Surgery on babies with tongue-tie will be more closely scrutinised after some health workers reported an increase in the controversial procedures.
Associate Health Minister Dr Ayesha Verrall says some children need the minor surgery, but warns there may also be "unnecessary focus on the condition", with anecdotal reports of possibly unnecessary procedures.
The Ministry of Health has released the first national guidelines on tongue-tie, amidst long-running debate about how best to treat a condition affecting 5 to 10 per cent of babies.
Tongue-tie (ankyloglossia) is when the small piece of tissue, called the frenulum, connecting the tongue to the bottom of the mouth is short or tight, which can stop the tongue moving properly.
In many cases breastfeeding will be possible without surgery, but about 2 to 5 per cent of all babies have a tongue-tie that may cause problems latching on.
Symptoms - like painful breastfeeding, and the baby being unsettled - can have other causes, and it may take time for mother and baby to learn to breastfeed.
That's led to concern some babies may be needlessly having minor surgery, when the tongue is lifted and their frenulum cut with sterile scissors.
"In some tongue-tied babies, the tissue needs to be cut to allow more movement. However, this is not needed for all of them," said Verrall.
"So far there has not been any national advice relating to tongue-tie, and there may also be an unnecessary focus on the condition, which may delay the management of other feeding-related issues in babies.
"Now that we have [the guidelines], people can audit their practice against them. It might help people make clearer decisions about which infants really need surgery - even though it is a simple surgery, we would rather avoid it for those who don't need it."
Verrall said there had been calls for change, with some health workers reporting an increase in the number of surgeries. Other problems included a lack of clear and consistent information for parents, and inequitable access to treatment.
The new guidelines were drawn up with the help of experts including from the Paediatric Society, Midwifery Council and College, Dental Association, College of Physicians, Plunket and the Lactation Consultants Association.
If a problem is suspected, a breastfeeding assessment will take place - where the health professional talks to the parent about their baby's feeding history, watches the baby breastfeeding, and adjusts technique if necessary.
A scoring tool is used to determine the degree of tongue-tie, and written consent should be gained before a frenotomy, including an explanation of treatment options and risks, and a baby must have had Vitamin K beforehand.
Frenotomy may be done by a midwife or GP, but complicated cases should be sent to a specialist such as a dental or paediatric surgeon. A midwife or lactation consultant should observe a breastfeed as soon as possible afterwards, with follow-up support given.
Most research papers found significant improvements in 80 to 90 per cent of cases after the minor surgery, the guidelines note, but, "there are conflicting opinions among health professionals and some state that it is difficult to be certain whether any perceived improvement in breastfeeding is due to division of the tongue-tie."
Rare but serious complications include infection, ulcers and pain. Being too quick to blame breastfeeding issues on tongue-tie may slow the diagnosis of underlying medical conditions.
The ministry says it is difficult to know the number of tongue-tie snips performed, because not all treatment is conducted within DHBs, and there had been no obligation for data to be provided.
"While the surgery is minor, it's not risk-free. With the new guidance, parents can be reassured that no matter who is treating your baby or where you live, all health professionals follow the same advice to refer, assess and treat the condition," Verrall said.
"The expectation in the guidelines is clear - practitioners should be auditing their practice for tongue-tie. This is a form of surgery that needs the same approach [as other procedures]."
• Around 2 to 5 per cent of babies have a tongue-tie that may cause a problem with breastfeeding or, in severe cases, bottle feeding.
• If a breastfeeding assessment suggests tongue-tie is causing problems, a release might be recommended (also called a tongue-tie snip, a division of the frenulum, or a frenotomy).
• This involves lifting the tongue and cutting the tissue connecting the tongue to the bottom of the mouth, with a pair of sterile scissors. There should be little bleeding.