The short term effect of pain is that it is unpleasant. There is no need to appeal to long term effects when someone is clearly suffering right there and then.
So by your logic, why should I work if I suffer at work? There are plenty of longterm factors and trade offs to consider. Temporary pain shouldn't be avoided as much as it is today.
You shouldn't suffer at work if you can work without suffering.
This sounds like I'm being pedantic because no one would never be in favor of suffering for no benefit, I'm arguing against a strawman.
But in the context of babies suffering, it might surprise you to learn that doctors used to give zero thought to their suffering at all, believing that they don't become conscious until they grow a little. Apparently when they screamed in pain it was like a mechanical autonomous response to a stimulus, not real human pain.
They weren't just being sadists. Applying anesthesia is always risky and if you can get away with not doing it then it's sometimes worth engaging in a bit of rationalization to ease the conscience.
> The short term effect of pain is that it is unpleasant. There is no need to appeal to long term effects when someone is clearly suffering right there and then.
There is also the fact that trauma is a thing that's not deeply researched, we don't know if pain trauma in babies could affect them later in life.
If there are any effects, they aren't readily noticeable in existing populations. Even 15 minutes after the procedure there are usually no issues.
So by your logic, why should I work if I suffer at work? There are plenty of longterm factors and trade offs to consider. Temporary pain shouldn't be avoided as much as it is today.
We aren't talking about any type of population, we are talking about children 0-1 year. There is very little research on how pain affects the development of humans at this stage because as you might guess, it's incredibly hard to do any sort of test. When humans are this young, small changes could affect how they evolve.
Short-term pain should be evaluated as something that could have long-term effect on a baby and weighted against the value that the surgery is going to bring, which is why is very disappointing to hear from a professional "they will not remember it" which implies a "why should you care", that's extremely bad.
Short-term pain is still pain and a human being is there, suffering, how could you not consider that for a surgery. Adults ask for anesthesia because are scared of short-term pain, the epidural is highly requested by all mothers giving birth, but babies having laser surgery aren't given anything more than tylenol (I understand why, but still), of course they are in very intense pain. How could we not consider that?
And that's overlooking the fact that after tongue tie release, the surgery spot must be rubbed for a minute (with oil) to prevent the tissue from regenerating, 4 times per day, for 15 days (I did this). So it's not really "short".
"We aren't talking about any type of population, we are talking about children 0-1 year."
Sure, you have the circumcised vs uncircumcised populations as the most prominent groups for long term observation.
"There is very little research on how pain affects the development of humans at this stage"
This isn't true. There is a fair amount of research on Pubmed. The general concensus is that repeated pain can have developmental impacts, but that one-off pain generally does not.
"I understand why"
It doesn't sound that way.
"How could we not consider that?"
I'm not saying it shouldn't be considered. It's simply not a significant enough factor to sway most decisions.
The rubbing with oil part is general uncomfortable but not nearly on the level of pain that the studies I've seen are finding to be a problem (eepeat surgeries, repetitive needles, etc).
> "I understand why"
> It doesn't sound that way.
There are only a handful of medications tested on infants and that are safe on them. It's pretty easy to understand since every medication is for "12 years+" essentially
> I'm not saying it shouldn't be considered. It's simply not a significant enough factor to sway most decisions.
I don't think that's the case. If a medium discomfort is being addressed, pain could sway to the "no procedure" option. If we are talking about a high discomfort, sure like you said, it doesn't sway.
Not only that, but it's on the parent to make the call, not on the professional.
The parents are making the call based in the benefits (perceived or real) and the risks. There is no objective benefit to the use of anesthesia at that age and the risks of use are significant. So it's all about the other risk/rewards of the procedure. Temporary pain is not a real factor.
FWIW, there's a lot of disagreement over how efficacious a tongue-tie release is, how it should be done, and who should do it, with a bit of a turf battle between pediatricians, ENTs (ear/nose/throat specialists), and dentists, and lactation consultants throwing fuel and misinformation onto the pile. Dentists tend to favor a laser tongue-tie release, while ENTs and pediatricians do it the old fashion way with scissors. Supposedly pediatricians often do a shallower cut that doesn't fully release the webbing. The practice in general has been relatively controversial. [1][2]
Personally, all 3 of my kids had tongue ties, as do I (one common type of tongue-tie is an autosomal dominant trait, meaning you have a 50% chance of passing it down to your kids with one copy, 100% with two). When I was a kid, tongue-tie surgeries were not really a thing, and my mom was never informed about it. But then, I have a speech impediment that might be related to it. My oldest kid had his released by an ENT at ~1 month (no anesthetic), my middle kid by a pediatrician at 2 days (sugar water, and possibly an incomplete release), and my youngest had to have his released by two different ENTs because the first didn't fully release the tongue (first was no anesthetic, the second used lidocaine).
We noticed an immediate improvement in breastfeeding with the first and he has no speech problems, the second never had any breastfeeding difficulties but has a slight speech impediment, and the third has seen zero improvement in breastfeeding (according to my wife at least...personally I think he's a bit less gassy) but at least has full range of motion with the tongue after the second procedure. Recovery was quick with the first 3 procedures but sucked with the 4th - he didn't want to eat for a good 12 hours afterwards.
All the ENTs and pediatricians we talked to said there's no special care required and you don't need to massage the mouth. Many of the lactation consultants we've met with say you do. Both groups are fond of throwing shade on each other. Personally we didn't do any special exercises and got good results with 2 out of the 3 kids.
I think it's really one of those cases where a parent needs to read all the evidence for and against and make a judgment call, and then it may or may not work. But then, many things in life are like that as well.
I had only one experience and it was positive. My daughter (oldest) had both tongue and lip tie, we went with the dentist and laser. Our lactation consultant spotted the lip/tongue tie, but she was able to get occasional proper breastfeeding position.
My wife's breasts were destroyed by day 3 though, she couldn't breastfeed anymore, so at roughly 1 month after trying many alternatives we went with the release.
It was incredibly painful to do and it was devastating for me to rub over the wounds for 15 days, but the results were great, there was immediate improvement in breastfeeding, no pain anymore. After 1 week my wife's breasts were recovering and my daughter has no speech impediment and was breastfed for 2 years on demand.
Still, I would have punched the dentist in the face when he said "she won't remember". The only person with empathy was the lactation consultant.
For what is worth, our lactation consultant provided high quality information and was the only person who was able to consistently get my wife to breastfeed properly while the tie was up. At the hospital they did a check as if it was a checkmark on a piece of paper (which probably was).
This can be empathy - reassuring you that the procedure won't have any memorable negative impact. If you say you know that they don't use anesthesia dusnto the risks, then the fact that the pain isn't memorable is the best possible outcome.
I have no doubt that was the best possible outcome, that's why we committed to it.
But I don't agree on using "she won't remember" as a sign of empathy. That's an excuse. You could do horrible things to babies based on that.
There are various resources for parents to help children deal with vaccination and one of the common thing is to never mention the pain, so using the won't remember excuse won't fly.
