Aim Tongue tie is a common problem affecting breastfeeding due to poor infant latch and/or maternal pain. Evidence of whether treatment improves breastfeeding outcomes is conflicting. We conducted a systematic review and meta‐analysis to examine the effectiveness of tongue‐tie treatment on breastfeeding difficulties. Methods We searched peer‐reviewed and grey literature in MEDLINE (OVID), PubMed, CINAHL Plus, EMBASE and PsycINFO, from 01/1970 to 09/2019. Inclusion: randomised and non‐randomised clinical trials, and quasi‐experimental study designs, involving breastfeeding interventions for full‐term singleton infants, using standardised measure of breastfeeding difficulty. Exclusion: qualitative and purely observational studies, lacked operational definition of breastfeeding difficulty, lacked control/comparison group. We assessed risk of bias, summarised study quality and results and conducted meta‐analysis using random effects modelling. Results Six studies on tongue‐tie division were included (4 randomised and 2 non‐randomised). Meta‐analysis of standardised mean differences in breastfeeding difficulty scores in four studies showed statistically significant differences in favour of frenotomy (Pooled SMD +2.12, CI:(0.17–4.08)p = 0.03). Similarly, a statistically significant difference in favour of frenotomy was observed for pain (Pooled SMD −1.68, 95% CI: (−2.87‐ −0.48). Conclusion Results support that infant frenotomy is effective for improving standardised scores on breastfeeding difficulty and maternal pain scales and could improve breastfeeding outcomes.

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Objective This study aimed to describe the journey of obtaining Baby-Friendly designation as a large metropolitan center in an urban city and review the initial patient-related outcomes. Study Design Our medical center participated in the New York City Department of Health and Mental Hygiene Breastfeeding Hospital Collaborative from 2012 to 2017. Monthly meetings were held to monitor data, and audits conducted among prenatal sites and maternity units. This hospital collaborative was established to help facilities through the designation process. Results Breastfeeding education in the prenatal setting was provided consistently at all outpatient sites. By 2017, 89.8% of patients had received appropriate education and support during their prenatal visits. There was a shift in feeding pattern from mostly formula feeding with some breastfeeding to primarily breastfeeding with fewer formula feeds. Baby-Friendly designation was achieved in June 2017 after a formal Baby-Friendly USA assessment. Conclusion Since embarking on this journey, there has been a consistent increase in antenatal patient education and a paradigm shift from some breastfeeding to mostly breastfeeding among the mother–baby dyads which combination feed. Our hospital center has continued to successfully maintain the workflow changes implemented during the Baby-Friendly process.