study is mixed in its analysis and inference stages. This study generates knowledge about what shapes the attitudes and beliefs of the many health professionals involved in caring for families where the breastfeeding experience is compromised by neonatal tongue-tie. Findings include that most health professionals involved in tongue-tie in New Zealand receive information that shapes their knowledge and practice about assessment, diagnosis, treatment and follow-up of tongued-tied infants from their colleagues. They appear, therefore, just as likely to take advice from their peers as read peer-reviewed academic papers to inform their knowledge and practice. Additionally, though health professionals in New Zealand are not as divided in opinion as those who have participated in other surveys, there are those with polarised views and strong opinions who impact the knowledge and practice of others on the tongue-tie stage.

This research recommends conscientious use of the best available evidence to inform practice, even though we are human and are subject to the vagaries of human nature. A recommendation for practice arising from this study is that individualised holistic treatment of problematic tongue-tie in the breastfeeding neonate is necessary. To enable equitable access, this treatment needs to be free, and it needs to be provided within a multidisciplinary team approach by skilled and appropriate health professionals. A further recommendation is that midwives should maintain their knowledge about breastfeeding and continuously upskill to be able to provide that dyad with the best possible support, information and education about the physiology of breastmilk production, good fit and hold (latch and positioning), and problem solving.