Tongue-tie in the newborn: what, when, who and how? Exploring tongue-tie division.

The division of tongue-tie (TT) in babies with feeding problems has become a more accepted procedure in recent years (Bowley & Arul 2013). Although case series reports had described the benefits of division in problematic breastfeeding (Ballard, Auer & Khoury et al 2002; Notestine 1990), it was not until randomised controlled trials (RCTs) provided significant evidence of improvement that the procedure became more accepted (Berry, Griffiths & Westcott 2012; Buryk, Bloom & Shope 2011; Dollberg et al 2006; Emond et al 2014; Hogan, Westcott & Griffiths 2005). However there are still several areas of debate. These include: 1) what type of TT produces problems with feeding and thus what type of TT should be divided, 2) who should have the procedure, 3) when should the TT division be performed and 4) how should the TT be divided. In this review I will discuss these areas of debate and shed some light on this very common but often devastating congenital condition.