I’ve been practicing pediatrics for close to thirty years, and I can tell you exactly what didn’t happen in that time: human anatomy did not change. Babies are not being born with dramatically more tongue-tie than they were in 1997.
What changed is who’s looking under the tongue, what they’re calling “tied,” and how much they’re charging to snip it.
Let’s start with the numbers, because they tell the story better than I can rant about it. Between 1997 and 2012, diagnoses of ankyloglossia — the medical term for tongue-tie — increased 834%, and the procedure to release it, frenotomy, increased 866% over the same period, according to a national database study of pediatric inpatients (Otolaryngology–Head and Neck Surgery). It didn’t stop there. From 2012 to 2016, diagnosis rates more than doubled again (HealthyChildren.org / AAP). In Australia, frenotomy claims per capita jumped more than fivefold between 2006 and 2016 (ABC News). New Zealand saw frenotomy rates climb from 7.5% to 11.3% of infants in just two years (Clinical Consensus Statement, Otolaryngology–Head and Neck Surgery). Nobody’s genome mutated. What multiplied was the diagnosis.
Follow the Zip Code, Not the Symptom
Here’s the part I find most telling as a clinician: the same national study found that children diagnosed with ankyloglossia were disproportionately male, privately insured, from higher-income zip codes, and concentrated in specific geographic regions like the Midwest (Otolaryngology–Head and Neck Surgery). Tongue-tie isn’t a disease that respects socioeconomic boundaries. Insurance status doesn’t effect frenulum anatomy. What it does effect is who can pay out of pocket for a same-day snip, and who has access to the lactation consultant → pediatric dentist → frenectomy referral pipeline that’s sprung up in affluent suburbs over the last decade.
The American Academy of Pediatrics said the quiet part out loud in their 2024 clinical report: fewer than 50% of infants with physical findings consistent with ankyloglossia actually had trouble breastfeeding (AAP, Pediatrics). Read that again. Half the babies who get labeled “tied” don’t even have the symptom the diagnosis is supposed to explain. We are surgically treating an exam finding, not a problem.
How a Loose Definition Became a Business Model
Part of the surge is genuinely well-intentioned — breastfeeding advocacy exploded over the last twenty years, and rightly so. But good intentions plus a diagnosis with no standardized criteria is exactly the recipe for overdiagnosis. There is no single, universally accepted definition of what counts as a “tie.” Clinicians use the Hazelbaker Assessment Tool, the Bristol Tongue Assessment Tool, the Coryllos classification, the Lingual Frenulum Protocol — take your pick, because none of them agree with each other (International Breastfeeding Journal). Then someone invented “posterior tongue-tie,” a category so subjective that an ENT specialist quoted in ENTtoday flatly stated it has led to overdiagnosis “in some areas of the country, leading to babies having procedures that are not really necessary” (ENTtoday). And don’t get me started on “upper lip tie,” a diagnosis so loosely defined that the specialty consensus statement itself says it’s being overdiagnosed too (Clinical Consensus Statement).
Vague criteria plus a fee-for-service procedure is not a diagnostic advancement. It’s a business opportunity, and plenty of people have recognized it as one. A frenotomy takes minutes, requires minimal equipment, is rarely covered by strict prior authorization the way more invasive surgeries are, and can be marketed directly to anxious new parents who’ve been told — often by non-physicians — that this tiny snip will fix everything from poor latch to reflux to speech delay to bad sleep. It is, from a purely business standpoint, close to the perfect procedure: quick, in-demand, emotionally charged, and largely unregulated by consistent standards.
What the Evidence Actually Shows
Here’s the inconvenient truth for the frenotomy industry: the evidence supporting the procedure is thin. A federal Agency for Healthcare Research and Quality review concluded the evidence base is small and inconsistent (AHRQ). A 2023 Pediatrics review found the overall strength of evidence for improved breastfeeding outcomes is low, and insufficient to determine whether frenotomy has any effect on how long a baby ultimately breastfeeds (NIH/Pediatrics). A 2025 review in Frontiers in Pediatrics put it bluntly: “we have expanded surgical indications beyond tongue frenotomy to lip and cheek procedures, despite weak evidence,” and called for a return to “evidence-based conservative care” (Frontiers).
Meanwhile, this is not a risk-free snip. A 2022 study on complications found real cases of misdiagnosis — babies referred for frenotomy who actually had unrelated neuromuscular issues like hypotonia that a scalpel was never going to fix (International Breastfeeding Journal). When you cut first and ask diagnostic questions later, you don’t just waste a family’s money — you delay the correct workup for whatever is actually going on. There was even a recent death down in Fort Worth, Texas during a procedure on a 4 year old child.
What I Tell Parents
I am not saying tongue-tie doesn’t exist or that frenotomy is never appropriate. True, significant ankyloglossia causing genuine feeding dysfunction is real, and releasing it can meaningfully help. That’s not what I’m pushing back on.
What I am saying, as someone who has watched this diagnosis inflate nearly tenfold in my professional lifetime without a corresponding tenfold increase in actual anatomical abnormality, is this: if your baby is having a hard time breastfeeding, the first stop should be a thorough feeding evaluation — positioning, latch mechanics, milk supply, oral motor function — not a five-minute frenulum inspection that ends with “let’s just snip it and see.” Ask what assessment tool was used. Ask what the evidence says for your baby’s specific situation. Ask what happens if the snip doesn’t fix the problem, because half the time, statistically, it wasn’t the problem to begin with.
A sliver of tissue under the tongue turned into an industry because it was easy to diagnose, quick to treat, emotionally compelling to worried parents, and — critically — nobody agreed on what it actually was. That’s not evidence-based medicine. That’s a gold rush, and your baby’s mouth is the claim everyone’s staking.
Any advice or information given in this blog should not supersede consultation with your pediatrician or practitioner of choice. Every child is unique, and medical decisions must be made in partnership with the healthcare provider who knows your child’s full history. This blog is intended for educational and informational purposes only, not as a substitute for personalized medical care.If you are looking for medical advice that is evidence-based, ethically grounded, and uncompromised by industry influence, you are in the right place.
Sources:
AAP Clinical Report: Identification and Management of Ankyloglossia, Pediatrics (2024)
HealthyChildren.org: AAP Addresses Rise in Tongue-Tie Diagnoses
Ankyloglossia and Lingual Frenotomy: National Trends, Otolaryngology–Head and Neck Surgery (2017)
ABC News: Tongue-tie procedures have skyrocketed in 30 years (Australia)
Clinical Consensus Statement: Ankyloglossia in Children, Otolaryngology–Head and Neck Surgery (2020)
Frenectomy for Ankyloglossia: Systematic Review and Meta-Analysis, International Breastfeeding Journal (2025)
ENTtoday: The Dramatic Rise in Tongue Tie and Lip Tie Treatment
AHRQ: Treatment of Ankyloglossia and Breastfeeding Outcomes
Treatment of Ankyloglossia and Breastfeeding Outcomes, Pediatrics/NIH (2023)
Evaluating the Efficacy of Frenotomy, Frontiers in Pediatrics (2025)
Complications and Misdiagnoses Associated with Infant Frenotomy, International Breastfeeding Journal (2022)