Ankyloglossia in Breastfeeding Infants: The Effect of Frenotomy on Maternal Nipple Pain and Latch

Srinivasan, Anjana; Dobrich, Carole; Mitnick, Howard; Feldman, Philip S.

doi:10.1089/bfm.2006.1.216

Cited by 57 publications

(100 citation statements)

References 12 publications

(31 reference statements)

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“…Forty-six studies reported that they looked for harms; either reporting actual harms or reporting that they found none. These included 5 RCTs, 7-11 1 cohort study, 12 25 case series, 13,15,16,[18][19][20][21][24][25][26][27][28][29][30]32,33,[35][36][37][38][39][40][41][42][43] and 15 case reports. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Most studies reporting harms information explicitly noted that no significant harms were observed (n = 17) 7,[9][10][11]13,15,18,20,24,…”

Section: Harmsmentioning

confidence: 99%

Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review

Krishnaswami²,

2015

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OBJECTIVE: Ankyloglossia is a congenital condition characterized by an abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility. The objective of this study was to systematically review literature on surgical and nonsurgical treatments for infants with ankyloglossia.METHODS: Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched up to August 2014. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics and outcomes and assigned quality and strength-of-evidence ratings.RESULTS: Twenty-nine studies reported breastfeeding effectiveness outcomes (5 randomized controlled trials [RCTs], 1 retrospective cohort, and 23 case series). Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence (confidence in the estimate of effect) for this issue is low. We included comparative studies published in English. The evidence base is limited, consisting of small studies, short-term outcomes, and little information to characterize participants adequately. No studies addressed nonsurgical interventions, longerterm breastfeeding or growth outcomes, or surgical intervention compared with other approaches to improve breastfeeding, such as lactation consultation.CONCLUSIONS: A small body of evidence suggests that frenotomy may be associated with motherreported improvements in breastfeeding, and potentially in nipple pain, but with small, shortterm studies with inconsistent methodology, strength of the evidence is low to insufficient. Dr Francis conceptualized and designed the study, and drafted the initial manuscript; Dr McPheeters conceptualized and designed the study, carried out the initial analyses, and reviewed and revised the manuscript; Dr Krishnaswami carried out the initial analyses, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Despite these studies, consensus on the role of ankyloglossia in breastfeeding difficulties is lacking. A minority of surveyed pediatricians (10%) and otolaryngologists (30%) believe ankyloglossia commonly affects feeding, whereas 69% of lactation consultants feel that it frequently causes breastfeeding problems. 3 Therefore, depending on the audience, enthusiasm for its treatment varies. Currently, the National Health Service and the Canadian Pediatric Society recommend treatment if ankyloglossia interferes with breastfeeding. 4 However, a standard definition of "interference" with breastfeeding is not provided, leaving room for interpretation and variation in treatment thr...

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Section: Harmsmentioning

confidence: 99%

Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review

Krishnaswami²,

2015

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“…2 The incidence of ankyloglossia is reported to be 1% to 10%, 3 and the association with breastfeeding difficulties is well documented. [3][4][5][6] Symptoms include maternal nipple pain, slow infant weight gain, infant breast refusal, 1 and low maternal milk supply due to poor milk removal. 7 Medical treatment of clinically significant ankyloglossia is frenotomy as recommended by the Academy of Breastfeeding Medicine, 8 and this recommendation has been supported by a recent randomized controlled study by Buryk et al 9 The Hazelbaker Assessment Tool for Lingual Frenulum Function 10 is used to assess ankyloglosssia; however, due to the absence of an accurate definition of ankyloglossia and limited investigation into the condition, no universal guidelines exist to determine when intervention is required.…”

mentioning

confidence: 99%

Evidence of Improved Milk Intake After Frenotomy: A Case Report

et al. 2013

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Ankyloglossia (tongue tie) is a well-recognized cause of breastfeeding difficulties and, if untreated, can cause maternal nipple pain and trauma, ineffective feeding, and poor infant weight gain. In some cases, this condition will result in a downregulation of the maternal milk supply. Milk-production measurements (24-hour) for a breastfeeding infant with ankyloglossia revealed the ineffective feeding of the infant (78 mL/24 hours), and a low milk supply (350 mL/24 hours) was diagnosed. Appropriate management increased milk supply (1254 mL/24 hours) but not infant milk intake (190 mL/24 hours). Test weighing convincingly revealed the efficacy of frenotomy, increasing breastfeeding milk transfer from 190 to 810 mL/24 hours. Postfrenotomy, breastfeeding almost completely replaced bottle-feeding of expressed breast milk. This case study confirms that ankyloglossia may reduce maternal milk supply and that frenotomy can improve milk removal by the infant. Milk-production measurements (24-hour) provided the evidence to confirm these findings.

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“…The tongue is completely formed at the end of the second month of intrauterine life (3) , and during its development, lingual brake cells undergo apoptosis and the brake retracts from its apex, forming a fibromucosa fold called the frenulum. There may be, during this stage of programmed cell death, a disturbance and the occurrence of a condition, which is known as ankyloglossia (4) . Ankyloglossia is a congenital anomaly, in which the lingual frenulum is abnormally short and thick (or even thin), and may vary widely in thickness, elasticity and fixation site on the tongue and floor of the mouth.…”

Section: Introductionmentioning

confidence: 99%

“…Another characteristic pointed to characterize the alteration of the frenulum is related to the functionality of the tongue, which is prevented from protruding beyond the gingival margin, besides the difficulty in touching the incisive papilla, among others (8) . Others consider an alteration when the insertion of the frenulum extends more than usual, towards the apex of the tongue (4) . Still, there is classification of frenulum with the following characteristics: thick, tight or short (9) .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, there is also a great variation in terms used in the literature, being tongue-tie (12) , ankyloglossia (4) , and typical ankyloglossia (13) . With special emphasis on ankyloglossia, several studies report that such an alteration causes difficulties in breastfeeding (8,14) , which appear in 25% of the cases of children with this anomaly (15) .…”

Section: Introductionmentioning

confidence: 99%

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Frênulo lingual e aleitamento materno: estudo descritivo

Fujinaga

Chaves

Karkow

et al. 2017

Audiol., Commun. Res.

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Introduction: Breast milk is the most suitable feeding for all newborns and has numerous benefits widely described in the literature. For the extraction of milk, the suckling function of the newborn depends on adequate functioning of the tongue, including the lingual frenum. However, it is unclear the relationship among the lingual frenum and breast feeding. Purpose: To evaluate the lingual frenum in newborn infants and to verify their association with breast feeding. Methods: The sample consisted of 139 mother/infant binomials, who were born full term. For the anatomy-functional evaluation of the lingual frenum, the "Evaluation protocol of the lingual frenum for infants" was used. For the evaluation of the breast feeding, the "UNICEF observation protocol of breast feeding" was applied. To verify the association among the lingual frenum and breast feeding, the chi-square test was applied. Results: In the evaluation of the lingual frenulum of the 139 infants, it was verified only one infant with a frenum alteration, equivalent to a prevalence of 0.8%, was found. In the evaluation of breastfeeding, of the 138 binomials, whose infants did not have alteration of the lingual frenum, 82 of them (59.4%) did not demonstrated any difficulty during breast feeding. The only infant with lingual frenum alteration did not present difficulties in breast feeding. Conclusion: There are insufficient subsidies to establish an association among lingual frenum and breast feeding.

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Ankyloglossia in Breastfeeding Infants: The Effect of Frenotomy on Maternal Nipple Pain and Latch

Abstract: Timely frenotomy and breastfeeding counseling is an effective intervention, improving latch and decreasing nipple pain.

Cited by 57 publications

References 12 publications

Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review

Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review

Evidence of Improved Milk Intake After Frenotomy: A Case Report

Frênulo lingual e aleitamento materno: estudo descritivo

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