Published online June 23, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e188-e194 (doi:10.1542/peds.2007-2553)
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ARTICLE

Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effect on Milk Removal and Sucking Mechanism as Imaged by Ultrasound

Donna T. Geddes, PhDa, Diana B. Langton, BSc, IBCLCb, Ian Gollow, MBBS, FRACSc, Lorili A. Jacobs, MScd, Peter E. Hartmann, PhDa and Karen Simmer, MBBS, FRCPH, PhDe

a School of Biomedical, Biomolecular, and Chemical Sciences, University of Western Australia, Perth, Australia
b Breastfeeding Centre, King Edward Memorial Hospital, Subiaco, Western Australia, Perth, Australia
c School of Pediatrics and Child Health, Princess Margaret Hospital, Perth, Australia
d Ultrasound Department
e Neonatal Clinical Care Unit, King Edward Memorial Hospital, Perth, Australia

OBJECTIVE. There is evidence that infants with ankyloglossia can experience breastfeeding difficulties including poor attachment to the breast, suboptimal weight gain, and maternal nipple pain, which may lead to early weaning of the infant. No studies have investigated the cause of these breastfeeding difficulties. The objective of this study was to determine the effectiveness of frenulotomy in infants experiencing persistent breastfeeding difficulties despite professional assistance by measuring changes in milk transfer and tongue movement during breastfeeding before and after frenulotomy.

PATIENTS AND METHODS. Twenty-four mother-infant dyads (infant age: 33 ± 28 days) that were experiencing persistent breastfeeding difficulties despite receiving professional advice were recruited. Submental ultrasound scans (Acuson XP10) of the oral cavity were performed both before and ≥7 days after frenulotomy. Milk transfer, pain, and LATCH (latch, audible swallowing, type of nipple, comfort, and hold) scores were recorded before and after frenulotomy. Infant milk intake was measured by using the test-weigh method.

RESULTS. For all of the infants, milk intake, milk-transfer rate, LATCH score, and maternal pain scores improved significantly postfrenulotomy. Two groups of infants were identified on ultrasound. One group compressed the tip of the nipple, and the other compressed the base of the nipple with the tongue. These features either resolved or lessened in all except 1 infant after frenulotomy.

CONCLUSIONS. Infants with ankyloglossia experiencing persistent breastfeeding difficulties showed less compression of the nipple by the tongue postfrenulotomy, which was associated with improved breastfeeding defined as better attachment, increased milk transfer, and less maternal pain. In the assessment of breastfeeding difficulties, ankyloglossia should be considered as a potential cause.

Key Words: ankyloglossia • tongue tie • frenulotomy • breastfeeding • ultrasound • feeding • lactation

Abbreviations: HSPJ—hard/soft palate junction • NHSPJD—nipple to the hard/soft palate junction distance • LATCH—latch, audible swallowing, type of nipple, comfort, and hold

Accepted Jan 18, 2007.


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Does Frenulotomy Improve Breast-Feeding?
Journal Watch (General), July 10, 2008; 2008(710): 1 - 1.
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