What do we mean by parenting controversies, and by them not mattering?

All decisions matter, and choosing how to help your baby could not matter more.  What we mean when we say that these decisions do not matter is that, in the greatest majority of cases, no matter which end of the divide you land upon, or which decision you make, the overall health and welfare of your child will be unchanged.  And so it is with each of these topics, a group of people have adopted a side and filled it with passion, often generating a passionate response, and in time both sides fill the information sphere with their very hot pleadings and create an amazing amount of confusion and unwelcome pressure.

Our goal today is to remove the passion, look only at the facts, and reassure all of you that you can decide either way on each of these issues, abandon the battlefield, relax with your preference, and enjoy your baby.

Parenting Controversies: Tongue Tie Cutting

Not too long ago, very few babies in America had their tongues cut to improve nursing.  Now it is being recommended for as many as 20% of all babies born.  That is over one million babies born each year whose parents are advised to cut their tongues.

Anatomy is important here.  After all, what is being cut?  To really understand this parenting controversy, go to a mirror, open your mouth and look at the underside of your tongue while making the “la” sound.  You will see a flat triangle of tissue that connects your tongue to the bottom of your mouth.  That band of tissue is called the frenulum of the tongue.

 

Now in a newborn, much like their fingernails and eyes, the tongue is always much, much smaller than that of an adult.  If you have a baby with you, take a look.  For every baby ever born, the front point of the frenulum is much closer to the tip of the tongue, because the part of the tongue in front of the frenulum has not grown yet.

So far everything we have put forth is rather bland fact.  Now, for the controversy…

On one side is a very large, very passionate group of people who are quite sure that, for about 5-20% of all babies born, the frenulum ties down the tongue and causes feeding to be seriously harmed, particularly breast-feeding.  This group argues strongly that for any infant-mother pair struggling to nurse, the frenulum needs to be looked at, and more often than not, will be the reason for poor nursing.  When the frenulum is cut, they argue, these very serious problems will be solved.

There is no doubt a large number of mothers who have seen their infant’s nursing improve after the tongue is cut, but does that prove it needed to be?

The other side is also a very large, also at times passionate, group who are skeptical of the claim that so many babies have poorly formed tongues, and resistant to the idea that cutting them would improve nursing.

This controversy is so hot that there is a reasonable chance even talking about it in this article or on our podcast will generate large scale trolling efforts to have the discussion blocked.

Fortunately, the act of the tongue cutting is relatively minor, so if it turns out the pro-tongue-cutting faction is wrong, there really is not much harm done.  As we all weather this storm, we can all take comfort in knowing that if you do cut, it is likely harmless.  But, beyond the furor, what does science and child medicine tell us?

We are pleased to share that the evidence strongly favors the position that humanity tends to be born with normal tongues, and that the uproar over newborn frenulums, so far, seems an over-reaction.

In an excellent article posted in one of the world’s leading medical journals, the authors found that after looking closely at over 100 newborns struggling to nurse, each of whom was advised to have their tongues cut, over half resolved their nursing issues with counseling, not cutting.

Further, the article documents that the medical literature has not yet produced much proof that large numbers of babies have anomalous tongues that need to be cut to improve eating and talking.

The highly regarded Cochrane Library found that cutting the tongue had no substantive impact on a baby’s ability to nurse, though they did note that it could improve nipple pain.

In contrast to an issue like swaddling, this controversy does include some babies who will clearly need to have their tongue’s cut, whose frenulum is so abnormal that such a cut will be necessary.  Our recommendations here have nothing to do with these infants.

In practice, one way to know if your baby’s tongue needs its frenulum cut is to simply see how the tip of their tongue looks when the stick out their tongue.  If they can get the tip of their tongue out to the outer edge of their lower lip without it puckering, that is a tongue that has plenty of tongue in front of the frenulum.

Ultimately, we would say that you should ask your pediatrician if you really have a question.  But, for all those newborns whose tongues look normal, who can stick them out well, and most importantly, whose pediatricians certify they have normal anatomy, we are pleased to say that your infant will very likely be fine with or without their tongue cut.

Once again, a controversy has risen up to disturb the tranquility that is so precious and needed after birth.  So please enjoy your return to tranquility around your baby’s tongue, knowing if you cut or do not cut, your baby will be fine.  This is another of our parenting controversies that can be vanquished.

Parenting Controversies: Offering Milk via the Breast or Bottle

This parenting controversy only involves baby’s fed by breast milk.  This is not related to the other controversy of formula feeding.  The argument is whether it is OK to give that breast milk by bottle.

Here are the sides of this argument.

Those upset about using a bottle to deliver breast milk argue passionately that this alters the experience of nursing, removes the power of the mother’s breast, and that it worsens the quality of the breast milk.

Those on the other side observe that the milk is actually unchanged by placing it in a bottle, as it leaves the mother’s breast either way, and that they would not be using a bottle unless use of the breast presented a problem.

We once again are pleased to say that no controversy is necessary.  Your baby will be fine with either choice.

The act of feeding your newborn is a most intimate act between mother (and at times father) and child.  We feel strongly that the world should only intrude in this most powerful space with great unease and caution, and only when the facts overwhelmingly support intruding.

The facts here clearly are not overwhelming.  They are barely facts.

If you are feeding your baby your breastmilk at the breast or via a bottle, it is the same food.  It really is exactly the same material.  If your baby sucks out an ounce of your breastmilk and swallows it, that is the same milk that you might pump and give your baby through a bottle.  The other side simply has not proof of any substantive difference in those two ounces.

Since the milk is the same, here is another of our parenting controversies that really does need to leave us all alone.  Once again, the right answer is to trust your sense of what is best for you and your baby, and enjoy your return to the tranquility that turns out to be an important value in itself.

Parenting Controversies: Circumcision

Because this parenting controversy involves a part of the body, like tongue tie cutting, there are groups of people for whom there is no controversy.  So, here we exclude those born with an anomaly of the foreskin or genitals that requires circumcision.  This discussion will also exclude any consideration of circumcision for religious reasons, as widely done in Jewish and Islamic communities.  This discussion is strictly limited to those baby boys born with perfectly normal male genitalia, including the foreskin, for whom there is no religious reason to circumcise.

As with the tongue cutting controversy, some basic anatomy will be a helpful background.  Every normal penis is formed with a shaft and a tip, and both are of course covered with skin.  The foreskin is simply an extension of the skin that covers the shaft.  The skin over the tip of the penis is of a different texture and sensitivity.  Curiously, there is no line that marks where the skin of the shaft ends and the skin of the foreskin begins as that line would move as the penis enlarges and shrinks.  At any point in time, however, there is skin that has no shaft attached to it, and under which is air, or the tip.  That skin is the foreskin.

 

Now for the controversy.

On one side is a group that is very passionately opposed.   This group brings many reasons to their passion.  They include the argument against mutilation: why cut part of the body if you don’t have to?  They also argue it reduces sexual sensation, or that it reflects the imposition of a choice and not a real choice.

On the other side are those who simply feel OK with the procedure.  They mostly support the action by having the son look like the Dad.  This informs most non-religious circumcisions in America.  This group at times will cite real evidence that the foreskin helps the spread of STD germs, like the HIV virus, and that circumcision nearly eliminates the risk of cancer of the penis.

This third time, we are once again pleased to share that this decision does not matter.  Your son will be fine either way.

If he is circumcised, what about decreased sexual sensation?   This idea has been tested across at least two continents.  In Europe, nearly all males are not circumcised and in the US about 64% are circumcised.  There is no evidence that European or North American men enjoy sex more or less.  What about risks of surgery– bleeding, infection and pain?  A circumcision done by a qualified professional has a vanishingly low chance of bleeding and infection or complication.  Pain is real, but very short-lived.  Boys who are circumcised in the newborn period tolerate it well as proven by the rapidity of their recovery from any pain or discomfort.

If he is not circumcised, what about more STD and cancer risk?  Well, on the STD front, one should wear a condom if sexual contact risks an STD, circumcised or not, period.  And the HPV vaccine will wipe out penile cancer, which is also astonishingly rare.

And so there you have it, if you circumcise your son, he will be fine, and if you do not, he will be fine.  Once again, the AAP agrees.

Bottom Lines

1.  There are more than these parenting controversies in infancy.  This is because babies are such an easy target for worry, and it takes so little to light up a red hot controversy.
2. In each controversy above, we exclude those infants who have a medical reason for an intervention from our discussion.  If a medical problem demands tongue cutting or circumcision, it needs to be done.  
3. But for the vast majority of healthy newborns, it turns out whether you cut the tongue, whether you feed the breast milk by bottle or breast, whether you circumcise, it does not matter.  Infants in both groups do well and it is hard to prove a difference.
4. The broader point is that our hearts go out to parents of newborns.  The world sees you as a target.  Adults impassioned about a perceived threat come to you with passionate argument.  Hopefully the practice of taking a step back and asking, is there really an issue to consider?, can help all parents enjoy even a bit more tranquility with their newborn.

Listen to our podcast episode, The Three Hottest Parenting Controversies (That Don’t Really Matter) for more information on these topics, or submit a question on the form below to join the conversation.

To Your Health,

Dr. Arthur Lavin