This randomized, controlled trial has clearly shown that tongue-ties can affect feeding and that division is safe, successful and improved feeding for mother and baby significantly better than the intensive skilled support of a lactation consultant.

There is a real, immediate improvement in breastfeeding, detectable by the mother, which is sustained and does not appear to be due to a placebo effect.

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This technique is safe and avoids the potential morbidity of a second anesthetic in this high-risk group of patients.

We believe that the incidence of gastrostomy revision could be reduced. Preventing epithelialisation is difficult and may be minimised by aggressive and generous use of topical silver nitrate. The gastrostomy exit site needs to be as far away from the rib edge as possible. Checking the bumper regularly or use of a gastrostomy balloon button instead of a tube eliminates BBS. Parents need to be aware of the possibility that a long-term gastrostomy may need surgical revision.

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